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Association between lower respiratory tract symptoms and falls in peak expiratory flow in children
1Child Health, Southampton General Hospital, UK.
Insights
Peak expiratory flow (PEF) measurements are not sensitive markers for childhood asthma episodes. Symptom reporting can detect respiratory morbidity earlier than PEF falls.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Asthma Management
Background:
- Peak expiratory flow (PEF) monitoring is recommended for childhood asthma.
- Limited data exist on the relationship between respiratory symptoms and PEF changes.
Purpose of the Study:
- To determine if PEF falls are sensitive markers for respiratory morbidity in children.
- To analyze the temporal relationship between respiratory symptoms and PEF declines.
Main Methods:
- A 12-month longitudinal study of 192 children (7-8 years) with respiratory symptoms.
- Daily recording of PEF and respiratory symptom scores.
- Defined PEF episodes as falls below 1.5 SD for >2 days; symptom events as scores >3 within 3 days.
Main Results:
- 29% of symptom events coincided with PEF episodes; 40% of PEF episodes lacked symptoms.
- 49% of PEF episodes were preceded by 2+ days of symptoms.
- Symptom reporting could detect morbidity 2 days earlier than PEF falls in nearly half of cases.
Conclusions:
- PEF falls alone are not sensitive markers for respiratory morbidity in children.
- Symptom reporting offers earlier detection of respiratory illness compared to PEF monitoring.
Abstract:
Peak expiratory flow (PEF) measurements are increasingly recommended in childhood asthma management. However, few data are available on the temporal relationship between the onset of upper and lower respiratory tract symptoms and significant falls in PEF. We wanted to determine whether falls in PEF constitute a sensitive marker for clinical episodes of respiratory morbidity. We therefore analysed data on daily PEF and respiratory symptom recording from a 12 month longitudinal study in 192 children aged 7 and 8 yrs with current respiratory symptoms. Outcome measures were number of and relationship between: 1) episodes of fall in PEF (defined as a fall in PEF for more than 2 days to < 1.5 SD below individual mean morning PEF); and 2) upper and lower respiratory tract symptom events (defined as a respiratory symptoms score of > 3 units within three consecutive days). One hundred and eight six of the 192 children completed the study. For the group as a whole, the mean number of PEF episodes per subject was 3.5, and the mean number of symptom events 8.9, with 29% of symptom events being temporally associated with a PEF episode, and 40% of PEF episodes not being accompanied by a symptom event. Forty nine percent of PEF episodes were preceded by at least two consecutive days of either upper or lower respiratory symptoms. We conclude that falls in PEF alone were not a sensitive marker for episodes of respiratory morbidity. On almost half of the occasions where PEF did fall, morbidity could have been detected at least 2 days earlier using symptom reporting.(ABSTRACT TRUNCATED AT 250 WORDS)