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[Relationship between PEF and SpO2 on acute asthma attack in children]
Insights
Peak Expiratory Flow (PEF) and oxygen saturation (SpO2) are related in children with asthma, but the relationship differs from WHO guidelines. Clinicians should consider both PEF and SpO2 for accurate asthma severity assessment, especially in older children.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Assessment
Context:
- Acute asthma exacerbations in children require accurate severity assessment for appropriate management.
- Peak Expiratory Flow (PEF) and oxygen saturation (SpO2) are commonly used clinical parameters.
- Existing guidelines, such as those from the Global Initiative for Asthma (GINA), provide reference values for these parameters.
Purpose:
- To evaluate the relationship between PEF and SpO2 in children experiencing acute asthma attacks.
- To compare the observed relationship with existing GINA guidelines.
- To identify factors influencing the PEF-SpO2 relationship, including age and pulmonary function status.
Summary:
- A study of 126 acute asthma attacks in 52 children (6-17 years) found a significant positive correlation between %PEF and SpO2 (R=0.472, p<0.001).
- The observed SpO2 values for given %PEF were higher than GINA recommendations.
- Significant relationships were found in younger age groups (6-12 years) and in children without obstructive changes during stable conditions. Older children and those with obstructive changes showed a disturbed relationship.
- Averaged pre-bronchodilator values indicated significant differences in %PEF, SpO2, heart rate, and respiratory rate between children requiring admission versus those not admitted.
- The study highlights that SpO2 may remain above 91% even with %PEF below 60%, particularly in older children or those with obstructive changes, necessitating the combined use of PEF and SpO2 for severity assessment.
Impact:
- Findings suggest that current GINA guidelines for SpO2 may overestimate severity in some pediatric asthma cases.
- Clinicians should be aware that elevated SpO2 does not always correlate with less severe airway obstruction in children.
- Integrating both PEF and SpO2 measurements is crucial for a more accurate and nuanced assessment of asthma exacerbation severity in pediatric patients, especially in specific age groups or those with pre-existing pulmonary conditions.
Abstract:
We evaluated the relationship between PEF and SpO2 on 126 acute asthma attacks of 52 asthmatic children (25 males, 27 females, age 6-17 yrs-old) whose PEF and SpO2 being measured either before or after inhalation of beta-agonist at out-patient clinic. In the whole age group over 6 yrs-old, values of %PEF were proportional to individual SpO2 (n = 76, R = 0.472, p < 0.001). However, the relationship between %PEF and SpO2 in the present study was different from that of the guideline proposed by WHO (Global Initiative for asthma, GINA), showing that the value of SpO2 corresponding to %PEF was higher in the present study than in GINA. Regarding the difference in age group, significant relationship between %PEF and SpO2 was observed in both lower (6-9 yrs-old) and middle age group (10-12 yrs-old) but not in older age group (over 12 yrs-old). Also, there was a significant relationship between %PEF and SpO2 in cases whose pulmonary function during stable condition showed no-obstructive change (FEV1.0% > 80%), but not in cases with obstructive change. On the other hand, averaged values of %PEF, SpO2, heart rate (HR), respiratory rate (RR) before inhalation of beta-agonist at out-patient clinic in cases with or without admission were 32.3% vs 50.0%, 93.0%, vs 95.0%, 115 bpm vs 100 bpm, and 27/min vs 25/min respectively, those difference being statistically significant. Although measurement of SpO2 is thought to be a useful index for assessing severity of childhood asthma exacerbation, clinician should recognize that value of SpO2 could be greater than 91% even though % predicted PEF is less than 60%. Especially in older age group, obstructive change during stable condition may disturb the relation of SpO2 to %PEF. In such cases, not only SpO2 but also PEF, which is objective index of airway obstruction, should be taken into account for assessing severity of exacerbation.