Spirometry improvement is similar for Australian children treated at outreach clinics and tertiary hospitals

Abstract

Introduction: Scant data exists on efficacy of paediatric regional/remote respiratory outreach services at improving lung function. Aim: To compare spirometry changes in Australian children treated in regional/remote Indigenous Respiratory Outreach Care (IROC) clinics to those of children treated at Brisbane paediatric tertiary hospitals (Hospital). Method: For children seen at IROC and Hospital between Oct-2010 to July-2019, we compared mean difference between baseline and follow-up spirometry with independent samples T-test. Lung function impairment as per Prospective Urban Rural Epidemiology (PURE)1 study is described. Results: Spirometry of 253 IROC and 2743 Hospital patients were compared. In both clinic types, spirometry values significantly improved. There were no significant differences in improvements of FEV1 or FVC for the whole cohort of children between IROC (change in z-score (?z)FEV1=0.35; ?FVC=0.40) and Hospital (?zFEV1=0.28; ?zFVC=0.28) groups (p=0.38; p=0.11); nor for children with asthma; IROC (?zFEV1=0.41; ?zFVC=0.47) or Hospital (?zFEV1=0.45; ?zFVC=0.40) groups (p=0.66; p=0.47), or for children with bronchiectasis; IROC (?zFEV1=0.35; ?zFVC=0.33) and Hospital (?zFEV1=0.45; ?zFVC=0.53) groups (p=0.59; p=0.26). There were significant increases in number of children at IROC with no FEV1 impairment (PURE criteria: zFEV1>0) for asthma (p=0.016) and bronchiectasis (p=0.027) sub-groups; and for Hospital asthma sub-group (p<0.0002) but not for Hospital bronchiectasis sub-group (p=0.19). Conclusion: Similar improvements in spirometry suggest outreach clinic model can be as effective as tertiary hospitals at improving lung function. 1Lancet Glob Health. 2019;7:e613.L6338019922021-01-05 <br />