{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T14:18:19Z","timestamp":1790000299795,"version":"4.0.1"},"reference-count":41,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Spirometry is essential for objective asthma assessment in children with sickle cell disease (SCD), but technically uninterpretable examinations may reduce the effectiveness of systematic screening. This study aimed to determine their frequency and identify associated demographic, clinical, social, disease-related, and center-level factors in French Guiana. Methods: We conducted a prospective multicenter observational study involving children and adolescents with confirmed SCD who underwent systematic asthma screening at Cayenne, Kourou, and Saint-Laurent-du-Maroni hospitals between January 2025 and May 2026. Spirometry technical quality was assessed according to the 2019 American Thoracic Society\/European Respiratory Society technical standards and classified as interpretable or technically uninterpretable according to the acceptability, usability, and repeatability of the recorded maneuvers. Across the three sites, spirometry was performed on the recorded MicroLab platform using GLI-2012 reference equations. Salbutamol was delivered by pressurized metered-dose inhaler with a valved holding chamber when bronchodilator testing was technically feasible; the exact device submodel\/manufacturer metadata, center-specific software versions, and administered salbutamol dose were not retained in the exported analytical dataset. Participant characteristics were compared between groups, and associated factors were examined using univariable and multivariable logistic regression. Results: After removal of duplicate records, 143 unique children were included. Spirometry was technically uninterpretable in 34 participants (23.8%). Children with uninterpretable examinations were significantly younger than those with interpretable spirometry (8.9 \u00b1 3.0 vs. 10.5 \u00b1 4.0 years; p = 0.015). In univariable analysis, each additional year of age was associated with a 12% reduction in the odds of uninterpretable spirometry (OR 0.88, 95% CI 0.78\u20130.99; p = 0.036). After adjustment for sex, recruitment center, and health-insurance status, the inverse association persisted in direction and magnitude but did not reach conventional statistical significance (adjusted OR 0.89, 95% CI 0.79\u20131.01; p = 0.075). Given the limited number of outcome events, this attenuation may reflect reduced statistical power. No other investigated factor was independently associated with non-interpretability. Conclusions: Nearly one-quarter of children had technically uninterpretable spirometry. Younger children may benefit from enhanced preparation, age-adapted coaching, experienced operators, and planned repeat testing to improve asthma-screening yield and reduce missed respiratory disease.<\/jats:p>","DOI":"10.3390\/children13091281","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:50:03Z","timestamp":1789995003000},"page":"1281","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors Associated with Uninterpretable Spirometry During Asthma Screening in Children with Sickle Cell Disease: An Expanded Multicenter Study in French Guiana"],"prefix":"10.3390","volume":"13","author":[{"given":"Gabriel","family":"Bafunyembaka","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University Hospital of Guiana, Saint-Laurent-du-Maroni Site, 1465 Boulevard de la Libert\u00e9, 97320 Saint-Laurent-du-Maroni, French Guiana, France"},{"name":"Department of Pediatrics, Provincial General Reference Hospital of Bukavu, 2 Avenue Michombero, Bukavu, South Kivu, Democratic Republic of the Congo"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"visualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"given":"Joddy","family":"Mafema","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Cayenne Hospital, 3 Avenue Alexis Blaise, 97300 Cayenne, French Guiana, France"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Christian","family":"Kinsiona","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Clinique La Canop\u00e9e, 5 Avenue de l\u2019Universit\u00e9, Harvard Hibiscus Business District, 97300 Cayenne, French Guiana, France"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5149-7975","authenticated-orcid":false,"given":"Nadia","family":"Nathan","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonology Department, Armand Trousseau Hospital, Assistance Publique\u2013H\u00f4pitaux de Paris (AP-HP), Sorbonne Universit\u00e9, 26 Avenue du Dr Arnold Netter, 75012 Paris, \u00cele-de-France, France"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"given":"Narcisse","family":"Elenga","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Cayenne Hospital, 3 Avenue Alexis Blaise, 97300 Cayenne, French Guiana, France"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e585","DOI":"10.1016\/S2352-3026(23)00118-7","article-title":"Global, regional, and national prevalence and mortality burden of sickle cell disease, 2000\u20132021: A systematic analysis from the Global Burden of Disease Study 2021","volume":"10","author":"Thomson","year":"2023","journal-title":"Lancet Haematol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"240005","DOI":"10.1183\/16000617.0005-2024","article-title":"Respiratory management of acute chest syndrome in children with sickle cell disease","volume":"33","author":"Ahmed","year":"2024","journal-title":"Eur. Respir. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2055","DOI":"10.1002\/ppul.24871","article-title":"Pulmonary functions in children and adolescents with sickle cell disease","volume":"55","author":"Bediwy","year":"2020","journal-title":"Pediatr. Pulmonol."},{"key":"ref_4","first-page":"35","article-title":"Patients with sickle cell disease and asthma have a higher risk for acute chest syndrome: A systematic review and meta-analysis of observational studies","volume":"31","author":"Dodos","year":"2026","journal-title":"Exp. Ther. Med."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Bafunyembaka, G., Nacher, M., Maniassom, C., Birindwa, A.M., and Elenga, N. (2024). Asthma is an independent risk factor for acute chest syndrome in children with sickle cell disease in French Guiana. Children, 11.","DOI":"10.3390\/children11121541"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1002\/ppul.20601","article-title":"Longitudinal changes in lung function and somatic growth in children with sickle cell disease","volume":"42","author":"Koumbourlis","year":"2007","journal-title":"Pediatr. Pulmonol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1164\/rccm.200708-1219OC","article-title":"Longitudinal decline in lung volume in a population of children with sickle cell disease","volume":"178","author":"MacLean","year":"2008","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1002\/ppul.20883","article-title":"Growth of lung function in children with sickle cell anemia","volume":"43","author":"Field","year":"2008","journal-title":"Pediatr. Pulmonol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1002\/ajh.25003","article-title":"Age is a predictor of a small decrease in lung function in children with sickle cell anemia","volume":"93","author":"Willen","year":"2018","journal-title":"Am. J. Hematol."},{"key":"ref_10","unstructured":"Global Initiative for Asthma (2026). Global Strategy for Asthma Management and Prevention. 2026 Update, Global Initiative for Asthma."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e70","DOI":"10.1164\/rccm.201908-1590ST","article-title":"Standardization of spirometry 2019 update: An official American Thoracic Society and European Respiratory Society technical statement","volume":"200","author":"Graham","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2101499","DOI":"10.1183\/13993003.01499-2021","article-title":"ERS\/ATS technical standard on interpretive strategies for routine lung function tests","volume":"60","author":"Stanojevic","year":"2022","journal-title":"Eur. Respir. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1002\/ppul.20908","article-title":"Acceptability and repeatability of spirometry in children using updated ATS\/ERS criteria","volume":"43","author":"Loeb","year":"2008","journal-title":"Pediatr. Pulmonol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"762","DOI":"10.3109\/02770903.2010.485664","article-title":"Clinically useful spirometry in preschool-aged children: Evaluation of the 2007 American Thoracic Society guidelines","volume":"47","author":"Gaffin","year":"2010","journal-title":"J. Asthma"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e004198","DOI":"10.1136\/bmjpo-2025-004198","article-title":"Asthma screening in children with sickle cell disease in French Guiana","volume":"10","author":"Bafunyembaka","year":"2026","journal-title":"BMJ Paediatr. Open"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1183\/09031936.00080312","article-title":"Multi-ethnic reference values for spirometry for the 3\u201395-yr age range: The global lung function 2012 equations","volume":"40","author":"Quanjer","year":"2012","journal-title":"Eur. Respir. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1002\/jha2.42","article-title":"Spirometry use in patients with sickle cell disease with and without asthma and acute chest syndrome: A multicenter study","volume":"1","author":"Duckworth","year":"2020","journal-title":"eJHaem"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e71655","DOI":"10.1002\/ppul.71655","article-title":"Spirometry assessments in children with sickle cell disease in Ghana","volume":"61","author":"Birgit","year":"2026","journal-title":"Pediatr. Pulmonol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"752","DOI":"10.4168\/aair.2022.14.6.752","article-title":"Influence of age on effort required to complete spirometry in children and adolescents","volume":"14","author":"Lee","year":"2022","journal-title":"Allergy Asthma Immunol. Res."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Kannan, A., Sarnaik, G., Agarwal, N., and Jindal, A. (2025). The pattern of lung function tests in children with sickle cell disease: A case-control study. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0329064"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1080\/02770903.2020.1729381","article-title":"Validation of the Breathmobile Case Identification Survey for asthma screening in children with sickle cell disease","volume":"58","author":"Patel","year":"2021","journal-title":"J. Asthma"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1787","DOI":"10.1080\/02770903.2023.2187305","article-title":"Screening for asthma in preschool children with sickle cell disease","volume":"60","author":"Chan","year":"2023","journal-title":"J. Asthma"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1542\/pir.2024-006659","article-title":"Breathing easier: Optimizing pulmonary health in children with sickle cell disease","volume":"46","author":"Kuntzman","year":"2025","journal-title":"Pediatr. Rev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2871","DOI":"10.1002\/ppul.26602","article-title":"Unsupervised home spirometry is not equivalent to supervised clinic spirometry in children and young people with cystic fibrosis: Results from the CLIMB-CF study","volume":"58","author":"Edmondson","year":"2023","journal-title":"Pediatr. Pulmonol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e71109","DOI":"10.1002\/ppul.71109","article-title":"Home monitoring using telehealth and mobile spirometry is feasible, acceptable, and accessible in children with asthma from rural and medically underserved areas","volume":"60","author":"Strang","year":"2025","journal-title":"Pediatr. Pulmonol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Berlinski, A., Leisenring, P., Willis, L., and King, S. (2023). Home spirometry in children with cystic fibrosis. Bioengineering, 10.","DOI":"10.3390\/bioengineering10020242"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1002\/ppul.26856","article-title":"Home spirometry monitoring to identify loss of asthma control in adolescents","volume":"59","author":"Burbank","year":"2024","journal-title":"Pediatr. Pulmonol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"00937","DOI":"10.1183\/23120541.00937-2023","article-title":"Home spirometry appears accurate and feasible for monitoring chronic respiratory disease","volume":"10","author":"Wilson","year":"2024","journal-title":"ERJ Open Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1080\/02770903.2022.2134795","article-title":"Airwave oscillometry and spirometry in children with asthma or wheeze","volume":"60","author":"Gunawardana","year":"2023","journal-title":"J. Asthma"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1002\/ppul.25923","article-title":"Oscillometry: A substitute of spirometry in children with neuromuscular diseases?","volume":"57","author":"Veldhoen","year":"2022","journal-title":"Pediatr. Pulmonol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1001\/jamapediatrics.2024.1341","article-title":"Spirometry interpretation after implementation of race-neutral reference equations in children","volume":"178","author":"Forno","year":"2024","journal-title":"JAMA Pediatr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1186\/s12931-023-02505-3","article-title":"Race-specific spirometry equations may overestimate asthma control in Black children and adolescents","volume":"24","author":"Burbank","year":"2023","journal-title":"Respir. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1164\/rccm.202302-0310ST","article-title":"Race and ethnicity in pulmonary function test interpretation: An official American Thoracic Society statement","volume":"207","author":"Bhakta","year":"2023","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"418","DOI":"10.5588\/ijtldopen.24.0224","article-title":"Impact of race-neutral global reference equations on spirometry interpretation in healthy children in The Gambia","volume":"1","author":"Nkereuwem","year":"2024","journal-title":"IJTLD Open"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1093\/annalsats\/aaoaf045","article-title":"Race-neutral spirometry reference equations change the interpretation of tests in South-East Asian and Black pediatric patients","volume":"23","author":"Chrenek","year":"2026","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e2316174","DOI":"10.1001\/jamanetworkopen.2023.16174","article-title":"Global, race-neutral reference equations and pulmonary function test interpretation","volume":"6","author":"Moffett","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"949","DOI":"10.23736\/S1973-9087.24.08617-9","article-title":"Efficacy of virtual reality on balance impairment in ataxic cerebral palsy children: Randomized controlled trial","volume":"60","author":"Mouhamed","year":"2024","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/j.pmn.2024.06.007","article-title":"Effects of virtual reality on pain and anxiety during children\u2019s circumcision: A systematic review and meta-analysis","volume":"25","author":"Chen","year":"2024","journal-title":"Pain Manag. Nurs."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Wang, H., Dong, Q., and Wang, X. (2025). The impact of asthma education grounded in virtual reality technology upon the quality of life of pediatric patients with bronchial asthma. Front. Pediatr., 13.","DOI":"10.3389\/fped.2025.1588562"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2281","DOI":"10.2147\/JMDH.S508524","article-title":"Virtual reality and videogaming in pulmonary rehabilitation for asthma: A systematic review of clinical outcomes and engagement","volume":"18","author":"Darabseh","year":"2025","journal-title":"J. Multidiscip. Healthc."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1080\/17476348.2024.2428217","article-title":"Some challenges in implementing updated European Respiratory Society\/American Thoracic Society 2022 interpretive strategies for routine pulmonary function tests","volume":"18","author":"Abdesslem","year":"2024","journal-title":"Expert Rev. Respir. Med."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/9\/1281\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:40:28Z","timestamp":1789998028000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/9\/1281"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,21]]},"references-count":41,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["children13091281"],"URL":"https:\/\/doi.org\/10.3390\/children13091281","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,21]]}}}