: Usefulness of peak expiratory flow rate assessment in the screening for bronchial hyper responsiveness in children with allergic rhinitis

Abstract

 

Title : Usefulness of Peak expiratory flow rate assessment in the  screening  for bronchial hyper responsiveness in children with Allergic Rhinitis.

Background: The unified airway hypothesis explains the sequence in onset of atopic march from Allergic Rhinitis(AR)  to bronchial hyper responsiveness (BHR) and subsequently to asthma in most of the children with AR. BHR better identified  with Peak expiratory flow rate (PEFR)  assessment .

Aim Identifying  BHR  in children with AR with  PEFR and to determine the effect of treatment of AR on BHR.

Methodology :

 

            Study design :Prospective observational study

            Study Period : October 2007 – September 2008

            Setting : Allergy clinic Kanchi Kamakoti CHILDS trust Hospital

            Inclusion criteria :

 children > 5 yrs fulfilling Allergic Rhinitis and its

                         Impact on Asthma (ARIA) criteria were included in the study and

classified as

                                    A.Mild intermittent

                                    B.Mild Persistant

                                    C.Severe Intermittent

                                    D.Severe persistant.

            Exclusion Ceriteria :

                        Children  aged < 5  yrs and  Unable to perform PEFR

Sample size : 82 was arrived with confidence interval of 95% ,Prevalence

of 10% based on previous studies

            Method:       Same Postgraduate will confirm the inclusion ,exclusion

Criteria. Detailed history ,complete examination and investigations (Ig E levels ,Absolute eosinophil count and  PEFR will be done after obtaining informed consent. Treatment (oral Antihistamines and or inhaled nasal steroids ) as per ARIA CRITERIA for various subgroups . Follow up done.

Results: Total 85 children were included and 58.8% were males and majority were in 6-9 yrs age group. Mild intermittent ,Mild Persistant ,Severe Intermittent, Severe persistant Allergic rhinitis were observed in 48,28,5,4 children respectively.As severity increases PEFR declined (P <0.001).

Serum Ig E levels were elevated in 41.2% children and levels increase with increase in severity of AR. Out of the 35 children with AR & BHR , after a 2 week treatment 7 lost for follow up and rest 28 showed improvement in PEFR.

Conclusion :

 

PEFR declines linearly as the severity of AR increases and increases significantly after treatment of AR alone .It has no correlation with Serum Ig E levels.