Proceedings of The Physiological Society

Europhysiology 2018 (London, UK) (2018) Proc Physiol Soc 41, PCA072

Poster Communications

Screening asymptomatic school children for early asthma by determining mild airway narrowing through PEFR measurement

B. Mehta1, B. Bhandari2, A. Singhal1, M. Mavai3, N. Dutt4, P. Raghav5

1. Physiology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, Rajasthan, India. 2. Physiology, GIMS, Greater Noida, Greater Noida, U.P., India. 3. Physiology, Government College, Bharatpur, Rajasthan, India. 4. Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Jodhpur, Rajasthan, India. 5. Community Medicine & Family Medicine, All India Institute of Medical Sciences, Jodhpur, Jodhpur, Rajasthan, India.

Peak expiratory flow rate (PEFR), has widely been used as a predictor of treatment of asthma patients. The serial PEFR measures airway variability and is usually the most appropriate first-line investigation in workers suspected of having occupational asthma. Measurement of peak expiratory flow (PEF) and forced expiratory volume in first second (FEV1) are most useful parameters for the diagnosis and exclusion of asthma. Studies even recommend measurement of predicted peak expiratory flow values, as an alternative to spirometry. Spirometry is not often available in the primary care setting and economic factors may limit referrals for it's testing. Mild airway narrowing may be present in asymptomatic children, which can be identified by determining their PEFR. We hypothesized that children with <80% of the predicted values of PEFR will show abnormal lung functions on spirometry which will confirm the diagnosis of obstructive disease in asymptomatic children. This will enable us to initiate early treatment. So we planned this study to detect evidence of mild airway obstruction in asymptomatic children through PEFR and further, to evaluate pulmonary functions by digital spirometer in children showing airway narrowing. We selected 200 asymptomatic children (123 males & 77 females) of age group 10-15 years without history of smoking, tuberculosis or any other acute or chronic respiratory illness. A detailed family history about asthmatic symptoms like shortness of breath, wheezing, cough, heaviness of chest and night time exacerbations of symptoms, was sought. 47 children gave a positive family history of asthma. PEFR values were then recorded in standing position, using the Mini Wright Peak Flow meter. 40 children showed PEFR values less than 80% of their predicted values. To confirm whether the low observed values were because of airway obstruction, we performed their spirometry by digital spirometer (Cosmed microquark). Out of these 40 children, only 9 had a family history of asthma. This means that 9 out of 47 (19.14%) children coming from asthmatic families and 20.26% (31 out of 153) children from non-asthmatic families, showed PEFR values below 80% of the predicted value. (p>0.05) Considering a decrease in the FEV1/FVC ratio to <80% for diagnosis of obstructive disease, only 2 out of 35 children were found to have it. The data was found to be non-parametric by Shapiro-Wilk test. Spearman test to see correlation, if any, between PEFR and FEV1/ FVC ratio was found not significant with r = 0.314 and p= 0.065. We conclude that asymptomatic children with low PEFR values may not show abnormal lung functions on spirometry. However, these children, particularly those having the risk of family history of asthma, may be followed for development of airway obstruction.

Where applicable, experiments conform with Society ethical requirements