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.
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
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.
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.