study of peak expiratory flow rate and pulmonary score in evaluation of acute exacerbation of ...

110 Pages·2014·2.19 MB·English

STUDY OF PEAK EXPIRATORY FLOW RATE AND
PULMONARY SCORE IN EVALUATION OF ACUTE
EXACERBATION OF ASTHMA IN THE AGE GROUP OF
5-18 YEARS
by
Dr. CHAITRA RAO B

Dissertation Submitted to the
Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore
In partial fulfillment of the requirements for the degree of
DOCTOR OF MEDICINE IN PAEDIATRICS
Under the guidance of
Dr. CHANDRAKALA P, MBBS, MD
Associate Professor

DEPARTMENT OF PAEDIATRICS
KEMPEGOWDA INSTITUTE OF MEDICAL SCIENCES
AND RESEARCH CENTRE
BANGALORE
2013

I
Rajiv Gandhi University of Health Sciences, Karnataka

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation/thesis entitled “ STUDY OF PEAK
EXPIRATORY FLOW RATE AND PULMONARY SCORE IN EVALUATION
OF ACUTE EXACERBATION OF ASTHMA IN THE AGE GROUP OF 5-18
YEARS " is a bonafide and genuine research work carried out by me under the
guidance of Dr. CHANDRAKALA P, Associate Professor, Kempegowda Institute
of Medical Sciences and Research Centre , Bangalore.

Signature of the Candidate
Date:

Place: Bangalore Name: Dr CHAITRA RAO
B

II
Rajiv Gandhi University of Health Sciences, Karnataka

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “ STUDY OF PEAK EXPIRATORY
FLOW RATE AND PULMONARY SCORE IN EVALUATION OF ACUTE
EXACERBATION OF ASTHMA IN THE AGE GROUP OF 5-18 YEARS " is a
bonafide research work done by Dr. CHAITRA RAO B in partial fulfillment of the
requirement for the degree of MD PAEDIATRICS

Signature of the Guide
Date:
Name: Dr CHANDRAKALA P
Place: Bangalore
Designation & Department

III
Rajiv Gandhi University of Health Sciences, Karnataka
ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE
INSTITUTION

This is to certify that the dissertation entitled “STUDY OF PEAK EXPIRATORY
FLOW RATE AND PULMONARY SCORE IN EVALUATION OF ACUTE
EXACERBATION OF ASTHMA IN THE AGE GROUP OF 5-18 YEARS" is a
bonafide research work done by Dr. CHAITRA RAO B under the guidance of Dr.
CHANDRAKALA P , Associate Professor , Kempegowda Institute of Medical
Sciences and Research Centre , Bangalore.
.

Seal & Signature of the HOD Seal & Signature of the Principal
Name: Dr A C RAMESH Name: Dr M K SUDARSHAN

Date: Date:
Place:
Place: Bangalore Place: Bangalore

IV
COPYRIGHT

Declaration by the Candidate

I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka shall
have the rights to preserve, use and disseminate this dissertation / thesis in print or
electronic format for academic / research purpose.

Date: Signature of the Candidate

Place: Bangalore Name: Dr CHAITRA RAO B

©Rajiv Gandhi University of Health Sciences, Karnataka

V
ACKNOWLEDGMENT
First, I thank God Almighty for all the grace he has bestowed upon me. This
dissertation is the culmination of the help, encouragement and guidance from a
number of people. I would like to thank them all.
It gives me immense pleasure to express my deep sense of gratitude and
indebtedness that I feel towards my teacher and guide Dr. CHANDRAKALA P,
Associate Professor of Paediatrics, Kempegowda Institute of Medical Sciences and
Research Centre, Bangalore, for her valuable suggestions, guidance, great care and
attention to detail that she has so willingly shown in the preparation of this
dissertation. I consider it to be a discrete privilege to have her as my guide and
teacher.
I am extremely thankful to Dr, M. K. SUDARSHAN, Dean, Principal and
Professor of Community medicine, for giving me an opportunity to conduct this
study.
I acknowledge and express my humble gratitude and sincere thanks to my
beloved teacher Dr. A. C. RAMESH, Professor and H.O.D, for his constant help to
undertake this study.
I thank Dr. SURESH, Medical Superintendent, Dr. (Capt.)
G.S.VENKATESH, Medical Director and Dr. VEERANNA, AMO, for allowing me
to conduct this study in their institute.
I owe a great deal of respect and gratitude to Dr. SRINIVASA S, Professor,
Dr. YASHODHA H.T, Professor, Dr. MURALI B. H, Associate Professor,
Dr. POORNIMA SHANKAR, Associate Professor, Department of Paediatrics, for
their scholarly suggestions and allround encouragement.

VI
I am immensely thankful to Dr. MADHU.G.N, Dr. H. S. RAMYA,
Dr. HARISH .J, Dr. SIVASHARANAPPA, Dr. GIRISH, Dr. SRINIVAS,
Dr. MOHAN KUMAR and Dr. CHAITRA, Assistant Professors in the Department
of Paediatrics for their kind guidance during the course.
I thank Dr. TANVIR, Dr. SHYLAJA and Dr. SNEHA, Senior Residents in
the Department of Paediatrics for their valuable support.
I thank Dr. LINGARAJ, Dr. MANJUNATH M. N, Dr. MANJUNATH V.
C, Dr. SANTOSH, Dr. DEVANG, Dr. GIRIJA, Dr. SHARANYA and all my other
Post graduate colleagues for their wholehearted support.
On a personal side, special thanks to my husband, Dr. I. S. SHRINIDHI, for
his patience, constant encouragement and support in the process of learning.
I shall forever be indebted to my parents, my in laws, my sister and friends for
their constant encouragement and support.
I am thankful to Mr PURANDER and Mr. BAABU for their cooperation.
Finally, I thank all my patients who formed the back bone of this study
without whom this study would not have been possible.

Date: Signature of the Candidate

Place: Bangalore Name: Dr CHAITRA RAO B

VII
LIST OF ABBREVIATIONS USED
AHR - Airway Hyperresponsivity
API -Asthma Predictive Index
AUC - Area under receiver operating characteristic curve
CAES - Clinical Asthma Evaluation Score
CAS - Clinical Asthma Score
CI -Confidence Interval
CO - Carbon monoxide
CO2 - Carbon dioxide
CSF - Cerebrospinal Fluid
CSGS - Clinical Symptom Grading System
CSS - Clinical Severity Score
DPI - Dry Powder Inhaler
ED - Emergency Department
FENO - Fractional Exhaled Nitric Acid
FEV1 - Forced Expiratory Volume in 1 second
FRC - Functional Residual Capacity
GINA - Global Initiative for Asthma
H+ - Hydrogen ions
H2O - Water
HFA -Hydroflouroalkanes
ICON -international consensus on on paediatric asthma
ICS - Inhaled Corticosteroid
ICU - Intensive Care Unit
IV - Intravenous
LABA - Long acting beta agonist
LTRA - Leukotriene Receptor Antagonist

VIII
MPFM - mini-Wright peak flow meter
N2 - Nitrogen
NAEP - National Asthma Education Programme
O2 - Oxygen
OCS - Oral Corticosteroid
PaCO2 - Partial Pressure of arterial carbon dioxide
PaO2 - Partial Pressure of arterial oxygen
PASS - Paediatric Asthma Severity Score
PEFR - Peak Expiratory Flow Rate
PFM - Peak Flow Meter
PFT - Pulmonary Function Test
PI - Pulmonary Index
pMDI - pressurised metered dose inhaler
PRACTALL- practical allergy consensus report
PRAM - Preschool Respiratory Assessment Measure
PS - Pulmonary Score
RADI - Respiratory Distress Assessment Index
Raw - Airway resistance
RFO - Resistance to forced oscillation
RV - Residual Volume
SABA - Short acting beta agonist
SaO2 - Saturation of oxygen
SCIT - Subcutaneous Immunotherapy
SIT - allergen Specific Immunotherapy
SLIT - Sublingual Immunotherapy
SPSS - Statistical Product and Service Solutions
TLC - Total Lung Capacity

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ABSTRACT
Background & Objectives: Numerous asthma scoring systems have been devised
which combine a number of physical signs to estimate the severity of an acute asthma
exacerbation. Although more than 16 scoring systems exist, many are difficult to use.
The pulmonary score was developed to provide ‘‘user-friendly’’ measure of asthma
severity for children with acute asthma exacerbation. The objective of the study is to
study the efficacy of pulmonary score in assessing the severity of acute exacerbation
of asthma in comparison to peak expiratory flow rate and to compare pulmonary score
with peak expiratory flow rate.
Methods: The study sampled 50 children, aged 5–17 years, with mild to moderate
acute exacerbation of asthma. The PEFR (best of three attempts) and the PS were
measured before and after treatment at 5, 10 and 15 minutes. The PS includes
respiratory rate, wheezing, and retractions, each rated on a 0–3 scale. Pre- and post-
treatment PEFR and PS score were compared using paired t-tests to establish
construct validity. Correlation of pre- and post-treatment PSs with PEFRs was
measured to establish criterion validity.
Results: The mean predicted PEFR improved with treatment by 21.2% (from 50.8%
to 72.0% of predicted) (p <0.0001) at 15 minutes. The mean PS improved by 2.8
(from 4.8 to 2) (p < 0.0001) at 15 minutes. Pre- and post-treatment PSs were
significantly correlated with PEFRs. The correlation of pre-treatment PEFR and PS is
r = -0.497 (p = 0.000), that for post treatment at 15 minutes is r = -0.589 (p = 0.000).

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