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The relationship between changes in peak expiratory flow and asthma exacerbations in asthmatic children
Xiongbin Chen1, Peng Han1, Yan Kong1
1Respiratory Department, Beijing Children's Hospital, Capital Medical University, China National Clinical Research Center of Respiratory Diseases, National Center for Children's Health, Beijing, China, 100045.
Insights
Peak expiratory flow (PEF) decreases in children with asthma approximately 1.34 days before symptom onset. Monitoring PEF can help predict and manage asthma exacerbations, especially those triggered by air pollution.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Asthma Management
Background:
- Asthma is a prevalent chronic airway disease in children.
- Effective asthma action plans aim to prevent exacerbations.
- Assessing exacerbations is challenging in children with poor symptom perception.
Purpose of the Study:
- To determine if children with asthma exhibit changes in peak expiratory flow (PEF) preceding acute exacerbations.
- To evaluate the relationship between PEF variations and asthma exacerbations in pediatric patients.
Main Methods:
- Retrospective analysis of data from the Electronic China Children's Asthma Action Plan (e-CCAAP) database (2017-2021).
- Inclusion of asthmatic children with 14 consecutive days of PEF measurements.
- Comparison of PEF% pred changes between an exacerbation group and a control group.
Main Results:
- A decrease in PEF was observed approximately 1.34 days before the onset of asthma symptoms.
- Patients experiencing reduced PEF without concurrent symptoms showed the most significant PEF decline.
- Upper respiratory tract infections were the most common cause of exacerbations; air pollution caused significantly higher PEF variation (P<0.05).
Conclusions:
- Children with asthma demonstrate a decline in PEF preceding symptom manifestation.
- Monitoring PEF is recommended for early intervention and stepping-up asthma therapy.
- Air pollution is a significant factor contributing to PEF variation during asthma exacerbations.
Background:
Asthma is one of the most common chronic airway diseases in children. Preventing asthma exacerbation is one of the objectives of all asthma action plans. In patients with poor perception, it is difficult to identify acute asthma exacerbations by clinical asthma score, asthma control test or asthma control questionnaire. The aim of this study is to analyze whether children with asthma have changes in peak expiratory flow(PEF)before an acute asthma exacerbation and to evaluate the relationship between PEF and asthma exacerbation.
Methods:
Basic information (including sex, age, atopy, etc.) and clinical information of asthmatic children who registered in the Electronic China Children's Asthma Action Plan (e-CCAAP) from 1 September 2017 to 31 August 2021 were collected. Subjects with 14 consecutive days of PEF measurements were eligible. Subjects in this study were divided into an exacerbation group and a control group. We analyzed the relationship between changes in PEF% pred and the presence of asthma symptoms.
Result:
A total of 194 children with asthma who met the inclusion criteria were included, including 144 males (74.2%) and 50 females (25.8%), with a male-to-female ratio of 2.88:1. The mean age of the subjects was 9.51 ± 2.5 years. There were no significant differences in sex, age, allergy history or baseline PEF between the two groups. In children with and without a history of allergy, there was no significant difference between the variation in PEF at 14 days. Patients who only had a reduced in PEF but no symptoms of asthma exacerbation had the greatest reduction in PEF compared to the other groups. The most common cause of acute exacerbations of asthma is upper respiratory tract infection. Among the causes of acute exacerbations of asthma, the variation in PEF caused by air pollution was significantly higher than that of other causes (P < 0.05). In acute exacerbations, the decrease in PEF was significantly greater in the exacerbation group than in the control group. In children with asthma symptoms, there was a decrease in PEF approximately 1.34 days before the onset of symptoms.
Conclusion:
Children with asthma show a decrease in PEF 1.34 days before the onset of asthma symptoms. We recommend that asthmatic children who show a decrease in PEF should step-up asthma therapy. The most common cause of acute exacerbations of asthma was upper respiratory tract infections, and the variation in PEF caused by air pollution was significantly higher than that caused by other factors.
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