Changes In Peak Expiratory Flow Rate Research Articles

A prospective comparative study of efficacy of intravenous magnesium sulfate infusion versus placebo, as an adjuvant to nebulized salbutamol in the management of acute exacerbations of chronic obstructive pulmonary disease

Background: Acute exacerbations of chronic obstructive pulmonary diseases (AECOPD) are a frequent cause of hospitalization, morbidity, and mortality and require serious medical attention. Much research has demonstrated the beneficial effects of intravenous and nebulized magnesium sulfate (MgSO4) as a bronchodilator, in the management of acute severe asthma. Nevertheless, the extent of the benefits of intravenous MgSO4 as an adjuvant to bronchodilators in AECOPD remains uncertain. Therefore, the current study aims to address this gap in knowledge. Aims and Objectives: The study aimed to compare the effectiveness of intravenous magnesium sulfate (MgSO4) versus placebo when used as an adjuvant to nebulized salbutamol in managing AECOPD. Materials and Methods: In this comparative prospective interventional, parallel-group, placebo-controlled study, a total of 60 subjects were assigned to two groups consisting of 30 individuals each. The allocation was non-randomized and open-label, with one group receiving intravenous MgSO4 as an adjuvant to nebulized salbutamol, while the other group received a placebo in the same manner. The evaluation of MgSO4 efficacy involved measuring the peak expiratory flow rate (PEFR), which served as the primary outcome parameter. PEFR measurements were taken at 0, 15, 30, and 45 min to assess the effectiveness of MgSO4. Safety and tolerability of MgSO4 were assessed based on changes in heart rate, blood pressure, deep tendon reflexes, and respiratory rate. Results: At 45 min, the mean change in PEFR was significantly higher (P = 0.061) in the MgSO4 group (178.33 ± 49.18) compared to the placebo group (155.43 ± 41.86). Moreover, the mean difference in PEFR between the two groups was consistently higher in the MgSO4 group at every observation. MgSO4 showed considerable safety and tolerability in subjects based on the postmedication monitoring of hypermagnesemia symptoms. Conclusion: Administering intravenous magnesium sulfate (MgSO4) as an adjuvant to bronchodilators in AECOPD led to the improvement of both clinical condition and PEFR. In AECOPD, MgSO4 exhibits enhanced early bronchodilator response when combined with other drugs, demonstrating significant efficacy, good safety, and tolerability at the prescribed dosage.

A prospective comparative study of efficacy of intravenous magnesium sulfate infusion versus placebo, as an adjuvant to nebulized salbutamol in the management of acute exacerbations of chronic obstructive pulmonary disease

Background: Acute exacerbations of chronic obstructive pulmonary diseases (AECOPD) are a frequent cause of hospitalization, morbidity, and mortality and require serious medical attention. Much research has demonstrated the beneficial effects of intravenous and nebulized magnesium sulfate (MgSO4) as a bronchodilator, in the management of acute severe asthma. Nevertheless, the extent of the benefits of intravenous MgSO4 as an adjuvant to bronchodilators in AECOPD remains uncertain. Therefore, the current study aims to address this gap in knowledge. Aims and Objectives: The study aimed to compare the effectiveness of intravenous magnesium sulfate (MgSO4) versus placebo when used as an adjuvant to nebulized salbutamol in managing AECOPD. Materials and Methods: In this comparative prospective interventional, parallel-group, placebo-controlled study, a total of 60 subjects were assigned to two groups consisting of 30 individuals each. The allocation was non-randomized and open-label, with one group receiving intravenous MgSO4 as an adjuvant to nebulized salbutamol, while the other group received a placebo in the same manner. The evaluation of MgSO4 efficacy involved measuring the peak expiratory flow rate (PEFR), which served as the primary outcome parameter. PEFR measurements were taken at 0, 15, 30, and 45 min to assess the effectiveness of MgSO4. Safety and tolerability of MgSO4 were assessed based on changes in heart rate, blood pressure, deep tendon reflexes, and respiratory rate. Results: At 45 min, the mean change in PEFR was significantly higher (P = 0.061) in the MgSO4 group (178.33 ± 49.18) compared to the placebo group (155.43 ± 41.86). Moreover, the mean difference in PEFR between the two groups was consistently higher in the MgSO4 group at every observation. MgSO4 showed considerable safety and tolerability in subjects based on the postmedication monitoring of hypermagnesemia symptoms. Conclusion: Administering intravenous magnesium sulfate (MgSO4) as an adjuvant to bronchodilators in AECOPD led to the improvement of both clinical condition and PEFR. In AECOPD, MgSO4 exhibits enhanced early bronchodilator response when combined with other drugs, demonstrating significant efficacy, good safety, and tolerability at the prescribed dosage.

Seasonal Patterns of Peak Expiratory Flow Rate in Young Healthy Individuals

Background: The seasonal changes are associated with changes in pulmonary functions including Peak Expiratory Flow Rate (PEFR). These changes are different among different population and location. This study thus aimed to evaluate the seasonal variations in PEFR among healthy young individuals in Kathmandu. Methods: A comaparative study was carried out among 60 undergraduate medical students of Maharajgunj Medical Campus in the department of Clinical Physiology. The students were selected by convenient sampling technique and after obtaining the informed consent, the PEFR was recorded with the help of Wright’s peak flow meter with proper training. The PEFR was recorded two times i.e. morning and daytime hours in winter season (January-February) 2023 and also in same daily hours of summer season (May-June) 2023 in the same participants. The data were analyzed using SPSS-16 version and the paired T test was used to compare the mean changes in PEFR in winter and in summer seasons. Results: The PEFR in summer morning (499.50±89.50 L/min) was recorded higher than in winter morning (487.50±86.09 L/min) among total participants and also in male participants (567.33±69.34; 550.83±69.58) which was statistically significant with P value <0.05. Similarly, the PEFR in summer daytime (505.08±88.85 L/min) was comparatively more than in winter daytime (491.27±92.07 L/min) which was statistically significant among all participants with P value <0.05. The PEFR in the winter and summer seasons of male participants and in the summer of total participants showed the existence of diurnal variation which was statistically significant. Conclusions: There is seasonal variation as well as diurnal variations of PEFR. So, the clinicians should be aware that the PEFR recorded in winter season and in the morning time might be less than that recorded in the summer and at the daytime respectively.

The Ionic Component of PM2.5 May Be Associated with Respiratory Symptoms and Peak Expiratory Flow Rate

(1) Background: Few studies have evaluated the association between the ionic components of PM2.5 and respiratory symptoms or peak expiratory flow rate (PEFR). The aim of this study was to clarify these associations. (2) Methods: Patients with allergic diseases treated at Fukuoka Hospital recorded their morning and evening PEFR and respiratory symptoms in a diary. We measured PM2.5 and its ionic components in Fukuoka City and examined the relationship with PEFR and respiratory symptoms by univariate and multivariate analysis. (3) Results: Among the ionic components of PM2.5, Cl−, NO3−, Na+, K+, and Mg2+ were significantly correlated with the frequency of coughing and nasal symptoms. In univariate analysis, the concentrations of each of the above ions was significantly associated with a decrease in PEFR and the concentrations of each was associated with at least one respiratory symptom or PEFR. Multivariate analysis of items significantly correlated with PEFR indicated that the concentration of ionic components may predict changes in PEFR. (4) Conclusions: In patients with allergic diseases, some ionic components of PM2.5 may increase the frequency of respiratory symptoms and decrease PEFR, so further study and caution are required in daily clinical practice.

Safety of Live Attenuated Influenza Vaccine in Children With Asthma.

Asthma is considered a precaution for use of quadrivalent live attenuated influenza vaccine (LAIV4) in persons aged ≥5 years because of concerns for wheezing events. We evaluated the safety of LAIV4 in children with asthma, comparing the proportion of children with asthma exacerbations after LAIV4 or quadrivalent inactivated influenza vaccine (IIV4). We enrolled 151 children with asthma, aged 5 to 17 years, during 2 influenza seasons. Participants were randomly assigned 1:1 to receive IIV4 or LAIV4 and monitored for asthma symptoms, exacerbations, changes in peak expiratory flow rate (PEFR), and changes in the asthma control test for 42 days after vaccination. We included 142 participants in the per-protocol analysis. Within 42 days postvaccination, 18 of 142 (13%) experienced an asthma exacerbation: 8 of 74 (11%) in the LAIV4 group versus 10 of 68 (15%) in the IIV4 group (LAIV4-IIV4 = -0.0390 [90% confidence interval -0.1453 to 0.0674]), meeting the bounds for noninferiority. When adjusted for asthma severity, LAIV4 remained noninferior to IIV4. There were no significant differences in the frequency of asthma symptoms, change in PEFR, or childhood asthma control test/asthma control test scores in the 14 days postvaccination between LAIV4 and IIV4 recipients. Vaccine reactogenicity was similar between groups, although sore throat (P = .051) and myalgia (P <.001) were more common in the IIV4 group. LAIV4 was not associated with increased frequency of asthma exacerbations, an increase in asthma-related symptoms, or a decrease in PEFR compared with IIV4 among children aged 5 to 17 years with asthma.

PRESCRIBING TRENDS IN ASTHMA IN PEDIATRICS: A LONGITUDINAL, OBSERVATIONAL STUDY

Objectives: In recent years, the prevalence of asthma has globally increased. Despite intensive treatment, many children with asthma are not achieving good symptom control. The present study aims to analyze the prescribing trends in pediatric asthma according to the World Health Organization (WHO) prescribing indicators.&#x0D; Methods: This was an observational, longitudinal study conducted for the duration of 6 months with a sample size of 62. Children with age 1–14 years with asthma, who fulfilled the inclusion criteria, were enrolled after obtaining the written informed consent. Data were collected from outpatient department prescription slips for 2 times, one at 1st enrollment and the next after 1 month and changes in the prescription were noted. Peak expiratory flow rate (PEFR) was measured on both visits and the change in PEFR was noted.&#x0D; Results: Male predominance was seen (67.74%) with age of 5–9 years (40.32%). Average number of drugs per prescription was 1.96. The most commonly prescribed anti-asthmatic drug was inhaled corticosteroids (ICS) (78.22%). Only 1.5% drugs were prescribed by generic names and 22.22% drugs from the essential drug list. Inhalational route (38.71%) was preferred over the oral route (20.97%). After 1 month of treatment, change in PEFR was found to be statistically significant.&#x0D; Conclusion: The study concluded that average number of drugs per prescription and use of antibiotics was conforming to the WHO prescribing standards but prescribing from essential medicines list and by generic name need to be encouraged.

Performance improvement of machine learning techniques predicting the association of exacerbation of peak expiratory flow ratio with short term exposure level to indoor air quality using adult asthmatics clustered data.

Large-scale data sources, remote sensing technologies, and superior computing power have tremendously benefitted to environmental health study. Recently, various machine-learning algorithms were introduced to provide mechanistic insights about the heterogeneity of clustered data pertaining to the symptoms of each asthma patient and potential environmental risk factors. However, there is limited information on the performance of these machine learning tools. In this study, we compared the performance of ten machine-learning techniques. Using an advanced method of imbalanced sampling (IS), we improved the performance of nine conventional machine learning techniques predicting the association between exposure level to indoor air quality and change in patients’ peak expiratory flow rate (PEFR). We then proposed a deep learning method of transfer learning (TL) for further improvement in prediction accuracy. Our selected final prediction techniques (TL1_IS or TL2-IS) achieved a balanced accuracy median (interquartile range) of 66(56~76) % for TL1_IS and 68(63~78) % for TL2_IS. Precision levels for TL1_IS and TL2_IS were 68(62~72) % and 66(62~69) % while sensitivity levels were 58(50~67) % and 59(51~80) % from 25 patients which were approximately 1.08 (accuracy, precision) to 1.28 (sensitivity) times increased in terms of performance outcomes, compared to NN_IS. Our results indicate that the transfer machine learning technique with imbalanced sampling is a powerful tool to predict the change in PEFR due to exposure to indoor air including the concentration of particulate matter of 2.5 μm and carbon dioxide. This modeling technique is even applicable with small-sized or imbalanced dataset, which represents a personalized, real-world setting.

Seasonal and monthly variation in peak expiratory flow rate in children with asthma.

BackgroundAlthough understanding the seasonal patterns of asthma deterioration is important to prevent asthma exacerbation, previous approaches have limitations in evaluating the actual trend of asthma exacerbation.ObjectiveThis study aimed to evaluate the seasonal and monthly variations in the peak expiratory flow rate (PEFR) among children with asthma.MethodsA total of 89 patients with asthma were enrolled between December 2012 and March 2015. The PEFR in the morning and evening was recorded daily, and the percentage change in PEFR from baseline was calculated. Generalized estimating equation models were constructed after adjusting for age, sex, body mass index, and sensitization to house dust mites or pollen.ResultsThe PEFR records of 11,222 person-days showed a significant decrease in the morning and evening in autumn than in winter by −1.9% (95% confidence interval [CI], −3.73 to −0.15) and −2.1% (95% CI, −3.80 to −0.37), respectively. The morning PEFR was significantly lower in April, August, October, and December than in January with changes of −4.2% (95% CI, −7.08 to −1.23) in April, −3.1% (95% CI, −5.79 to −0.47) in August, −3.7% (95% CI, −6.09 to −1.21) in October, and −1.9% (95% CI, −3.62 to −0.12) in December. The percentage change of evening PEFR significantly decreased by −3.3% (95% CI, −6.38 to −0.25) in April and by −3.3% (95% CI, −5.56 to −1.07) in October.ConclusionThe PEFR in children with asthma was lower in autumn than in winter. In terms of monthly patterns, the PEFR was significantly reduced in April and October than in January. These results can serve as a basis for preventing asthma exacerbations by developing seasonal or monthly management strategies for children with asthma.

JA:2021-31. Does the Use of a Nasal Lavage Intervention Improve Pulmonary Function for Dairy Workers?

ABSTRACT Purpose: Dairy workers are at the frontline of exposure to bioaerosols, which typically contain bacteria and associated pro-inflammatory constituents (e.g., endotoxin). As such, dairy workers are at an increased risk for respiratory illness, most likely mediated through a strong proinflammatory response. Very few studies have systematically evaluated control strategies to reduce exposure and improve health. Given the challenges and limitations of implementing engineering controls, we propose the use of a low-cost and low-burden intervention. Hypertonic saline (HTS) was recently shown to attenuate inflammation in trauma patients. Here, we conducted an intervention to administer HTS in a nasal lavage to determine if the inflammatory response was mitigated and if the airway function improved among dairy workers. Methods: Ten participants were recruited from a large herd dairy and randomly assigned to treatment (n = 5) and control groups (n = 5). Each participant received normotonic saline (308 mOsm) nasal lavage (NL) before their shift over 5 consecutive days. After each shift, the treatment group received HTS, while the control group received normotonic saline. All samples were analyzed for 10 different cytokines using a multiplex assay. Spirometry was performed pre- and post-shift to examine forced expiratory volume in one second, forced vital capacity and the subsequent ratio, and peak expiratory flow rate (PEFR). Personal breathing zone samples for inhalable bioaerosols were collected across the work shift; mass concentrations and endotoxin abundance were determined by gravimetry and a fluorescent assay, respectively. Statistical analyses and models were performed using SAS. Results/Findings: Differences in pro-inflammatory cytokines were observed. There was an interaction effect on IL-10 between treatment, day, and time of day, indicating promotion of anti-inflammatory effect. The treatment group experienced an increase in PEFR change (0.76 L, p = 0.12) near statistical significance; no statistically significant differences were observed in the other spirometry measures. Both groups of dairy workers in this study experienced less of a decline in cross-shift pulmonary function when compared to other studies. Practical Application: The HTS nasal lavage is designed as a low-cost intervention that can be self-administered before and after every shift across other agricultural operations. This study was limited by small sample size and warrants further investigation.

Post Exercise Change in Peak Expiratory Flow Rate and its Relation with Body Adiposity in Nepalese Settings

Background: The Queens College Step Test is used to determine aerobic fitness. Peak Expiratory Flow Rate (PEFR) is the maximum rate of forceful exhalation following full inspiration. PEFR primarily reflects bronchial airflow and depends on the voluntary effort and muscular strength of the individual. Studies that correlate ventilatory capacity with body fat percentage are rare in published literature in Nepalese settings. Body fat percentage is regarded as a better indicator of obesity recently. Hence, this study aims to find an association between post-exercise change in PEFR and body adiposity in the context of Nepal.&#x0D; Methods: A cross-sectional study was carried out from 20th July 2019 to 15th November in the laboratory of Clinical Physiology of Maharajgunj Medical Campus. Body fat percentage was measured by using OMRON BF 214. Pre-exercise PEFR of each subject was recorded by using Wright’s peak flow meter. Post-exercise PEFR was also recorded after three minutes of Queen’s College step test, which is the submaximal exercise test, and change in PEFR was calculated and correlated with body fat percentage.&#x0D; Result: The study showed a negative correlation of change in PEFR with body fat percentage (r=-0.324; P&lt;0.001). A significant difference (P = 0.002) was observed between different quartiles of body fat percentage. A highly significant difference (P = 0.003) was noted with the first and fourth quartiles.&#x0D; Conclusion: Less ventilatory adjustment in response to exercise was noted in subjects with more body fat percentage compared to those with less body fat percentage.

Sex Differences in the Prevalence and Severity of Exercise-Induced Bronchoconstriction in Kindergarteners in Japan.

BackgroundExercise‐induced bronchoconstriction (EIB), a strong positive predictor of asthma, becomes progressively less frequent with age. Although asthma tends to become less common only in boys during adolescence, sex differences in EIB, especially in preschoolers, remain unclear. To find EIB for early diagnosis and intervention asthma, mass‐screening tests considering sex differences in preschoolers are needed. In this study, we investigated whether sex differences influence the prevalence and severity of EIB in prepubertal children aged 5–6 years.MethodsFifty‐one children aged 5–6 years who were attending a kindergarten in Matsuyama City, Ehime, Japan, were enrolled in this cross‐sectional study. The children underwent a 6‐minute free‐running test in 2015. The peak expiratory flow rate (PEFR) was measured before exercise and 0, 3, 10, and 20 minutes after exercise. The severity of EIB was classified according to the reduction in PEFR, measured as the difference between the postexercise PEFR and the highest pre‐exercise PEFR.ResultsOf the 51 children (23 boys and 28 girls) enrolled, the prevalence of EIB defined as three criteria: a ≥15%, ≥20%, or ≥25% decrease was 54.9% (28/51), 41.2% (21/51), and 25.5% (13/51), respectively. The prevalence of EIB defined as ≥25% decrease was significantly higher in girls than in boys (39.3% vs 8.7%, P = .013). In girls, the mean percentage change in PEFR was significantly higher 20 minutes than 10 minutes postexercise (P = .043).ConclusionsSex difference in the prevalence and severity of EIB should be considered when evaluating EIB, even in young, prepubertal children.

Exhaled breath temperature as a tool for monitoring asthma control after an attack in children.

Exhaled breath temperature (EBT) has been suggested as a non-invasive marker of airway inflammation in asthma. There have been no studies examining longitudinal changes in EBT following asthma attacks. To investigate changes in EBT during and after an asthma attack and to relate these changes to changes in respiratory physiological measurements. We evaluated 38 hospitalized children aged 5-18 years diagnosed with an asthma attack. Spirometry was performed upon hospitalization. During hospitalization, EBT, peak expiratory flow rate (PEFR), and asthma score were measured daily. These tests were repeated 1 week and 1 month after discharge. The overall PEFR change, temporal changes in plateau values at the end of expiration, and time-dynamic associations were evaluated using linear mixed models. FEV1 was lower at admission than at discharge (63.3 ± 24 vs 99.5 ± 14 percent of predicted, P < 0.001). The EBT was higher at admission than at 1 week after discharge (34.1°C [range: 33.9-34.8°C] vs 33.6°C [range: 33.0-34.2°C], P = 0.007); overall, EBTs decreased over time (P = 0.007). Among individual subjects, decreased EBT was correlated with increased PEFR over time. Furthermore, plateau values at the end of expiration had a time-dependent, dynamic association with the PEFR during hospitalization (P = 0.005) and between asthma attack onset and asthma status stabilization (P = 0.032). The EBT was elevated during asthma attacks and gradually decreased until asthma was well controlled. The EBT may be a useful, non-invasive tool for monitoring asthma control in children.

Efficiency of nebulised magnesium sulphate in infective exacerbations of chronic obstructive pulmonary disease

Conflicting results has been achieved in a small number of clinical studies evaluating the efficiency of magnesium sulphate (MS) in COPD exacerbations. We aimed to investigate the efficiency of nebulised MS in COPD exacerbations. Twenty patients who met the study criteria were randomized into two groups. All patients were treated with O2, antibiotics and oral corticosteroids. Additionally one group received ipratropium bromide (IB) 500 µg together with MS 151 mg/dose, while the other group received IB together with placebo. The patients were followed-up with forced expiratory volume in 1 second (FEV1) and visual analogue scale dyspnea scores for 48 hours. Peak expiratory flow rates (PEFRs) were measured before and 10, 30, 60 and 120 minutes after each nebule treatment. The baseline characteristics of the patients in both groups were similar. The FEV1 values measured at 24 and 48 hours did not show significant changes compared to baseline in both groups. Dyspnea scores in both groups decreased significantly in the first day, and in only MS group in the second day. The % change in the dyspnea score at the end of first day was significantly more in the MS group [-23.8% (13.6)] compared with the placebo group [-9.4% (12.9)] (p= 0.002). The % changes in PEFRs at 10 minutes [4.7 (7.5) and -3.5 (6.0), p= 0.005] and 30 minutes [8.2 (6.7) and 1.3 (5.5), p= 0.03] were significantly greater in the MS group compared with the placebo group on the first day. No side effects developed due to MS. Nebulised MS is a cheap, feasible and safe drug that can be added to the standart bronchodilator treatment since it provides additional relief of dyspnea in patients with COPD exacerbations. This needs to be evaluated in future clinical studies including greater number of patients.

Daily Peak Expiratory Flow Rate and Disease Instability in Chronic Obstructive Pulmonary Disease.

Rationale: Chronic obstructive pulmonary disease, (COPD) is a major cause of morbidity and mortality in the United States. Peak expiratory flow rate (PEFR) monitoring could provide a daily objective measurement of lung function in COPD patients at home. We hypothesized that individuals with greater variability in daily PEFR would signal an unstable patient population with worse outcomes. Methods: This was a retrospective analysis of prospectively collected data using an electronic diary to record daily PEFR and symptoms in severe and very severe COPD patients. Rates of PEFR change were used to characterize patients into stable and unstable groups determined by the distribution of slopes. Exacerbation-free days, time to first hospitalization, hospitalization rate, length of hospitalization, and all-cause mortality were assessed. Results: A total of 104 severe and very severe COPD patients met entry criteria, and were observed for 37,702 patient-days. There were no significant differences in baseline symptoms, demographics, forced expiratory volume in 1 second (FEV1) or comorbidities between stable versus unstable groups. The unstable group had 34.7 less exacerbation-free days and significantly shorter 6 minute walk distances (6MWD) (227.1 versus 270.7 meters, p=0.031), shorter time to first hospitalization (163 versus 286 days, p=0.017), more frequent hospitalizations (2.6 versus 1.7 per year, p=0.032) and higher all-cause mortality (10.8 versus 5.1%, p= 0.04). Conclusion: Patients with severe to very severe COPD with greater changes in PEFR have shorter 6MWD, reduced time to first hospitalization, more frequent hospitalizations, and higher all-cause mortality despite similar demographic, spirometric and comorbid parameters at baseline. Daily peak flow monitoring can be a useful tool in identifying COPD patients predisposed to worse outcomes.

Effect of Submaximal Warm-up Exercise on Exercise-induced Asthma in African School Children.

Regular physical activity has long been regarded as an important component of a healthy lifestyle. Exercise-induced asthma (EIA) is one of the major problems interfering with the performance of exercise. A warm-up exercise programme has been cited as a non-pharmacologic means of reducing EIA, but its effect has not been fully elucidated. The aims of this study were to determine the prevalence of unrecognized EIA in Pretoria primary school children, determine the effect of a warm-up exercise programme on EIA and to establish the relationship between history of allergy, family history of asthma and EIA. A random sample of 640 school children was selected. The study was divided into three phases. In phase one, a descriptive cross-sectional study was done using the standardized European Community Respiratory Health Survey (ECRHS) questionnaire. In phase two, non-asthmatic participants that returned a completed questionnaire were included in the field study. Pre-test and post-test experimental designs were used, where peak expiratory flow rate (PEFR) was measured at baseline and within ten minutes after exercise. A total of 340 subjects completed the Free Running Asthma Screening Test (FRAST); EIA was defined as a decrease in baseline PEFR ≥ 10% after exercise and 75 children (22%) had EIA. In phase three, 29 of the 75 subjects participated in the warm-up programme which was performed in the laboratory and subjects acted as their own controls. Predefined protocols for the study were followed. Seventy-five (22%) of the 340 participants had EIA. The mean age, height and weight were 10.51 years, 139.26 cm and 33.45 kg, respectively. Exercise-induced asthma symptoms were cough (25%), chest pain (16%), wheeze (12%) and chest tightness (12%). The history of allergy was 75%, family history of allergy 40% and positive history of allergy when near animals, feathers or in dusty areas 38%. Wheezing during or after exercise, wheezing when near animals, feathers or in dusty areas and chest pain was significant (p < 0.05). The mean PEFR after exercise without warm-up was 4.43 L/min. The mean PEFR after exercise (warm-up) was 4.98. The mean percentage change in PEFR between exercise without warm-up and exercise with warm-up was 14.83%. The paired t-test showed a significant difference between PEFR with warm-up and PEFR without warm-up (p < 0.05). There was a high prevalence of EIA among study participants. Exercise-induced asthma symptoms were significant for wheezing and chest pain. Exercise after warm-up was significant in reducing EIA. This study reports the effect of warm-up exercise on EIA and highlights the need to screen school children for EIA.

Magnesium for acute exacerbation of chronic obstructive pulmonary disease: A systematic review of randomised trials.

The efficacy of magnesium sulphate in chronic obstructive pulmonary disease (COPD) was assessed by conducting a systematic review of published randomized clinical trials through extensive searches in MEDLINE and SCOPUS with no date limits, as well as manual review of journals. Outcome measures varied depending on route(s) of administration of magnesium sulphate and medications co-administered. Risk of bias was evaluated and quality of evidence was graded. Four (4) randomized trials were included. All trials had a moderate risk of bias and were of average methodological quality. Magnesium sulphate given intravenously did not seem to have an immediate bronchodilatory effect; however it appears to potentiate the bronchodilatory effect of inhaled beta-2 agonists. Increase in peak expiratory flow rate (PEFR) at 30 and 45 min was greater in those who received magnesium sulphate compared to placebo (P = 0.03), although the mean percentage change in PEFR was just 24%, without significant differences in dyspnoea scores, hospital admission rates, or emergency department readmission rates compared to placebo. Nebulized magnesium sulphate with salbutamol versus nebulized salbutamol with saline placebo showed no significant differences is forced expiratory volume in 1 s (FEV1) measured at 90 min after adjustment for baseline FEV1 (P = 0.34) or differences in the need for hospital admission. Combined inhalational and intravenous magnesium sulphate versus intravenous saline placebo and nebulized ipratropium bromide were comparable in terms of hospital admission, intubation and death, but the ipratropium bromide group showed better bronchodilator effect and improvement in arterial blood gas parameters. Overall, trial evidence for trial evidence for magnesium sulphate in acute exacerbation of COPD is poor, and further well-designed trials are needed.

PREDICTION OF UNSUCCESSFUL TREATMENT IN PATIENTS WITH SEVERE ACUTE ASTHMA: AN ANALYSIS FROM THE 3MG TRIAL

Objectives & BackgroundClinical assessment can be used to identify which patients with acute asthma are at risk of unsuccessful initial treatment. We aimed to determine, using data from the 3MG...

Prediction of unsuccessful treatment in patients with severe acute asthma

BackgroundClinical assessment can be used to identify which patients with acute asthma are at risk of unsuccessful initial treatment.ObjectiveTo determine which elements of clinical assessment predict unsuccessful treatment, defined as...

Nebulized magnesium sulphate versus nebulized salbutamol in acute bronchial asthma

Aim of workThe aim of this study is to investigate the efficacy of nebulized magnesium sulphate as a bronchodilator in acute asthma as compared to nebulized salbutamol. Subjects and methodsThis was a randomized controlled study conducted in El-Giza Chest Hospital Emergency Department between January 2010 and June 2011. Randomization was achieved by closed envelope technique. This study involved 48 known bronchial asthma patients presenting with acute or subacute exacerbations. Patients were divided into Control group (A) and Study group (B). Initial assessment of all patients included history, clinical examination (auscultation, respiratory rate (RR), heart rate (HR) and working of accessory muscles). In addition to measurement of peak expiratory flow rate (PEFR) and oxygen saturation (SO2). Patients received standard treatment for their acute attacks in the form of Sodium hydrocortisone hemisuccinate 100mg every 6hours, Supplemental oxygen and nebulized bronchodilator which was salbutamol in group (A) in the form of 4 doses of nebulized solution 0.5gm% (each dose 1ml containing 5mg salbutamol) twenty minutes apart and Magnesium sulphate in group (B) in the form of 4 doses of nebulized solution 10gm% (each dose 1ml containing 100mg magnesium sulphate) twenty minutes apart. Reassessment of the patients was performed after 2hours to detect improvement. ResultsThe percent change in PEFR in Group A was significantly higher than that in Group B (58.90% and 13.92% respectively, p value 0.00). There was a statistically significant reduction in the final mean HR in Group B compared to Group A (85bpm and 96.1bpm respectively, p value 0.011). There was a significant reduction in mean final RR in Group A compared to Group B (22.17bpm. and 25bpm respectively, p value 0.002).There was a significant increase in oxygen saturation (SO2) in both groups. ConclusionThe use of MgSO4 by nebulization in patients with acute asthma attacks results in improvement of clinical condition, increase in peak expiratory flow rate (PEFR), reduction in heart rate (HR), reduction in respiratory rate (RR) and improvement in oxygen saturation (SO2). The increase in PEFR (bronchodilatory effect) was significantly less than that achieved in patients receiving the usual treatment with Short acting β2 agonists, e.g. salbutamol, when either agents were used alone.

Assessment of Dyspnea in Acute Decompensated Heart Failure: Insights from ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) on the Contributions of Peak Expiratory Flow

This study hypothesized that peak expiratory flow rate (PEFR) would increase with acute heart failure (AHF) treatment over the first 24 h, related to a Dyspnea Index (DI) change and treatment effect.Dyspnea is a key symptom and clinical trial endpoint in AHF, yet objective assessment is lacking.In a clinical trial substudy, 421 patients (37 sites) underwent PEFR testing at baseline, 1, 6, and 24 h after randomization to nesiritide or placebo. DI (by Likert scale) was collected at hours 6 and 24.Patients were median age 70 years, and 34% were female; no significant differences between nesiritide or placebo patients existed. Median baseline PEFR was 225 l/min (interquartile range [IQR]: 160 to 300 l/min) and increased to 230 l/min (2.2% increase; IQR: 170 to 315 l/min) by hour 1, 250 l/min (11.1% increase; IQR: 180 to 340 l/min) by hour 6, and 273 l/min (21.3% increase; IQR: 200 to 360 l/min) by 24 h (all p < 0.001). The 24-h PEFR change related to moderate or marked dyspnea improvement by DI (adjusted odds ratio: 1.04 for each 10 l/min improvement [95% confidence interval (CI): 1.07 to 1.10]; p < 0.01). A model incorporating time and treatment over 24 h showed greater PEFR improvement after nesiritide compared with placebo (p = 0.048).PEFR increases over the first 24 h in AHF and could serve as an AHF endpoint. Nesiritide had a greater effect than placebo on PEFR, and this predicted patients with moderate/marked improvement in dyspnea, thereby providing an objective metric for assessing AHF. (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure [ASCEND-HF]; NCT00475852).