Protocol - Spirometry - Child

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The procedures for performing spirometry with a child are very similar to those for performing spirometry with an adult. However, young children require more training and visual cues (e.g., animation), and they may have a greater number of unsuccessful spirometry test maneuvers. The results from children’s spirometry tests are also more variable than those from adults’ tests.

Specific Instructions

This protocol may be administered to children as young as 3 to 6 years of age; however, young children may not fully comprehend the instructions and may have fewer successful spirometry attempts.

See Table 2 of Aurora et al., 2004 for the success rates of forced expiratory parameters by age. Of healthy children aged 2 to 6, 78% were successful with FVC and FEV0.5 tests and 71% of children with cystic fibrosis in the same age groups were successful with the same tests.

The Sickle Cell Disease Curative Therapy Working Group recommends that this protocol be performed in transplant patients at one time point pre-transplant (baseline) and 100 days, six months, and annually post-hematopoietic cell transplant (HCT). The Working Group notes that a reduction in forced expiratory volume in 1 second (FEV1) can be caused by chronic graft versus host disease (GvHD) of the lungs.




The following description summarizes some of the key points. For the full protocol, see Beydon et al., 2007 and Miller et al., 2005.


Spirometers usually come with computer software. The spirometer must be connected to a computer during the spirometry tests. Provide the child with his/her own mouthpiece and nose clip. Allow the child to put the mouthpiece in the mouth and blow with the nose clip on the nose. Record whether or not a nose clip was used.


Provide a brief explanation of the spirometry test. Do multiple demonstrations of the spirometry test for the child. Encourage the child to inspire fully into the spirometer and blow fast. Ideally this demonstration and the spirometry tests are performed with visual cues via animation software. Instructions may need to be tailored to the child.


The child may be standing up or sitting in a chair. The position should be noted.

Successful maneuvers

After the child blows into the spirometer, the technician determines if the attempt was a successful “maneuver.” The child should have at least two to three successful and reproducible maneuvers, which may take up to 15 attempts.

Recommended end of test criteria:

1) The subject cannot or should not continue further exhalation.

2) The volume-time curve shows no change in volume (<0.025 L) for ³1 s, and the subject has tried to exhale for ³3 s in children aged <10 yrs and for ³6 s in subjects aged >10 yrs.

Recorded results

(Some children will not be able to expire for a full second.)

  • Forced Vital Capacity (FVC)
  • Forced Expiratory Volume in .5 seconds (FEV.5)
  • Forced Expiratory Volume in .75 seconds (FEV.75)
  • Forced Expiratory Volume in 1 second (FEV1)
  • Repeatability of parameters above
  • Number of satisfactory attempts (maneuvers)
  • Posture
  • Nose clips

Variability of results

A child’s spirometry results may not be as repeatable as an adult’s results. Repeatable results should be recorded.

Personnel and Training Required

Technician trained in conducting pulmonary function tests (PFTs) with a spirometer.

Equipment Needs

The primary instrument used in pulmonary function testing is the spirometer.

Requirement CategoryRequired
Major equipment No
Specialized training Yes
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Physical Measurement




Preschoolers (ages 3-6) and children

Selection Rationale

This protocol is recommended by the American Thoracic Society and the European Respiratory Society and represents 15 years of preparation and review by expert committees.



caDSR Form PhenX PX091602 - Spirometry Child 6872376 caDSR Form
Derived Variables


Process and Review

The Expert Review Panel #6 (ERP 6) reviewed the measures in the Respiratory domain.

Guidance from ERP 6 includes:

• New child protocol for the Spirometry measure

• New Data Dictionary

Protocol Name from Source

Beydon, N., et al, An official American Thoracic Society/European Respiratory Society statement: Pulmonary function testing in preschool children, AM J RESP CRIT CARE, 2007


Beydon, N., Davis, S. D., Lombardi, E., Allen, J. L., Arets, H. G., Aurora, P., … Wilson, N. M. (2007). An official American Thoracic Society/European Respiratory Society statement: Pulmonary function testing in preschool children. American Journal of Respiratory and Critical Care Medicine, 175(12), 1304-1345.

Miller, M. R., Hankinson, J., Brusasco, V., Burgos, F., Casaburi, R., Coates, A., … Wanger, J. (2005). Standardisation of spirometry. European Respiratory Journal, 26(2), 319-338.

General References

Aurora, P., Stocks, J., Oliver, C., Saunders, C., Castle, R., Chaziparasidis, G., Bush, A. (2004). Quality control for spirometry in preschool children with and without lung disease. American Journal of Respiratory and Critical Care Medicine, 169(10): 1152-1159.

Gaffin, J. M., Shotola, N. L., Martin, T. R., & Phipatanakul, W. (2010). Clinically useful spirometry in preschool-aged children: Evaluation of the 2007 American Thoracic Society Guidelines. Journal of Asthma, 47(7), 762-767.

Protocol ID


Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
PX091602030000 Was the child provided a demonstration and more
encouraged to inspire fully into the spirometer and blow fast? show less
PX091602090000 What is the Forced Expiratory Volume in 1 more
second (FEV1)? show less
PX091602070000 What is the Forced Expiratory Volume in .5 more
seconds (FEV.5)? show less
PX091602080000 What is the Forced Expiratory Volume in .75 more
seconds (FEV.75)? show less
PX091602060000 What is the Forced Vital Capacity (FVC)? N/A
PX091602050000 Was the manuever successful? The child more
should have at least two to three successful and reproducible manuevers show less
PX091602010000 Was the child allowed put the mouthpiece more
into his/her mouth and blow with the nose clip on the nose? show less
PX091602020000 Was a nose clip used? N/A
PX091602040000 Which position is the child in during this test? N/A
PX091602100000 What is the repeatability of parameters above? N/A
PX091602110000 What is the number of satisfactory attempts more
(maneuvers)? show less
Measure Name


Release Date

January 29, 2010


Spirometry is a common pulmonary function test (PFT) measuring the amount (volume) and/or speed (flow) of air being inhaled and exhaled.


Spirometry is a tool used to screen for the presence of obstructive and restrictive lung diseases.


Respiratory, pulmonary function test, PFT, American Thoracic Society, ATS, European Respiratory Society, ERS, forced vital capacity, FVC, forced expiratory volume, FEV

Measure Protocols
Protocol ID Protocol Name
91601 Spirometry - Adult
91602 Spirometry - Child

There are no publications listed for this protocol.