Peak Expiratory Flow Rate Measurements Research Articles

The Accuracy of PUMA Questionnaire in Combination With Peak Expiratory Flow Rate to Identify At-risk, Undiagnosed COPD Patients

IntroductionThe English PUMA questionnaire emerges as an effective COPD case-finding tool. We aimed to use the PUMA questionnaire in combination with peak expiratory flow rate (PEFR) to improve case-finding efficacy in Chinese population. MethodsThis cross-sectional, observational study included two stages: translating English to Chinese PUMA (C-PUMA) questionnaire with linguistic validation and psychometric evaluation, followed by clinical validation. Eligible participants (with age ≥40 years, respiratory symptoms, smoking history ≥10 pack-years) were enrolled and subjected to three questionnaires (C-PUMA, COPD assessment test [CAT], and generic health survey [SF-12V2]), PEFR measurement, and confirmatory spirometry. The C-PUMA score and PEFR were incorporated into a PUMA-PEFR prediction model applying binary logistic regression coefficients to estimate the probability of COPD (PCOPD). ResultsC-PUMA was finalized through standard forward–backward translation processes and confirmation of good readability, comprehensibility, and reliability. In clinical validation, 240 participants completed the study. 78/240 (32.5%) were diagnosed with COPD. C-PUMA exhibited significant validity (correlated with CAT or physical component scores of SF-12V2, both P<0.05, respectively). PUMA-PEFR model had higher diagnostic accuracy than C-PUMA alone (area under ROC curve, 0.893 vs. 0.749, P<0.05). The best cutoff values of C-PUMA and PUMA-PEFR model (PCOPD) were ≥6 and ≥0.39, accounting for a sensitivity/specificity/numbers needed to screen of 77%/64%/3 and 79%/88%/2, respectively. C-PUMA ≥5 detected more underdiagnosed patients, up to 11.5% (vs. C-PUMA ≥6). ConclusionC-PUMA is well-validated. The PUMA-PEFR model provides more accurate and cost-effective case-finding efficacy than C-PUMA alone in at-risk, undiagnosed COPD patients. These tools can be useful to detect COPD early.

The Effect of Diaphragmatic Breathing Exercises on Peak Expiratory Flow Rate in Bronchial Asthma Patients

Background: Asthma is a prevalent, chronic, and varied condition in which most people experience dyspnea, wheezing, chest tightness, and coughing due to reversible airway obstruction, airway inflammation, and bronchial hyperreactivity. cause the quality of life to diminish. The breathing method known as diaphragmatic breathing is tailored to the needs of asthmatics. During a deep inhale, a breathing method called diaphragmatic breathing relaxes the respiratory muscles. Objective: To determine the effect of diaphragmatic breathing exercises on peak expiratory flow rate (PEFR) patients with bronchial asthma. Method: This type of research is quasi-experimental with a one-group pre-test and post-test design. The sampling method used purposive sampling with 15 respondents. The PEFR measurement instrument uses a peak flow meter. Data were analyzed univariately and bivariately using the paired T-Test. Results: The average PEFR value before and after diaphragmatic breathing exercise therapy was 246.67 L/minute and 300 L/minute. There was a significant difference in PEFR before and after being given diaphragmatic breathing exercise therapy with an increase in PEFR value of 53.33 L/minute (p-value 0.00). Conclusion: Diaphragmatic breathing exercises have a significant influence on PEFR values in bronchial asthma patients

The anthropometric determinants of peak expiratory flow rate among children in Dar Es Salaam, Tanzania

BackgroundPeak expiratory flow rate (PEFR) is an important tool for assessing lung function, which can be affected by environmental and physical factors such as altitude, nutrition, genetics, age, height, and weight. Conducting a study to assess the correlation between peak expiratory flow rate and anthropometric measurements in Tanzanian schoolchildren is crucial to derive a population-specific prediction formula and further simplify respiratory health assessment.MethodsThis cross-sectional study was conducted in a single center private primary and secondary school in Dar es Salaam, Tanzania using data from an asthma screening camp. Variables of interest were height, weight, Body Mass Index (BMI) and PEFR. Independent t-test was performed to identify any differences in mean flow rate values between different ethnicities and genders. Correlation coefficients (r) were used to observe the relationship between PEFR and anthropometric measurements. A prediction equation by gender was generated using linear regression analysis. Statistical significance was set at the 5% level. All statistical data was analyzed using SPSS version 25.0.ResultsThe study involved 260 participants with a mean age of 9.5 years. Males were 51.2% and 65% of participants were of Asian ethnicity. PEFR was not observed to differ across the different ethnic groups and genders. Height was found to have the strongest correlation coefficient of 0.745, while BMI had the weakest correlation coefficient of 0.366. The strongest correlation was found with height for females (r = 0.787), while the weakest was with body mass index for boys (r = 0.203). The derived prediction equation for males was PEFR = 279.169 (Height of Student in meters) —134.12, while the predictive equation for females was PEFR = 318.32 (Height of Student in meters) —195.69.ConclusionThis study found a strong correlation between PEFR and anthropometric characteristics in school children from Dar es Salaam, Tanzania. A prediction equation by gender for PEFR was developed based on anthropometric characteristics. This equation may be applied in population-based studies or situations where peak flow meters are not readily available. Further research is needed to explore how well this prediction formula performs in other Tanzanian settings and to determine other factors that may affect lung function in this population.

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 Comparison Of Respiratory Function Parameters Of The Individuals Recovered From Mild Covid-19 And Their Non-Infected Counterparts

Purpose: The COVID-19 epidemic especially attacks the immune and respiratory system, causing intensive care and deaths. Even if the post-illness tests of COVID-19 patients are negative, the effects, especially related to respiratory system, defined as post-covid-19 may continue. The objective of this study is to compare the body composition and chosen respiratory parameters between the adults surviving the disease mildly and their non-infected counterparts. Material and Methods: 60 sedentary adults (positive n=12 and negative n=24 male; positive n=15 and negative n=9 female) participated in the study voluntarily. The groups were named as positive (in the last 6 months) and negative (non-infected). Body composition and respiratory parameters such as vital capacity, forced vital capacity, forced expiratory volume in one second, forced expiratory flow between 25%-75% of vital capacity, tiffeneau index and peak expiratory flow rate measurements were taken. Results: According to the Independent samples t-test results, no statistically significant difference was found between the spirometric values of the sedentary adults who had COVID-19 six months ago and their non-infected counterparts (p&amp;gt;0.05). Conclusion: As a result of the study, it is believed that the respiratory functions of the patients who survived COVID-19 mildly may have returned to normal after 6 months.

Impact of COVID-19 on Physical Fitness in Central Indian Athletes Aged 20-30 Years: A Cross-Sectional Pilot Study.

Background Physical fitness is of utmost importance to athletes as it ensures better performance in competitive sports. Athletes who contracted COVID-19 frequently experienced persistent symptoms for weeks or months afterward. Due to the direct effects of COVID-19 infection on pulmonary, cardiovascular, and neurological systems, combined with the negative effects of isolation and inactivity, it has been observed that physical fitness decreases in individuals. This study aimed to evaluate the physical fitness of young athletes in the age group of 20 to 30 years after mild-to-moderate COVID-19 infection and compare them with unaffected athletes of the same age group. Methodology A field-based, cross-sectional, comparative study was conducted from July 2022 to August 2022 in Nagpur, India. Physical fitness levels of 50 young athletes in the age group of 20-30 years who never got infected with COVID-19 were compared to 50 athletes with a recent history of mild-to-moderate COVID-19 infection using the Harvard step test, breath-holding test, and peak expiratory flow rate measurement. Participants were included based on COVID-19 diagnosis using standard procedures and confirmation of recovery through negative reverse transcriptase polymerase chain reaction tests. Results Overall physical fitness of athletes who suffered from mild-to-moderate COVID-19 infection was significantly less than those who were not infected. Compared to their non-COVID-19 counterparts, the COVID-19-recovered athletes showed reduced physical fitness index (p < 0.0001 for males and p = 0.0003 for females), reduced peak expiratory flow rate (p < 0.0001 for males and p < 0.0001 for females), and reduced breath-holding time (p < 0.0001 for males and p < 0.0001 for females). Conclusions COVID-19 had a significant impact on various components of physical fitness which may potentially affect the athletic performance and overall well-being of young athletes.

The Efficacy of Nebulized Epinephrine in Children with Acute Asthma: A Randomized Double-blind Trial

Introduction: Countries like Bangladesh have seen an increase in the prevalence of bronchial asthma. The goal of the study was to compare the efficacy of nebulized salbutamol and nebulized epinephrine in treating children with acute asthma. Objectives: To assess the clinical improvement of acute bronchial asthma in children following nebulization with salbutamol and epinephrine. Methodology: This random, double-blind clinical trial was conducted in the paediatric department of the Mymensingh Medical College Hospital. Children of either sex with clinical features of acute exacerbation of asthma, an asthma score &gt;5 to 11, an age range from 6 to 12 years, and the ability to measure peak expiratory flow rate (PEFR) were enrolled in this study. Outcomes were observed by measuring PEFR, respiratory rate, pulse rate, and SaO2 and also by determining asthma scores at 15, 35, 55, and 90 min after nebulization at a regular interval at 0, 20, 40, and 60 min. Differences from the base line and differences between both groups were observed. Results: A total of 56 patients with acute asthma were enrolled in this study. Among them, 27 children were in the salbutamol group, and 29 patients were in the epinephrine group. Among baseline characteristics, there was no statistically significant difference (p &gt; 0.05) between the two groups. Asthma score and respiratory rate decreased more in the salbutamol group with time after nebulization, but no statistically significant differences existed for the follow-up at 15, 35, and 55 minutes. A statistically significant increase in asthma score and respiratory rate was seen at 90 minutes of treatment in the salbutamol group. On the other hand, percent of predicted PEFR and SpO2 increased with time in both groups, and no statistically significant differences existed except for SpO2 at 35 min of follow-up in the salbutamol group. The epinephrine-treated group had a higher incidence of side effects as compared with the salbutamol group, but there was no statistically significant difference. Conclusion: Based on this study, in the treatment of asthmatic children with a mild to moderate exacerbation, both nebulized epinephrine and nebulized salbutamol were effective when given in addition to oral steroids.

Incidence of Immunological Occupational Asthma in 2015–2022 by Occupation: Macedonian Experience

BACKGROUND: Immunologic occupational asthma (OA), a more prevalent OA type than non-immunologic OA, became an important public health problem in the last decades worldwide. AIM: To present the distribution of new diagnosed cases of immunologic OA in the RN Macedonia in the period 2015–2022 by occupation. METHODS: Immunologic OA was diagnosed by the serial measurement of peak expiratory flow rate (PEFR) at and away from work or by combination of serial PEFR measurement at and away from work and non-specific bronchial provocation at and away from work in workers with diagnosed asthma and work-relatedness of the symptoms. Sensitization to common inhalant and occupational allergens was evaluated by skin prick test. RESULTS: The annual incidence rate of the diagnosed immunologic OA in this period varied from 1.9 / 100,000 working population in 2015–2.6 / 100,000 in 2022 with a drop in 2020 and 2021, i.e. in the period of COVID-19 pandemic (0.6 and 0.5, respectively). Cleaning, bakery, cleaning, textile manufacture, wood industry, agriculture, and metal-parts manufacture were the most important occupations for the development of immunologic OA. More than a half of the new diagnosed immunologic OA cases were atopics. CONCLUSION: Our findings indicated the occupations with the highest incidence of immunologic OA that could enable targeting of preventive measures and activities to reduce the occurrence of immunologic OA as well as its adverse health outcomes.

Development of a core set of clinical skills for pharmacist prescribers working in general practice: A Delphi study.

With increasing numbers of pharmacists working in general practices and undertaking patient-facing roles, it has been recognised that they must have the necessary clinical skills. However, previous studies have highlighted that practice-based pharmacists (PBPs) do not feel confident regarding their clinical skills, and it is unclear what skills are needed. To develop a core set of clinical skills (CSs) required for pharmacists who intend to practise as independent prescribers working in general practice/family medicine. Based on a previous study, 18 CSs were selected for inclusion in a three-round Delphi consensus questionnaire. These skills were rated by a Delphi panel on a 9-point Likert scale (ranging from 1=limited importance to 9=critical). The Delphi panel comprised designated leads of pharmacist independent prescribing programmes in each United Kingdom educational provider listed on the General Pharmaceutical Council website. A CS was included in the core set if 80% or more of participants scored between 7 and 9, and 15% or less scored between 1 and 3. Following Round 1, seven CSs met the criteria for inclusion: 'Measuring heart rate (radial pulse)', 'Assessing respiratory rate', 'Measuring blood pressure (manual, e.g. with aneroid sphygmomanometer)', 'Measuring blood pressure (automated, i.e. electronic blood pressure monitor)', 'Measuring peripheral oxygen saturation (using pulse oximeter)', 'Measuring temperature', 'Measuring Peak Expiratory Flow Rate'. After two further rounds, a further four CSs were included consisting of 'Undertaking a urinalysis', 'Respiratory examination (includes inspection, palpation, percussion and listening to breath sounds)', 'Screening for/assessment of depression and anxiety using a validated questionnaire (e.g. Patient Health Questionnaire-9 [PHQ-9] scoring)', and 'Patient assessment via National Early Warning Score (NEWS)'. No consensus was reached on nine CSs. This study has produced a core set of CSs for prescribing pharmacists. This study may contribute to standardisation of training and assessment for pharmacist prescribers working in general practice/family medicine.

A quantitative method to evaluate rest periods and respiratory functions in the recovery process of chest trauma cases: peak expiratory flow rate measurement

A quantitative method to evaluate rest periods and respiratory functions in the recovery process of chest trauma cases: peak expiratory flow rate measurement

Chronic Low-dose Exposure to Highly Toxic Gas Phosgene and Its Effect on Peak Expiratory Flow Rate.

Phosgene is a highly toxic gas causing irritation of the airways and eyes though at high dose exposure. The effect on airways can be assessed by peak expiratory flow rate (PEFR) which is a cheaper, simple, and easy to perform test under field conditions and routine monitoring. Thus, this study is undertaken to understand the effect of chronic low-dose phosgene exposure on PEFR and the associated factors. This study included 287 workers of phosgene production and captive units. After recording the demographic, occupational, and clinical history on a questionnaire, every participant was subjected to clinical examination, chest radiography, and measurement of PEFR using Spirovit SP-10. The mean age and mean duration of the job of participants was 42.8 ± 10.4 years and 18.9 ± 9.6 years, respectively. The PEFR was significantly reduced with increasing age, increasing duration in the job, and those having direct exposure. PEFR is affected by chronic low-dose exposure to phosgene.

Can the Remote Use of a Peak Flow Meter Predict Severity of Subglottic Stenosis and Surgical Timing?

We aimed to assess the relationship between patient-performed and patient-reported peak flow meter (PFM) measurements with pulmonary function testing (PFT) and Dyspnea Index (DI) scores as a tool for monitoring Subglottic stenosis (SGS) disease progression remotely. Thirty-five SGS patients were prospectively enrolled. Patients were given PFMs to report serial measurements from home. DI scores and PFT were recorded at serial clinic visits. Data were analyzed to determine the correlation between PFM measurements and PFT data. Pre-operative and post-operative PFM measurements, PFT, and DI scores were analyzed for patients who underwent operative intervention. Receiver operating characteristic (ROC) curves were created for PFM measurements, PFT data, and DI scores to predict the likelihood of surgery. PFM measurements had a "strong" correlation with the peak expiratory flow rate (PEFR), r=0.78. Means of PEFR, PIFR, EDI, PFM measurements, and DI scores all significantly improved after the operative intervention (p ≤ 0.05). The area under the curve for ROC curves for DI scores, PFM measurements, and EDI were highest in our cohort with values of 0.896, 0.823, and 0.806, respectively. In our SGS cohort, PFM measurements correlate strongly with PEFR measurements. PFM measurements can adequately demonstrate disease progression and predict the need for surgery in this patient population. Together, DI scores and PFM measurements may be a useful tool to remotely follow patients with SGS and inform timing of in-person assessments. 2 Laryngoscope, 133:628-633, 2023.

Effect of Short-term Respiratory Proprioceptive Neuromuscular Facilitation on Peak Expiratory Flow Rate and Six-minute Walk Test in Patients with Stable Chronic Obstructive Pulmonary Disease: A Quasi-experimental Study

Introduction: Proprioceptive Neuromuscular Facilitation (PNF) of respiratory muscles was found to improve lung function and haemodynamic parameters in mechanically ventilated patients. It has been proven that respiratory PNF had immediate significant effects in Chronic Obstructive Pulmonary Disease (COPD) patients. As pulmonary rehabilitation for COPD patients is a long-term hospital based service, there arises a need to provide a therapy that provides optimal benefit in short term. Aim: To study the effect of short term respiratory PNF on Peak Expiratory Flow Rate (PEFR) and six-minute walk test in patients with stable COPD. Materials and Methods: This quasi-experimental study was carried out in the Department of Physical Medicine and Rehabilitation, Rajah Muthiah Medical College and Hospital at Annamalai University, Chidambaram, Tamil Nadu, India. Twelve male COPD patients attending Medicine Department outpatient service between December 2020 to January 2021 were conveniently recruited. They were assessed for their PEFR using peak flow meter and exercise tolerance by six-minute walk test. They were treated with three respiratory PNF techniques namely, intercostal stretch, vertebral pressure high and anterior stretch by lifting posterior basal area for five consecutive days. Each treatment session lasted for about 30-40 minutes. The post intervention assessment of PEFR and six-minute walk was made. The pre and post intervention data were statistically analysed using paired samples t-test. Results: In this study, the mean age of the participants was 63.0 ± 5.80 years. The mean post intervention measurement of PEFR (226.67±51.09 L/min) and six-minute walk distance (271.92±50.55 m) was found to be significantly higher (p=0.001) than the mean pre interventional values (165.42±46.19; 219.58±43.24 respectively). Conclusion: Implementation of respiratory PNF techniques on short term basis optimally improves the functional exercise capacity and PEFR in patients with stable COPD.

Which skin prick test wheal size detects true allergy to Salsola kali?

Background. Sensitization to Salsola kali (Sk) weed pollen allergen is the most common cause of seasonal allergic rhinitis (SAR) in Middle East countries. Aim. To identify Salsola kali skin prick test (SkSPT) wheal size cut-off, able to determine true allergy among adult patients with moderate to severe SAR, who are in need of Salsola kali allergen specific immunotherapy (SkAIT). Methods. In 151 adults with moderate to severe SAR, mean age 32.79 ± 10.79 years, of both gender (females: 43.05%), with a positive SkSPT, (i.e., cut off wheal longest diameter of 3 mm) and one or more other local weed pollens, Salsola kali nasal provocation test (SkNPT) was carried out. Response was assessed both subjectively, with scores, and objectively, by measuring peak nasal inspiratory flow (PNIF). Safety profile of SkNPT was assessed using peak expiratory flow rate (PEF) measurements. Results. SkNPT positive response was found in 125 patients (82.78%). Mean skin prick test (SPT) wheal size to Sk was bigger in the nasal provocatin test (NPT) positive group (9 mm) compared to the NPT negative patients (5 mm), p less than 0.0001. ROC analysis showed that a SPT wheal size to Sk at the threshold of > 7.5 mm enabled identification of SkNPT positivity with a sensitivity of 73.6% and specificity of 100.0% (area under the curve 0.9498, standard error 0.01808; 95% confidence interval (CI): 0.9144 to 0.9853; p less than 0.0001). Conclusions. SPT wheal size of 3 mm might overestimate the presence of real allergy to Sk in a desert environment. A SPT wheal size > 7.5 mm for Sk appears to distinguish individuals who develop disease from those who does not. Physicians should select the proper SPT wheal size value as an appropriate criterion according to the allergen than using a uniform cut off value in patients eligible for SkAIT.

1507A cross sectional study on respiratory morbidity among traffic police personnel in Hyderabad, Telangana

Abstract Background Occupational hazards cause early deaths to millions of people worldwide and result in avoidable morbidity that adversely affect the quality of life. The problem of air pollution is also addressed in two of the Sustainable Development Goals (SDGs) – SGD3 and SDG11. Traffic police are one of the worst sufferers because they are continuously exposed to the toxic pollutants emitted from the automobiles. Methods A community based cross-sectional study was carried out from June 2016 to October 2017 among traffic police personnel of Hyderabad district, Telangana. The study was done with a sample size of 270. Data collection was done using a standardized pretested structured schedule developed using ATS-DLD questionnaire, Peak Expiratory Flow Rate (PEFR) measurements and spirometry for lung volumes. Results The average roadside working hours per day for the study participants was 6 hrs per day. The prevalence of respiratory morbidity was found to be 29.85%. Chronic phlegm, chronic cough and chronic wheeze was reported in 18.99%, 13.17%, 2.32% respectively. Respiratory morbidity was significantly associated with age, duration of occupation related exposure to air pollution and the Air Quality Index of workplace (p &amp;lt; 0.05). Around 29% showed obstructive pattern Peak Expiratory Flow Rate (PEFR). Around 68% had FEV1 less than 80% predicted. Conclusions The respiratory morbidity may be attributed to the harmful effects of air pollution due to vehicular exhaust. Key messages Respiratory morbidity among traffic police personnel in Hyderabad warrants implementation of preventive measures.

Screening asymptomatic school children for early asthma by determining airway narrowing through peak expiratory flow rate measurement.

BACKGROUND:Peak expiratory flow rate (PEFR) is widely used as a predictor of treatment of asthma patients. Peak expiratory flow and forced expiratory volume in first second (FEV1) are the most useful parameters for the diagnosis of asthma. Spirometry is not often available in the primary care setting, and economic factors may limit its testing. Mild airway narrowing may be present in asymptomatic children, which can be identified by determining their PEFR. This will enable us to initiate early treatment.MATERIALS AND METHODS:We selected 200 asymptomatic children at the age of 10–15 years without a history of smoking, tuberculosis, or other respiratory illness. A family history about asthmatic symptoms was sought. PEFR values of all children were recorded, and 40 children showed PEFR values less than 80% of their predicted values. To confirm whether the low observed values were because of airway obstruction, their spirometry was performed.RESULTS:Nine out of 47 (19.14%) children from asthmatic families and 31 out of 153 (20.26%) from nonasthmatic families showed PEFR values <80% of the predicted value (P > 0.05). Considering a decrease in the FEV1/forced vital capacity (FVC) ratio to <80% for the diagnosis of obstructive disease, only two out of 35 children were found to have it. Correlation between PEFR and FEV1/FVC ratio was not significant (r = 0.314 and P = 0.065).CONCLUSIONS:Asymptomatic children with low PEFR values may not show abnormal lung functions on spirometry. However, these children, particularly those having the risk of family history of asthma, may be followed for the development of airway obstruction.

Pre-hospital emergency care providers’ knowledge and use of peak flow meters in the management of acute asthma in Johannesburg, South Africa

Background: Peak flow meters (PFMs) measure the speed of airflow from the lungs during a forced exhalation. Current clinical practice guidelines advocate the use of PFMs in the management of acute asthma. No literature could be found describing local prehospital emergency care providers’ use of PFMs. We aimed to investigate and describe a sample of prehospital emergency care providers’ knowledge and use of PFMs in the management of acute asthma in Johannesburg, South Africa. Method: Fifty respondents (22 basic, 16 intermediate and 12 advanced life support providers) completed a pre-piloted questionnaire consisting of closed questions with pre-set response options focusing on exploring respondents’ knowledge, understanding and use of PFMs. Results: Responses highlighted a general lack of knowledge and understanding of PFMs. None of the basic life support providers, and only 19% of intermediate life support providers, indicated they had received training on the device. PFMs do not appear to be readily available in ambulances, with only 8% of the respondents indicating they had ever used a PFM on a real patient. Conclusion: A lack of training on the device and its apparent unavailability are concerning since the peak expiratory flow rate (PEFR) measurement for asthma cases is considered best practice, and literature shows that emergency medical service (EMS) providers are commonly dispatched to asthmatic cases. Additional training and further research on the value and use of PFMs in local prehospital emergency care contexts is therefore recommended.

An accurate prediction model to identify undiagnosed at-risk patients with COPD: a cross-sectional case-finding study

Underuse or unavailability of spirometry is one of the most important factors causing underdiagnosis of COPD. We reported the development of a COPD prediction model to identify at-risk, undiagnosed COPD patients when spirometry was unavailable. This cross-sectional study enrolled subjects aged ≥40 years with respiratory symptoms and a smoking history (≥20 pack-years) in a medical center in two separate periods (development and validation cohorts). All subjects completed COPD assessment test (CAT), peak expiratory flow rate (PEFR) measurement, and confirmatory spirometry. A binary logistic model with calibration (Hosmer-Lemeshow test) and discrimination (area under receiver operating characteristic curve [AUROC]) was implemented. Three hundred and one subjects (development cohort) completed the study, including non-COPD (154, 51.2%) and COPD cases (147; stage I, 27.2%; II, 55.8%; III–IV, 17%). Compared with non-COPD and GOLD I cases, GOLD II-IV patients exhibited significantly higher CAT scores and lower lung function, and were considered clinically significant for COPD. Four independent variables (age, smoking pack-years, CAT score, and percent predicted PEFR) were incorporated developing the prediction model, which estimated the COPD probability (PCOPD). This model demonstrated favorable discrimination (AUROC: 0.866/0.828; 95% CI 0.825–0.906/0.751–0.904) and calibration (Hosmer-Lemeshow P = 0.332/0.668) for the development and validation cohorts, respectively. Bootstrap validation with 1000 replicates yielded an AUROC of 0.866 (95% CI 0.821–0.905). A PCOPD of ≥0.65 identified COPD patients with high specificity (90%) and a large proportion (91.4%) of patients with clinically significant COPD (development cohort). Our prediction model can help physicians effectively identify at-risk, undiagnosed COPD patients for further diagnostic evaluation and timely treatment when spirometry is unavailable.

Exercise-induced bronchoconstriction and therapeutic modulation in Iraqi girls intermediate school students

EIB (Exercise-Induced Bronchoconstriction) describes the narrowing that occurs in the airway follow a short period of exercise. EIB is found in 8-10% of normal children population as occult bronchospasm during or after physical activities. The mechanismsofEIB are related to rapid ventilation and mouth breathing which cause heat and water loss during breathing leading to bronchoconstriction. Peak Expiratory Flow Rate (PEFR) measured pre and post-exercise in students aged 12-16 years in girl intermediate school. Any female shows PEFR values reduction 15% after 6 minutes continuous free running considered as asthmatic patient, this give an incidence rate of asthmatic patient of 9% in female students in this age. Treatment of EIB, Zafirlukast treatment gives (85.7%) protection rate. While salbutamol inhalation gives a protection rate 88%. Only 66.6 % of girls with EIB give an improvement in PEFR values after sodium cromoglycate treatment. A regular measurement of PEFR in school students appears to be a good indicator of EIB, while inhalation of salbutamol 15 minutes before exercise give a good protection against EIB attacks at least for 4 hours.

Clinical study of respiratory complications in patients undergoing elective upper abdominal surgery

Background: Postoperative pulmonary complication is a major cause of morbidity, mortality, prolonged hospital stay and increased cost of care especially when it involves Upper Abdominal surgery. The predictable changes in lung function include a decrease in vital capacity and functional residual capacity, which are more striking in obese patients and in the supine. Aim is to study the incidence of respiratory complications in patients undergoing elective upper abdominal surgery with identification of risk factors namely Age, Sex, Obesity, Smoking and duration of upper abdominal Surgery for the development of Respiratory complications using a Peak Flow Meter as a bedside predictive test.Methods: Peak expiratory flow rate (PEFR) measurement daily up to 7 days post-surgery, were noted to monitor the occurrence of postoperative respiratory complications.Results: The study results according to our study showed that14 (34.1%) male patients out of 41 had postoperative complications as compared to 15 (48.3%) out of 31 female patients. 30.5% patients were obese and had postoperative complications of 9.75%. Overall 40% of smokers had postoperative complications. Postoperatively sub costal incision had complications (41%) in 36 patients, roof top incisions 4 out of 5 (80%) and para-umbilical incisions 3 out of 4 (75%). 80% of the patients who had upper abdominal transverse incisions developed microatelectasis followed by 75% of patients who had par median incisions.Conclusions: Respiratory complications following elective upper abdominal surgery are influenced by Increasing age and obesity and Smoking affected post-operative pulmonary recovery. Type of incision could also help change the incidence of complications.