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Assessment and prediction of asthma and its severity in the pediatric community
J C Pereira1, F Carswell, A O Hughes
1Instituto de Saúde da Secretaria de Estado da Saúde-Rua Santo Antonio, São Paulo, Brasil.
Insights
The coefficient of variation of peak expiratory flow rate (PEF) objectively measures asthma severity in children. Objective measures like PEF variation, skin allergy, and exercise response predict asthma development and severity.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Respiratory Medicine
Background:
- Childhood asthma management relies on subjective symptom reporting and treatment intensity.
- Objective markers are needed to accurately assess asthma severity and predict disease progression in pediatric populations.
Purpose of the Study:
- To evaluate the coefficient of variation of peak expiratory flow rate (PEF) as an objective measure of asthma severity in children.
- To determine the predictive value of skin allergy and airways responsiveness to exercise for asthma development and severity.
Main Methods:
- A 28-day follow-up study involving 74 asthmatic children (7-11 years) and age/sex-matched controls.
- Recorded daily morning and evening PEF, symptoms, and treatment.
- Assessed skin allergy and airways response to exercise using logistic regression analysis.
Main Results:
- The coefficient of variation of PEF significantly correlated with asthma symptoms (rs = .36) and treatment needs (rs = .60).
- This PEF measure effectively differentiated mild from severe asthmatics (p ≤ .008).
- Positive skin tests (88% probability for asthma, 70% for severe asthma) and 10% PEF reduction post-exercise (73% probability for asthma, 64% for severe asthma) were significant predictors.
Conclusions:
- The coefficient of variation of PEF is a reliable objective indicator of childhood asthma severity.
- Skin allergy and exercise-induced airway responsiveness are crucial predictors for asthma diagnosis and severity assessment in children.
- Combined predictors demonstrate a multiplicative effect, significantly increasing the risk for developing and experiencing severe asthma.
Abstract:
Seventy four asthmatic children aged 7 to 11 years were examined along with controls matched by age and sex. Clinical and laboratory investigations preceded a 28-day follow-up where data about morning and evening peak expiratory flow rate (PEF), symptoms and treatment were recorded. The coefficient of variation of PEF was found to be an objective measurement of asthma severity that has statistically significant correlation with both symptoms (rs = .36) and treatment (rs = .60). Moreover, it separates mild and severe asthmatics, as confirmed by statistically significant differences (p = .008 or less) in symptoms, treatment, skin allergy and airways response to exercise. Skin allergy and airways responsiveness to exercise were found to be predictors of both disease and severity. By means of logistic regression analysis it was possible to establish the probabilities for both asthma and severe asthma when children presenting and not presenting these characteristics are compared. One single positive skin test represent a probability of 88% for the development of asthma and a probability of 70% for severe disease. A PEF reduction of 10% after an exercise test implies a probability of 73% for disease and a probability of 64% for severe disease. Increases in these variables imply geometrically increased risks and their presence together have a multiplicative effect in the final risk.