Journal Article

The Role of Computer Games in Measuring Spirometry in Healthy and “Asthmatic” Preschool Children

Asher Barak, Arie Augarten, Lea Bentur, Ori Efrati, Daphna Vilozni, Yacov Yahav, Chaim Springer

2005

Overview

Study objectives: To explore the role of respiratory interactive computer games in teaching spirometry to preschool children, and to examine whether the spirometry data achieved are compatible with acceptable criteria for adults and with published data for healthy preschool children, and whether spirometry at this age can assess airway obstruction. Design: Feasibility study. Settings: Community kindergartens around Israel and a tertiary pediatric pulmonary clinic. Participants: Healthy and asthmatic preschool children (age range, 2.0 to 6.5 years). Intervention: Multitarget interactive spirometry games including three targets: full inspiration before expiration, instant forced expiration, and long expiration to residual volume. Measurements and results: One hundred nine healthy and 157 asthmatic children succeeded in performing adequate spirometry using a multitarget interactive spirometry game. American Thoracic Society (ATS)/European Respiratory Society spirometry criteria for adults for the start of the test, and repeatability were met. Expiration time increased with age (1.3 ± 0.3 s at 3 years to 1.9 ± 0.3 s at 6 years [± SD], p < 0.05). FVC and flow rates increased with age, while FEV 1 /FVC decreased. Healthy children had FVC and FEV 1 values similar to those of previous preschool studies, but flows were significantly higher (> 1.5 SD for forced expiratory flow at 50% of vital capacity [FEF 50 ] and forced expiratory flow at 75% of vital capacity [FEF 75 ], p < 0.005). The descending part of the flow/volume curve was convex in 2.5- to 3.5-year-old patients, resembling that of infants, while in 5- to 6-year-old patients, there was linear decay. Asthma severity by Global Initiative for Asthma guidelines correlated with longer expiration time (1.7 ± 0.4 s; p < 0.03) and lower FEF 50 (32 to 63%; p < 0.001) compared to healthy children. Bronchodilators improved FEV 1 by 10 to 13% and FEF 50 by 38 to 56% of baseline. Conclusions: Interactive respiratory games can facilitate spirometry in very young children, yielding results that conform to most of the ATS criteria established for adults and published data for healthy preschool children. Spirometric indexes correlated with degree of asthma severity.

• Publisher: American College of Chest Physicians