Modified Pulmonary Index Score Research Articles

High-Flow Nasal Cannula in Pediatric Critical Asthma.

High-flow nasal cannula (HFNC) has been used in the treatment of pediatric asthma, although high-quality data comparing HFNC to aerosol mask nebulizer are lacking. We hypothesized that HFNC would perform similarly to the aerosol mask for meaningful clinical outcomes in children with critical asthma. We retrospectively reviewed the medical records of children with critical asthma (age 2-17 y) with a modified pulmonary index score (MPIS) ≥ 8 admitted to our pediatric ICU as part of a quality improvement project. Patients were managed with our MPIS-based, respiratory therapist-driven protocol. Subjects were divided into 2 cohorts by initial respiratory support: HFNC or aerosol mask. Data included demographics, initial respiratory support, and MPIS over time. Primary outcome was hospital length of stay (LOS). Secondary outcome was difference in MPIS over time. We included 171 subjects, with 104 in the HFNC group and 67 in the aerosol mask group. Median (interquartile range [IQR]) age was lower in the HFNC group (5 [IQR 4-9] vs 7 [IQR 5-10] y, P = .006)], while other demographic characteristics were similar. Initial MPIS was similar between HFNC and aerosol mask groups (11 [IQR 9-12] vs 10 [IQR 9-12], P = .15). There were no significant differences for hospital LOS (2.9 [IQR 2.1-3.9] vs 3.0 [IQR 2.3-4.4] d, P = .47), pediatric ICU LOS (1.9 [IQR 1.4-2.8] vs 1.8 [IQR 1.5-3.0] d, P = .92), or time to MPIS < 6 (1.0 [IQR 0.6-1.6] vs 1.3 [IQR 0.8-1.9) d, P = .09) between the HFNC and aerosol mask groups, respectively. Median time on continuous albuterol was shorter in the HFNC group compared to the aerosol mask group (1.0 [IQR 0.7-1.8] vs 1.5 [IQR 0.9-2.3] d, P = .048). Of note, 16 (24%) subjects in the aerosol mask group were eventually treated with HFNC. Use of a helium-oxygen mixture and noninvasive ventilation was similar between groups. HFNC performed similarly to aerosol mask in pediatric patients with critical asthma.

Mesh nebulizer is as effective as jet nebulizer in clinical practice of acute asthma in children

Background/aim The aim of this study was to compare the effect of salbutamol delivered to children by jet nebulizer (JN) and mesh nebulizer (MN).Materials and methods Children admitted with acute asthma were treated with 3 doses of nebulized salbutamol, 1 given by MN. The patients’ vital signs, lung function measurements, modified pulmonary index score (MPIS), and whole body plethysmography (WBP) measurements were evaluated before and 20 min after each dose of salbutamol.ResultsThirty-onechildren [9.5 (6.4–17.2) years, 67.7% male, 32.3% female] with mild (67.7%) and moderate (32.3%) asthma attacks were included in the study. The improvements with MN were comparable with JN in terms of changes in pretreatment and posttreatment forced expiratory volume in the first second (FEV1) (2.57 ± 4.57, 3.65 ± 5.44; P = 0.44), forced vital capacity (FVC) (2.52 ± 5.29, 4.17 ± 7.54; P = 0.28), heart rate (7.33 ± 10.21, 4.14 ± 9.32; P = 0.24), peripheral capillary oxygen saturation (SpO2) (0.38 ± 0.23, 0.43 ± 0.15; P = 0.83), and modified pulmonary index score (MPIS) (−6.30 ± 22.70, −8.77 ± 25.46; P = 0.70). The pre- and posttreatment values of total lung capacity (TLC), residual volume (RV), specific conductance (sGaw), and RV/TLC were similar for the JN and MN groups. Adverse effects were not different: however, complaints of palpitation were significantly higher in the posttreatment MN group than the pretreatment MN group (32.3% vs 9.7%, respectively, P = 0.016).ConclusionsThese findings support the previous evidence found in studies of adults that MN is as effective as and as safe as JN in the treatment of acute asthma in children.

A Respiratory Therapist-Driven Asthma Pathway Reduced Hospital Length of Stay in the Pediatric Intensive Care Unit.

Asthma is a common reason for admissions to the pediatric intensive care unit (PICU). Since June 2014, our institution has used a pediatric asthma clinical pathway for all patients, including those in PICU. The pathway promotes respiratory therapist-driven bronchodilator weaning based on the Modified Pulmonary Index Score (MPIS). This pathway was associated with decreased hospital length of stay (LOS) for all pediatric asthma patients; however, the effect on PICU patients was unclear. We hypothesized that the implementation of a pediatric asthma pathway would reduce hospital LOS for asthmatic patients admitted to the PICU. We retrospectively reviewed the medical records of all pediatric asthma subjects 2-17 y old admitted to our PICU before and after pathway initiation. Primary outcome was hospital LOS. Secondary outcomes were PICU LOS and time on continuous albuterol. Data were analyzed using the chi-square test for categorical data, the t test for normally distributed data, and the Mann-Whitney test for nonparametric data. A total of 203 eligible subjects (49 in the pre-pathway group, 154 in the post group) were enrolled. There were no differences between groups for age, weight, gender, home medications, cause of exacerbation, medical history, or route of admission. There were significant decreases in median (interquartile range) hospital LOS (4.4 [2.9-6.6] d vs 2.7 [1.6-4.0] d, P < .001), median PICU LOS (2.1 [1.3-4.0] d vs 1.6 [0.8-2.4] d, P = .003), and median time on continuous albuterol (39 [25-85] h vs 27 [13-42] h, P = .001). Significantly more subjects in the post-pathway group were placed on high-flow nasal cannula (32% vs 6%, P = .001) or noninvasive ventilation (10% vs 4%, P = .02). The implementation of an asthma pathway was associated with decreased hospital LOS, PICU LOS, and time on continuous albuterol. There was also an increase in the use of high-flow nasal cannula and noninvasive ventilation after the implementation of this clinical pathway.

Low-dose l-isoproterenol versus salbutamol in hospitalized pediatric patients with severe acute exacerbation of asthma: A double-blind, randomized controlled trial

BackgroundAlthough the guidelines in most countries do not recommend continuous inhalation of l-isoproterenol to treat pediatric patients with acute severe exacerbation of asthma, lower dose of l-isoproterenol has been widely used in Japan. To determine whether the efficacy of low-dose l-isoproterenol was superior to that of salbutamol, we conducted a double-blind, randomized controlled trial. MethodsHospitalized patients aged 1–17 years were eligible if they had severe asthma exacerbation defined by the modified pulmonary index score (MPIS). Patients were randomly assigned (1:1) to receive inhalation of l-isoproterenol (10 μg/kg/h) or salbutamol (500 μg/kg/h) for 12 hours via a large-volume nebulizer with oxygen. The primary outcome was the change in MPIS from baseline to 3 hours after starting inhalation. Trial registration number UMIN000001991. ResultsFrom December 2009 to October 2013, 83 patients (42 in the l-isoproterenol group and 41 in the salbutamol group) were enrolled into the study. Of these, one patient in the l-isoproterenol group did not receive the study drug and was excluded from the analysis. Compared with salbutamol, l-isoproterenol reduced MPIS more rapidly. Mean (SD) changes in MPIS at 3 hours were −2.9 (2.5) in the l-isoproterenol group and −0.9 (2.3) in the salbutamol group (difference −2.0, 95% confidence interval −3.1 to −0.9; P < 0.001). Adverse events occurred in 1 (2%) and 11 (27%) patients in the l-isoproterenol and salbutamol groups, respectively (P = 0.003). Hypokalemia and tachycardia occurred only in the salbutamol group. ConclusionsLow-dose l-isoproterenol has a more rapid effect with fewer adverse events than salbutamol.

Differentiating non-responders from responders in children with moderate and severe asthma exacerbations

Objective: Our goal was to assess factors associated with non-response to treatment in children presenting to the Emergency Department (ED) with moderate and severe asthma exacerbations. Methods: A retrospective chart review was completed from 9/2014 to 2/2017 for patients with a discharge diagnosis of asthma exacerbation. The Modified Pulmonary Index Score (MPIS) was used to quantify illness acuity. The rate of change of MPIS per hour was calculated, and differentiated responders from non-responders. After examining a histogram of ΔMPIS/h, a threshold of ΔMPIS/h > 0 was used to define response for duration of ED stay. Children included were >2 years and had initial MPIS > 10. Results: Eight hundred and fifty-two children were included. There were 178 (21%) non-responders and 674 (79%) responders. Non-responders were significantly older (7.0 ± 4.0 versus 5.6 ± 3.2 years; p < 0.001), but there were no differences in gender, race, ethnicity or insurance status. There was also no statistical difference in time to first albuterol treatment (50 ± 41 versus 43 ± 40 min; p = 0.05), or in time to corticosteroid (95 ± 75 versus 79 ± 64 min; p = 0.06). Non-responders were significantly more likely to arrive by ambulance (OR 2.2; 95% CI 1.6–3.2), to be admitted to the hospital (OR 2.7; 95% CI 1.8–4.0), and to be admitted to the ICU (OR 5.0; 95% CI 3.1–8.1). Conclusions: One in five children with exacerbations did not respond to treatment. These children were older and more likely to be admitted. Non-measured factors, possibly genetic, may contribute to response to treatment.

Ischemia-modified albumin levels in children with asthma: a pilot study.

Hypoxia may occur in the severe exacerbations of asthma. Ischemia-modified albumin (IMA) may increase in ischemia, in addition to oxidative stress and inflammation. The aim was to evaluate IMA levels in children during the asthma exacerbation and the asymptomatic period. Children with asthma who were followed up in our clinic were included and healthy children were selected as the control group. The severity of exacerbation was evaluated with Global Initiative for Asthma and Modified Pulmonary Index Score. Serum IMA levels were measured at the time of exacerbation and 4 weeks after treatment during asymptomatic period. Skin prick test and C reactive protein (CRP) levels were measured. A total of 26 patients and 26 controls were included. Mean IMA level was 0.45±0.12 absorbance units -ABSU- during asthma exacerbation and 0.32±0.08 ABSU in the control group (p=0.001). Mean IMA levels (0.41±0.14 ABSU) during the stable period were higher than the control group (p=0.005). There was no difference in terms of IMA levels when patients were grouped according to anti-inflammatory treatment, upper respiratory tract infection before exacerbation, CRP levels or sensitivity of skin prick tests. However, IMA levels were higher in patients with severe asthma exacerbation (p=0.009) in comparison with mild/moderate exacerbation. Positive correlation was observed between IMA levels and severity of exacerbation (r: 0.498, p=0.010). Asthmatic children had higher IMA levels than the control group, both in stable and exacerbated asthma. There was a positive relationship between IMA levels and severity of asthma exacerbation.

Clinical Utility of the Modified Pulmonary Index Score as an Objective Assessment Tool for Acute Asthma Exacerbation in Children.

Introduction: The Modified Pulmonary Index Score (MPIS) was developed as an objective assessment tool for acute asthma exacerbation in children. Although it is considered reliable, there are no known studies of its clinical utility. The objective of this study was to evaluate the validity of the MPIS for children with acute asthma in a clinical setting. Methods: In this retrospective study conducted between July 2009 and June 2011 using electronic medical records at the emergency department of a single pediatric medical center in Tokyo, Japan, the MPIS was recorded for patients with acute asthma at initial assessment and after treatment with an inhaled beta-agonist. We evaluated the responsiveness and predictive validity of the MPIS using disposition as an outcome. Results: A total of 2242 patients were assessed using the MPIS (median age, 3 years; 71.2% patients were 5 years or younger). The mean (SD) MPIS at initial assessment was 7.1 (3.6) and was significantly higher for the admission group than for the non-admission group (9.9 [2.9] vs. 5.9 [3.1]; P < 0.001). The receiver operator characteristic curve of the initial MPIS for hospital admission demonstrated moderate predictive ability (area under the curve, 0.83). An MPIS reduction of 3 or more indicated a clinically significant change when the MPIS at initial assessment was between 6 and 10 (risk ratio for admission [95% CI], 0.41 [0.28–0.60]; P < 0.001). Conclusion: The MPIS demonstrated good concurrent validity, predictive validity, and responsiveness in a wide range of clinical settings.

Relationships Between Adipokine Profiles, Physique Index, and Severity of Bronchiolitis in Infancy

ABSTRACTIntroduction: Relationships between adipokines, adiposity and severity of acute viral bronchiolitis in infancy have not been elucidated. Materials and Methods: We investigated the relationships between three serum adipokines (leptin, adiponectin and TNF-α), physique index (Kaup index) and clinical severity in 13 bronchiolitis infants. Seven healthy infants were enrolled as the control group. We used Modified Pulmonary Index Score (MPIS) to evaluate bronchiolitis severity. Results: No significant differences in adipokine levels were found between groups. In bronchiolitis infants, Kaup index negatively correlated with MPIS (r = −0.614, p = 0.03). A positive correlation was observed between the serum leptin/adiponectin ratio and MPIS (r = 0.618, p = 0.03), although correlations were not observed between respective serum adipokines levels and MPIS. Serum leptin and adiponectin had significantly negative correlations with age (r = 0.815, p = 0.001 and r = 0.566, p = 0.04, respectively), but not Kaup index. Conclusion: The severity of viral bronchiolitis in infancy may be related to the adipokine profile, but not adiposity.

The effect of nebulised magnesium sulphate in the management of childhood moderate asthma exacerbations as adjuvant treatment

BackgroundAfter the bronchodilator effect of magnesium was shown, the use of magnesium in treatment of asthma exacerbations became common. With the results of recent studies, the use of intravenous magnesium in severe asthma exacerbations took its place. We aimed to examine the effects of adding isotonic magnesium sulphate instead of isotonic saline into nebulised salbutamol on the Modified Pulmonary Index Score (MPIS) and the hospitalisation rate in moderate asthma exacerbations. MethodsOur study population included 100 children age between 3 and 15 years with asthma admitted to emergency department due to moderate asthma exacerbations. The patients were randomised to placebo or magnesium, with 50 patients in each arm. All patients received 1mg/kg of systemic methylprednisolone at the beginning of treatment and thereafter received either nebulised salbutamol (0.15mg/kg/dose) and 1ml magnesium sulphate (15%)+1.5ml isotonic saline on three occasions at roughly 20min intervals (Magnesium group) or nebulised salbutamol (0.15mg/kg/dose) and 2.5ml isotonic saline mixture on three occasions at roughly 20min intervals (Placebo group). The MPIS of patients on 0th min, 20th min, 40th and 120th min were calculated and compared. The primary outcome was to compare MPIS values at the end of 120th min. ResultsBoth groups have similar demographic, allergic characteristics and baseline MPIS scores. When the MPIS scores in the 120th min and admission rates in the 200th min, there was no significant difference between the two groups. ConclusionsThe use of nebulised magnesium sulphate in moderate asthma exacerbation as adjuvant treatment showed no benefit to standard treatment in our study.

Modified Pulmonary Index Score Was Sufficiently Reliable to Assess the Severity of Acute Asthma Exacerbations in Children

The Modified Pulmonary Index Score (MPIS) was developed as an indicator of the severity of acute asthma in children. The objective of this study is to evaluate the reliability and validity of the MPIS for children with acute asthma, including those five years or younger in age. We evaluated the inter-rater reliability and internal consistency of the MPIS by having at least two trained physicians and a nurse-each of whom was blinded to the others' scores-simultaneously examine inpatients with asthma exacerbation and rate them according to the MPIS. We also evaluated the intraclass correlation coefficient (ICC), kappa, Cronbach's α and correlations between the MPIS and other indicators associated with asthma severity. A total of 25 children (median age, five years; 13 patients were five years or younger in age) were enrolled in this study. The MPIS showed excellent inter-rater reliability (all ages: ICC = 0.95, 95% CI = 0.94-0.97; five years or younger: ICC = 0.93, 95% CI = 0.89-0.96) and good internal consistency (all ages: Cronbach's α = 0.87; five years or younger: Cronbach's α = 0.85). The MPIS showed good correlation with a visual analogue scale assessed by the physicians. The MPIS was a sufficiently reliable assessment tool for children with acute asthma, including those five years or younger in age.

Predicting Hospitalization in Children with Acute Asthma

BackgroundAcute asthma is one of the most common medical emergencies in children. Appropriate assessment/treatment and early identification of factors that predict hospitalization are critical for the effective utilization of emergency services. ObjectiveTo identify risk factors that predict hospitalization and to compare the concordance of the Modified Pulmonary Index Score (MPIS) with the Global Initiative for Asthma (GINA) guideline criteria in terms of attack severity. MethodsThe study population was composed of children aged 5–18 years who presented to the Emergency Departments (ED) of the tertiary reference centers of the country within a period of 3 months. Patients were evaluated at the initial presentation and the 1st and 4th hours. ResultsOf the 304 patients (median age: 8.0 years [interquartile range: 6.5–9.7]), 51.3% and 19.4% required oral corticosteroids (OCS) and hospitalization, respectively. Attack severity and MPIS were found as predicting factors for hospitalization, but none of the demographic characteristics collected predicted OCS use or hospitalization. Hospitalization status at the 1st hour with moderate/severe attack severity showed a sensitivity of 44.1%, specificity of 82.9%, positive predictive value of 38.2%, and negative predictive value of 86.0%; for MPIS ≥ 5, these values were 42.4%, 85.3%, 41.0%, and 86.0%, respectively. Concordance in prediction of hospitalization between the MPIS and the GINA guideline was found to be moderate at the 1st hour (κ = 0.577). ConclusionAttack severity is a predictive factor for hospitalization in children with acute asthma. Determining attack severity with MPIS and a cut-off value ≥ 5 at the 1st hour may help physicians in EDs. Having fewer variables and the ability to calculate a numeric value with MPIS makes it an easy and useful tool in clinical practice.

Bronchodilatory effect of inhaled budesonide/formoterol and budesonide/salbutamol in acute asthma: a double-blind, randomized controlled trial

BackgroundThere are no published studies that have compared bronchodilatory effect of inhaled budesonide/formoterol combination with budesonide/salbutamol delivered by metered dose inhaler with a spacer in acute exacerbation of asthma in children. We, therefore, compared the bronchodilatory effects of inhaled budesonide/formoterol (dose: 200 μg and 12 μg respectively) combination with budesonide (200 μg)/salbutamol (200 μg) administered by metered dose inhaler and spacer in children of 5-15 years with mild acute exacerbation of asthma [Modified Pulmonary Index Score (MPIS) between 6-8] in this double-blind, randomized controlled trial. The primary outcome was FEV1 (% predicted) in the two groups at 1, 5, 15, 30, 60 min after administration of the study drug.ResultsWe did not observe any significant differences in the % predicted FEV1 and MPIS between formoterol and salbutamol at various time points from 1 min to 60 min post drug administration. There was significant improvement in FEV1 (% predicted) from baseline in both the groups as early as 1 min after drug administration.ConclusionsSalbutamol or formoterol delivered along with inhaled corticosteroid by metered dose inhaler with spacer in children between 5-15 years of age with mild acute exacerbation of asthma had similar bronchodilatory effects.Trial RegistrationClinicalTrials.gov: NCT00900874

Effect of addition of single dose of oral montelukast to standard treatment in acute moderate to severe asthma in children between 5 and 15 years of age: a randomised, double-blind, placebo controlled trial

ObjectiveTo study the effect of the addition of a single dose of oral montelukast to standard therapy in acute moderate to severe asthma.DesignDouble-blind randomised controlled trial.SettingEmergency room/outpatient paediatric services of...

β2-Adrenergic Receptor Polymorphisms Affect Response to Treatment in Children With Severe Asthma Exacerbations

Carroll CL, Stoltz P, Schramm CM, Zucker AR. Chest. 2009;135(5):1186–1192PURPOSE OF THE STUDY. The purpose of this study was to explore the hypothesis that genotypic differences of the β2-adrenergic receptor (β2-AR) affect patient responses to short-term β2-AR agonist treatment for children who experience severe exacerbations of asthma.STUDY POPULATION. Children between 2 and 18 years of age with physician-diagnosed asthma admitted to the ICU at a Connecticut medical center during a 4-year period (N = 37).METHODS. A modified pulmonary index score (MPIS) was used to assess the severity of asthma exacerbation. β2-AR therapy was titrated on the basis of hourly MPISs. Children who did not respond to high-dose nebulized therapy were treated with intravenously administered terbutaline. Children also received intravenously administered methylprednisolone at 4 mg/kg per day. Genetic samples were obtained from saliva. Genotyping of the adjacent Arg16Gly and Gln27Glu was performed to determine the frequency of the 4 most common haplotypes. Clinical data were retrospectively extracted from the medical record.RESULTS. At baseline, children with the Gly/Gly genotype at amino acid position 16 of the β2-AR were more likely to have intermittent asthma exacerbations than were those with either the Arg/Arg or Arg/Gly genotype. Otherwise, there were no statistical differences in the demographic features, baseline characteristics, or medical histories between these 2 patient groups. No differences were found in admission MPISs among the study groups; however, children with the Gly/Gly genotype had significantly shorter ICU length of stay, duration of continuously nebulized albuterol therapy, and duration of supplemental oxygen therapy and were significantly less likely to require intravenous β2-AR agonist therapy, compared with those with the Arg/Arg or Arg/Gly genotype. Genetic polymorphisms at position 27 were not associated with response to β2-AR agonist therapy or with the other clinical outcomes measured.CONCLUSIONS. In this group of children with severe asthma exacerbations, those with the Gly/Gly genotype at position 16 of the β2-AR had more-rapid responses to β2-AR agonist therapy and shorter ICU lengths of stay.REVIEWERS COMMENTS. This article provides further evidence of the complexity of asthma genetics. The relationship between β2-AR genotypes and responses to β2-AR agonists is controversial, with different studies coming to opposing conclusions. Responses may depend largely on how the β2-AR agonist is dosed (short-term, single-dose treatment versus long-term, repeated dosing). This study was limited by the small study size. However, the study presents another step toward linking asthma genotypes with asthma phenotypes. This should allow the use of pharmacogenetics to treat specific patient populations in an evidence-based manner, an exciting future!

Protocol‐based titration of intravenous terbutaline decreases length of stay in pediatric status asthmaticus

Although frequently used to treat status asthmaticus in children, intravenous (IV) terbutaline has not been shown to decrease hospital length of stay (LOS). We theorized that this lack of demonstrable benefit resulted from variations in dosing and titration, rather than the drug per se, and that intensive care unit (ICU) LOS would be shortened by the administration of terbutaline according to a protocol incorporating a quantitative assessment of severity of illness. We prospectively treated 20 consecutive children with status asthmaticus with IV terbutaline according to a protocol that titrated the dose based on a clinical asthma score, the Modified Pulmonary Index Score (MPIS). Data were compared to a historic cohort of the previous 20 consecutive ICU patients with status asthmaticus who were treated with IV terbutaline prior to initiation of the protocol. Patients who received terbutaline by standardized protocol had significantly shorter ICU LOS (3.5 +/- 1.1 vs. 5.0 +/- 2.0 days, P = 0.01), shorter hospital LOS (5.5 +/- 1.3 vs. 8.3 +/- 2.7 days, P < 0.01), and reduced hospital charges ($19,298 +/- $10,516 vs. $26,528 +/- $12,328, P = 0.04). The method of administration of IV terbutaline significantly influenced ICU length of stay and hospital charges.

A Modified Pulmonary Index Score with predictive value for pediatric asthma exacerbations

Several clinical asthma scores have been derived from combinations of physical findings in pediatric asthmatic patients. To test the reproducibility and validity of one such score, the Modified Pulmonary Index Score (MPIS), and to evaluate its predictive value in children hospitalized for asthma. In the MPIS, 6 categories are evaluated: oxygen saturation, accessory muscle use, inspiratory to expiratory flow ratio, degree of wheezing, heart rate, and respiratory rate. For each of these 6 measurements or observations, a score of 0 to 3 is assigned. To evaluate the reproducibility of the MPIS, inpatients with status asthmaticus were examined by an attending physician, nurse, and respiratory therapist who were blinded to the other observers' scores. To evaluate the validity of the MPIS as a scale of severity of illness in asthmatic patients, the score at admission was compared with selected outcomes in the same patients. A total of 30 patients participated in this study (mean +/- SD age, 7.6 +/- 5.5 years). Our finding revealed that the MPIS is highly reproducible with a high degree of interrater reliability across caregiver groups (physician to nurse: r = 0.98; 95% confidence interval [CI], >0.96; physician to respiratory therapist: r = 0.95; 95% CI, >0.92; nurse to respiratory therapist: r = 0.94; 95% CI, >0.90). The admission MPIS positively correlated with intensive care unit admission (P < .001), days of continuous albuterol therapy (P = .002), days of supplemental oxygen (P = .002), and length of hospital stay (P = .004). The MPIS is a highly reproducible and valid indicator of severity of illness in children with asthma. To our knowledge, this is the first pediatric clinical asthma score demonstrated to be reproducible across groups of health care professionals who treat pediatric patients with asthma.

A Modified Pulmonary Index Score With Predictive Value for Pediatric Asthma Exacerbation

Background: Several clinical asthma scores have been derived from combinations of physical findings in pediatric asthmatic patients. Objective: To test the reproducibility and validity of one such score, the Modified Pulmonary Index Score (MPIS), and to evaluate its predictive value in children hospitalized for asthma. Methods: In the MPIS, 6 categories are evaluated: oxygen saturation, accessory muscle use, inspiratory to expiratory flow ratio, degree of wheezing, heart rate, and respiratory rate. For each of these 6 measurements or observations, a score of 0 to 3 is assigned. To evaluate the reproducibility of the MPIS, inpatients with status asthmaticus were examined by an attending physician, nurse, and respiratory therapist who were blinded to the other observers’ scores. To evaluate the validity of the MPIS as a scale of severity of illness in asthmatic patients, the score at admission was compared with selected outcomes in the same patients. Results: A total of 30 patients participated in this study (mean SD age, 7.6 5.5 years). Our finding revealed that the MPIS is highly reproducible with a high degree of interrater reliability across caregiver groups (physician to nurse: r 0.98; 95% confidence interval [CI], 0.96; physician to respiratory therapist: r 0.95; 95% CI, 0.92; nurse to respiratory therapist: r 0.94; 95% CI, 0.90). The admission MPIS positively correlated with intensive care unit admission (P .001), days of continuous albuterol therapy (P .002), days of supplemental oxygen (P .002), and length of hospital stay (P .004). Conclusions: The MPIS is a highly reproducible and valid indicator of severity of illness in children with asthma. To our knowledge, this is the first pediatric clinical asthma score demonstrated to be reproducible across groups of health care professionals who treat pediatric patients with asthma. Ann Allergy Asthma Immunol. 2005;94:355–359.