https://www.infirmiere-canadienne.com/blogs/ic-contenu/2026/06/01/preserver-la-qualite-spirometrie-pediatrique
A nurse’s perspective on preparation, precision, and seasonal pressure in pediatric testing
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Preparing children for spirometry may seem like a modest intervention, but improving readiness for diagnostic testing has the potential to reduce anxiety, improve the clinical experience for families, and support the collection of meaningful data for clinicians.
Wildfires have become a seemingly persistent feature of prairie summers. My cousins, both nurses working in northern communities, have grown increasingly concerned about the impact worsening air quality is having on their communities, their families, and their health care facilities. Both are mothers navigating the familiar winter burden of respiratory viruses while also worrying about how repeated smoke exposure may affect healthy lung development in their children.
During one particularly difficult season, their children temporarily relocated to our area to finish the school year due to wildfire disruption. Around that same time, I had begun a new role as a spirometry technician in my rural health care facility. Those conversations about respiratory health, environmental exposure, and parenting concerns began to shape how I thought about pediatric lung function testing.
This experience also prompted a broader professional question: how can we ensure children are adequately prepared to participate in spirometry testing so that results accurately reflect their lung function?
The challenge: pediatric spirometry depends on preparation
Preparation can significantly influence how pediatric patients engage with spirometry. While spirometry is widely considered a gold-standard diagnostic tool in respiratory care, its accuracy relies heavily on patient understanding, cooperation, and technique. These requirements can present unique challenges for children.
Spirometry is a common pulmonary function test used to measure how well the lungs work. During the test, a person takes a deep breath and then exhales as forcefully and completely as possible into a handheld device called a spirometer. The test measures how much air a person can exhale and how quickly the air leaves the lungs. Spirometry is frequently used to assess and monitor conditions such as asthma and chronic obstructive pulmonary disease. To produce reliable results, the test typically requires a patient to perform several consistent breathing maneuvers both before and after administration of a bronchodilator medication. Because the test relies on effort, timing, and coordination, patient understanding and engagement are critical to obtaining accurate results.
Nationally and provincially, rates of asthma and other respiratory conditions in children have been increasing. Governments and health organizations have responded by emphasizing early identification, testing, treatment, and education. At the same time, families and clinicians are navigating a complex landscape. In many communities there is increasing confusion surrounding childhood vaccination, influenza, and COVID-19 vaccination in youth. In rural areas, access to allergy testing and ear, nose, and throat specialists is also limited. In my home province, wait lists for pediatric allergy testing can exceed a year, and out-of-province referrals are sometimes required for more complex cases.
Within this context, spirometry has become more accessible. As health authorities recognize the economic and social burden of respiratory disease, funding has supported expanded training opportunities and broader access to lung function testing. I was fortunate to benefit from this investment, completing spirometry training and onboarding my rural health care facility as a testing site.
My perspective on pediatric respiratory care is also shaped by my role as a parent. My son was born via cesarean section, developed eczema early in life, and received antibiotics within the first 24 hours after birth. Throughout early childhood he experienced recurring respiratory symptoms that required intermittent treatment with Ventolin and inhaled corticosteroids. He was born during the pandemic, when access to in-person care and specialist services was limited. Like many families, we adopted a watch-and-wait approach while focusing on lifestyle interventions to support his lung development.
Now that he is approaching the age where spirometry testing becomes feasible, I find myself reflecting on the intersection between my professional training and my background as a parent navigating the health system.
Spirometry is a powerful diagnostic tool, but it is also highly dependent on patient cooperation and technique. To generate acceptable results, children must understand and perform specific breathing maneuvers correctly, typically repeating them multiple times both before and after bronchodilator administration.
In clinical practice this can be challenging. Children may feel anxious in unfamiliar medical environments. They must listen carefully to instructions, use a nose clip, seal their lips around a mouthpiece, and exhale forcefully for several seconds. The process may then need to be repeated several times.
These requirements can be difficult for younger patients and, in my experience, the success of the test often depends on how comfortable and prepared the child feels.
Evidence and implications: why quality matters
Research highlights the importance of both technical standards and patient engagement when conducting spirometry in children. Clear communication and collaboration between clinicians, parents, and young patients are important elements in helping children successfully complete lung function testing (Jat, 2013).
At the same time, the broader evidence base regarding the clinical impact of routine spirometry in pediatric asthma remains limited. A 2022 systematic review examining the use of spirometry in children identified only one eligible randomized controlled trial. That study did not demonstrate significant differences in asthma-related quality of life or clinical outcomes between children whose care included spirometry and those who were managed without it. The authors concluded that additional high-quality research is needed to determine how spirometry influences pediatric outcomes (Boonjindasup et al., 2022).
These findings do not diminish the value of spirometry as a diagnostic tool, but they do highlight the importance of ensuring that when spirometry is performed, the data collected are as reliable and meaningful as possible.
A practical proposal: a pediatric spirometry ‘homework package’
As I began working with pediatric patients, I noticed a recurring pattern. Many children were encountering spirometry for the first time during their clinic appointment. They were asked to learn a new breathing technique quickly while also managing the stress of a medical visit.
This raised an important question in my practice: could preparation before the appointment improve the testing experience for children and clinicians alike?
Drawing on my background as both a mother and a youth baseball coach, I began thinking about the role of practice in helping children succeed. When children understand what is expected of them and have the opportunity to practise a new skill ahead of time, anxiety often decreases and performance improves.
This insight led me to develop a simple concept: providing pediatric spirometry preparation materials to families prior to testing.
The idea would be to send learning materials to families several weeks before the scheduled spirometry appointment so that children and parents have time to understand the test and become familiar with the breathing maneuvers. The preparation package could include a short educational video created with children in mind, featuring a child explaining and demonstrating the spirometry test step by step. Seeing another child complete the process may help normalize the experience and reduce anxiety.
The package could also include written information for parents and caregivers explaining what spirometry is, why the test is performed, what will happen during the appointment, and how they can support their child during the test. Providing this information ahead of time may help families arrive with a clearer understanding of the purpose and expectations of the assessment.
Finally, the materials could include a brief explanation of the breathing maneuvers and encourage children to learn the pattern at home before the appointment. For example, children could be asked to practise taking a deep breath and blowing out as hard and fast as possible, similar to blowing out birthday candles. The goal would not be to coach a specific result but rather to help children become comfortable with the technique so that the clinical appointment focuses on refining the maneuver rather than introducing it for the first time.
This approach reflects a broader principle in pediatric care: successful testing often depends on collaboration between clinicians, parents, and children. Studies examining spirometry in children highlight the importance of supportive environments and clear communication in helping young patients successfully complete lung function testing (Jat, 2013).
Providing preparation materials in advance may represent a small but meaningful systems-level improvement that supports families while also helping clinicians obtain reliable spirometry data.
Multiple factors affecting kids and care
Children today are growing up in a respiratory environment shaped by multiple factors, including environmental air quality concerns, seasonal viral illness, evolving vaccination discussions, and limited access to certain specialist services in rural communities.
Within this landscape, nurses and other frontline clinicians often identify practical gaps in care delivery. Preparing children for spirometry may seem like a modest intervention, but improving readiness for diagnostic testing has the potential to reduce anxiety, improve the clinical experience for families, and support the collection of meaningful data for clinicians.
Further research could explore whether structured preparation programs improve pediatric spirometry performance and reliability. In the meantime, collaboration, creativity, and shared learning among clinicians and families remain essential tools in supporting children’s respiratory health. Sometimes the most meaningful improvements in care begin with small ideas emerging from everyday practice.
References
Boonjindasup, W., Chang, A. B., McElrea, M. S., Yerkovich, S. T., & Marchant, J. M. (2022). Does the routine use of spirometry improve clinical outcomes in children? A systematic review. Pediatric Pulmonology, 57(10), 2390–2397. https://pubmed.ncbi.nlm.nih.gov/35754141/
Jat, K. R. (2013). Spirometry in children. Primary Care Respiratory Journal, 22(2), 221–229. https://pubmed.ncbi.nlm.nih.gov/23732636/
Celise Hack, RN, works at the Foam Lake Health Centre in Saskatchewan.
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