Peak Expiratory Flow Parameters Research Articles

Design and Development of Flow Analyzer for Peak Inspiratory Flow (PIF) and Peak Expiratory Flow (PEF) Parameters.

The PIF and PEF parameters on the ventilator need to be taken into account to monitor the condition of patients undergoing mechanical ventilation. Both of these parameters need to undergo periodic testing to ensure that the ventilator can provide accurate information to its users. The testing of these two parameters can be conducted using a flow analyzer. The objective of this research is to develop a flow analyzer for PIF and PEF parameters using the AFM3000 flow sensor, with the results displayed on an LCD TFT screen in the form of graphs and numerical values. The research measurements were conducted in Volume Control (VC) mode with VT settings of 200, 300, 400, 500, and 600 mL. Data collection was done using two methods to obtain two different types of data. From the first data collection, the largest errors in reading PIF and PEF values were found to be 3.49% and 2.99%, respectively. The second data collection resulted in a sensor's change in reading constant flow of ±0.1 LPM. Overall, the research findings indicate that the AFM3000 sensor has good accuracy and stability. Additionally, the AFM3000 flow sensor has good sensitivity and very short delay, making it suitable for real-time graph display in the module.

Predictive Regression Equations of Flowmetric and Spirometric Peak Expiratory Flow in Healthy Moroccan Children.

Peak Expiratory Flow (PEF) has never been characterised among healthy Moroccan school children. To study the relationship between PEF and anthropometric parameters (sex, age, height and weight) in healthy Moroccan school children, to establish predictive equations of PEF; and to compare flowmetric and spirometric PEF with Forced Expiratory Volume in 1 second (FEV1). This cross-sectional study was conducted between April, 2016 and May, 2016. It involved 222 (122 boys and 100 girls) healthy school children living in Ksar el-Kebir, Morocco. We used mobile equipments for realisation of spirometry and peak expiratory flow measurements. SPSS (Version 22.0) was used to calculate Student's t-test, Pearson's correlation coefficient and linear regression. Significant linear correlation was seen between PEF, age and height in boys and girls. The equation for prediction of flowmetric PEF in boys was calculated as 'F-PEF = -187+ 24.4 Age + 1.61 Height' (p-value<0.001, r=0.86), and for girls as 'F-PEF = -151 + 17Age + 1.59Height' (p-value<0.001, r=0.86). The equation for prediction of spirometric PEF in boys was calculated as 'S-PEF = -199+ 9.8Age + 2.67Height' (p-value<0.05, r=0.77), and for girls as 'S-PEF = -181 + 8.5Age + 2.5Height' (p-value<0.001, r=0.83). The boys had higher values than the girls. The performance of the Mini Wright Peak Flow Meter was lower than that of a spirometer. Our study established PEF predictive equations in Moroccan children. Our results appeared to be reliable, as evident by the high correlation coefficient in this sample. PEF can be an alternative of FEV1 in centers without spirometry.

Respiratory health concerns in children at some strategic locations from high PM levels during crop residue burning episodes

Particulate Matter (PM) levels in the ambient air of three urban sites of strategic importance in Punjab (second largest agricultural state of India) were monitored from September 2013 to June 2014 covering two seasons of crop residue burning episodes of rice and wheat, respectively. During both crop periods, the levels varied from 71 to 167 μgm−3(PM10) and 43–107 μgm−3 (PM2.5), which were observed to be much beyond the permissible limits of 100 μgm−3 for PM10 and 60 μgm−3 for PM2.5 set by state pollution control agencies. Simultaneously, Pulmonary Function Test (PFT) parameters of children (age group 10–16 years) residing at these sites were monitored. PFT parameters like Forced Vital Capacity (FVC) and Peak Expiratory Flow (PEF) were monitored on 50 healthy subjects at each site. The results indicated an alarming fall in FVC (5%–7%) and in PEF (4%–6%) parameters during the crop residue burning period’s .The decrement was almost same for all age groups of children. The adverse effect was more on female subjects than male subjects. The impact of particulate matter pollution was more prominent in industrially important site (7%, SIS) as compared to historically (3%, HIS) and commercially (4%, CAS) important sites.

Pulmonary Functions in Children With Thalassemia Major.

Thalassemia major (TM) is a chronic disease requiring regular transfusions that may result in generalized iron loading, such as in the heart, the liver, endocrine organs, and the lungs. We aimed to determine pulmonary function abnormalities in children with TM in our center. In this study, pulmonary function tests (PFTs) of 49 patients with TM who received regular blood transfusion and had no history of chronic respiratory disease were evaluated. The relationship between PFTs and the age, the body surface area, pretransfusional hemoglobin, and serum ferritin was evaluated. Among the β-TM patients included in this study, 61% were male and 39% were female, with a mean age of 10.8±3 years (range, 5 to 17 y). The patients' mean level of ferritin was 3873±2011 ng/dL (range, 676 to 9476 ng/dL). A reduced forced vital capacity (FVC) was found in 33 patients (67%). A reduced forced expiratory volume in 1 second (FEV1) was found in 15 patients (30%). A forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) ratio of >80% was found in all patients. The peak expiratory flow (PEF) was decreased in 23 patients (46.9%). The forced mid-expiratory flow between 25% and 75% of the exhaled vital capacity (MEF25%-75%) was decreased in 5 patients (10%). FVC and FEV1 values in patients with a high ferritin level (>2500 ng/dL) were decreased compared with patients with a low ferritin level (<2500 ng/dL) (P=0.04, 0.03). FVC, FEV1, and PEF parameters were negatively correlated with the age and the body surface area. Age was a predictor of FVC (β=-0.450, P<0.001), FEV1 (β=-0.419, P<0.001), and PEF (β=-0.505, P<0.001), and hemoglobin was a predictor of FEV1/FVC (β=0.366, P=0.01) and MEF25%-75% (β=0.323, P=0.003). Our results concluded that the respiratory system should be evaluated by PFTs even in asymptomatic patients with high serum ferritin levels during the adolescent period annually to prevent the squeal of pulmonary disease in TM. Patients who have abnormal PFTs should be reevaluated for compliance with chelation therapy and the transfusion program.

The association of forced expiratory volume in one second and forced expiratory flow at 50% of the vital capacity, peak expiratory flow parameters, and blood eosinophil counts in exercise-induced bronchospasm in children with mild asthma.

BackgroundExercise-induced bronchoconstriction (EIB), which describes acute airway narrowing that occurs as a result of exercise, is associated with eosinophilic airway inflammation, bronchial hyperresponsiveness. The forced expiratory volume in one second (FEV1) is the most commonly used spirometric test in the diagnosis of EIB in exercise challenge in asthma. Other parameters such as forced expiratory flow at 50% of the vital capacity (FEF50%) and peak expiratory flow (PEF) are used less often in the diagnosis of EIB.ObjectiveThe purpose of this study is to evaluate the association of FEV1 and FEF50%, PEF parameters, blood eosinophil counts in EIB in children with mild asthma.MethodsSixty-seven children (male: 39, female: 28) with mild asthma were included in this study. Pulmonary functions were assessed before and at 1, 5, 10, 15, and 20 minutes after exercise. The values of spirometric FEV1, FEF50%, PEF, and blood eosinophil counts were evaluated in EIB in children with mild asthma.ResultsThere was a positive correlation between FEV1 with FEF50% and PEF values (p<0.05; FEF50%, r=0.68; PEF, r=0.65). Also, a positive correlation was found between blood eosinophil counts and the values of spirometric FEV1, FEF50%, and PEF (p<0.05; FEV1, r=0.54; FEF50%, r=0.42; PEF, r=0.26). In addition to these correlations, in the exercise negative group for FEV1, the FEF50% and PEF values decreased more than the cutoff values in 3, and 2 patients, respectively.ConclusionAccording to the presented study, eosinophil may play a major role in the severity of EIB in mild asthma. FEF50% and PEF values can decrease in response to exercise without changes in FEV1 in mild asthmatic patients.

A simple, reliable quantitative score for grading chest X-ray in adult asthma

The purpose of the present study was to rate the level of spread of the morphological changes on chest X-ray (CXR), using the modified Shwachman–Kulczycki (S–K) rating scale, in relation to changes in routinely measurable parameters in outpatient clinic, such as frequency of respiration (FR), heart rate (HR), wheeze (WHZ) and peak expiratory flow (PEF). Asthma patients were classified into 4 groups; Group-1⩽2 visits per week with reversible symptoms, Group-2 two visits per week with irreversible symptoms, Group-3: 3–4 visits per week with irreversible symptoms; Group-4: patients with severe shortness of breath in whom SaO2 was threatening, hence were admitted as inpatients. CXR for group-2 showed bilateral increase in perihelia marking, bronchovascular markings but normal lungs fields and ruled out for costophrenic angles. Group-3 showed hyperinflation, obvious perihelia marking associated with bronchial thickening and blocking as well as unfolding aorta, with significantly (p<0.05) lower PEF, higher HR, FR and WHZ than group 1 and 2. There was also some evidence of bronchial edema with clearly observed fleeting terminal bronchial opacities. CXR for Group-4 showed, extensive atelectasis secondary to obstruction and infection due to bronchiolitis and/or signs of right heart failure. Intra-classcorrelation coefficient showed a significant (p<0.05) reliability among evaluators of CXR, implying its consistent applicability. Based on the results of the present study it can be concluded that monitoring PEF, FR, WHZ and HR parameters in outpatient clinic can be an objective estimate of the S–K score in order to classify the severity of asthma-induced-morphological changes in CXR.

Effects of two exercise interventions on pulmonary functions in the patients with ankylosing spondylitis

Objective The aim of this study was to evaluate the impact of two different home-based daily exercise programs on pulmonary functions in the patients with ankylosing spondylitis (AS). Methods Fifty-one patients with AS were distributed into three groups. Group 1 ( n = 19) was given a conventional exercise regimen. Group 2 ( n = 19) received exercises based on the Global Posture Reeducation (GPR) method. Group 3 ( n = 13) was accepted as the control group. Patients were assessed according to pain, functional capacity (The Bath Ankylosing Spondylitis Functional Index – BASFI), disease activity (The Bath Ankylosing Spondylitis Disease Activity Index – BASDAI), chest expansion, pulmonary function parameters, and 6-min walk distance (6MWD) test. Results Although there were significant improvements for BASDAI and BASFI scores in all groups, significant improvements in the VAS pain, chest expansion, pulmonary function parameters and 6MWD test were observed in the exercise groups. The improvements in pain, functional capacity, disease activity, chest expansion, pulmonary function parameters and 6MWD test were better in the exercise groups than in the control group. The GPR method resulted in greater improvements than the conventional exercise program in specific pulmonary function parameters like forced vital capacity, forced expiratory volume in 1 s, and peak expiratory flow parameters. Conclusion Both exercises are efficient in improving pulmonary functions. Since the improvements in pulmonary function tests were greater in the patients who performed the exercise according to GPR method, motivated patients should be encouraged to perform this exercise program.

Efficacy and safety of a new pressurised metered-dose inhaler formulation of budesonide/formoterol in children with asthma: A superiority and therapeutic equivalence study

Aim: This paediatric asthma study evaluated the efficacy and safety of a novel hydrofluoroalkane pressurised metered-dose inhaler (pMDI) formulation of budesonide/formoterol versus budesonide pMDI and budesonide/formoterol dry-powder inhaler (DPI). Methods: The study was a 12-week, multinational, double-blind trial involving children (aged 6–11 years) with symptomatic asthma on inhaled corticosteroids ( 375 – 1000 μ g / day ) , with a history of exercise-induced bronchoconstriction and peak expiratory flow (PEF) ⩾ 50 % of predicted. Patients were randomised (two inhalations twice daily) to budesonide pMDI 100 μ g , budesonide/formoterol DPI 80 / 4.5 μ g or budesonide/formoterol pMDI 80 / 4.5 μ g . The primary endpoint was change from baseline in morning PEF. Results: Overall, 622 patients were randomised. Increases in morning PEF with budesonide/formoterol pMDI and budesonide/formoterol DPI were therapeutically equivalent (29.5 versus 30.2 l/min, respectively; 95% confidence interval: - 6.0 to 4.6 ; P = 0.78 , also confirmed by per-protocol analysis). Improvements in secondary efficacy endpoints with both budesonide/formoterol formulations were not significantly different. Significantly greater improvement was achieved with budesonide/formoterol pMDI versus budesonide pMDI for morning PEF ( + 9.6 l/min; P < 0.001 ) and other lung function parameters. The safety profile of budesonide/formoterol pMDI was favourable and similar to that of budesonide/formoterol DPI and budesonide pMDI. Conclusion: Budesonide/formoterol, administered via the therapeutically equivalent hydrofluoroalkane pMDI or DPI, is an effective and well-tolerated treatment for children with asthma.

Peak Expiratory Flow(PEF) Measured by Peak Flow Meter and Correlation Between PEF and Other Ventilatory Parameters in Healthy Children

Background : In diagnosis or monitor of the airway obstruction in bronchial asthma, the measurement of in the standard method because of its reproducibility and accuracy. But the measurement of peak expiratory flow(PEF) by peak flow meter is much simpler and easier than that of especially in children. Yet there have been still no data of the predicted normal values of PEF measured by peak flow meter in Korean children. This study was conducted to provide equations to predict the normal value of PEF and correlation between PEF and in healthy children. Method : PEF was measured by MiniWright peak flow meter, and the forced expiratory volume and the maximum expiratory flow volume curves were measured by Microspiro HI 501(Chest Co.) in 346 healthy children(age:5-16 years, 194 boys and 152 girls) without any respiratory symptoms during 2 weeks before the study. The regression equations for various ventilatory parameters according to age and/or height, and the regression equations of by PEF were derived. Results : 1. The regression equation for PEF(L/min) was: age(year)+height(cm)-263() in boys, and age(year)+height(cm)-293() in girls. 2. The value of FEFmax(L/sec) derived from the maximum expiratory flow volume curves was multiplied by 60 to compare with PEF(L/min), and PEF was faster by 125 L/min in boys and 118 L/min in girls, respectively. 3. The regression equation for (ml) by PEF(L/min) was:PEF-550() in boys, and PEF-146 () in girls, respectively. Conclusion : This study provides regression equations predicting the normal values of PEF by age and/or height in children. And the equations for , a gold standard of ventilatory function, was predicted by PEF. So, in taking care of children with airway obstruction, PEF measured by the peak flow meter can provide useful information.

Hyperlactatemia during acute severe asthma.

To evaluate arterial lactate levels during treatment of acute severe asthma (ASA) and the prognostic value of arterial hyperlactatemia in ASA. Prospective study. A respiratory intensive care unit (ICU) of a university hospital. 29 consecutive patients admitted to the ICU for ASA not intubated on admission and with a peak expiratory flow (PEF) < 150 l/min or an arterial carbondioxide tension (PaCO2) > 40 mm Hg. All patients received standardized treatment during the first 24 h including i.v. and nebulized salbutamol, i.v. theophylline, and dexamethasone. Arterial lactate levels were serially measured by an enzymatic method during the first 24 h following admission. On admission, the mean arterial lactate level was 3.1 +/- 0.38 mmol/l (range 1.1-10.4); 17 patients (59%) had arterial hyperlactatemia with a lactate level > 2 mmol/l. No difference was found in lactate levels between patients with progressively worsening asthma and those with an acute onset of severe asthma. No correlation was found between arterial lactate levels on admission, on the one hand, and respiratory rate (RR), heart rate, PEF, pH, PaCO2, arterial oxygen tension, potassium, phosphorus, creatine kinase, or transaminase values on admission, on the other hand. All patients developed an important but transient increase in arterial lactate levels during treatment, with a peak at 7.72 +/- 0.46 mmol/l and a mean elevation of 4.62 +/- 0.45 mmol/l (range 0.4-12.1), from the initial admission value contrasting with a significant clinical improvement assessed by RR, PEF, and arterial blood gas parameters. This study suggests that, in ASA, arterial hyperlactatemia is frequently present on admission to the ICU. Delayed hyperlactatemia is a constant finding during treatment of ASA. Initial or delayed hyperlactatemia seems of no prognostic value because none of the patients required mechanical ventilation. The effects of therapy for acute asthma on lactate metabolism still need to be studied.

The Normal Predicted Value of Peak Expiratory Flow(PEF) Measured by the Peak Flow Meter and Correlation Between PEF and Other Ventilatory Parameters

연구배경: 기관지 천식 환자들과 만성폐쇄성폐질환의 진단이나 기도폐쇄 정도를 알기 위하여 통상적으로 노력성 호기곡선이나 최대호기류량곡선을 이용한 환기기능검사가 널리 이용되고 있다. 그러나 외래를 방문하는 환자들이나 자가 치료를 하는 환자들의 경과관찰에는 검사의 간편성으로 인해 peak flow meter를 이용한 peak expiratory flow(PEF)가 많이 이용된다. 이 경우 PEF의 변이성이 크기 때문에 절대값이나 증상이 없을 때의 최대값을 기준으로 비교하여 사용하기도 하는데 검사 판정의 객관성은 추정정상치가 가장 높을 것이다. 그러나 현재까지 국내에서는 최대호기류량곡선을 이용한 PEF(FEFmax)의 추정정상치의 보고는 다수 있으나 peak flow meter를 이용한 보고는 아직까지 없었다. 이에 실제 환자들이 스스로 쉽게 측정할 수 있는 PEF의 추정정상치를 산출하고 이 값이 $FEV_1$ 을 비롯한 다른 환기기능검사를 어느 정도 정확하게 예측할 수 있는 지를 조사 연구하였다. 방 법: 호흡기 증상이나 기왕 병력이 없는 건강한 남자 129명(나이 ; 19-74 세), 여자 125명(나이 ; 18-67세)을 대상으로 외래에서 mini-Wright peak flow meter(Clement Clarke International Ltd. England)를 이용하여 3 회 이상 PEF를 측정하였다. 아울러 Microspiro HI-501 portable spirometer(Chest Co., Japan)로 노력성호기곡선, 최대호기류량곡선을 측정 분석하여 $FEV_1$ , FVC, $FEV_1/FVC$ , $FEF_{25-75%}$ , $FEF_{25%}$ , $FEF_{50%}$ , $FEF_{75%}$ 와 FEFmax를 구하여 각각의 추정정상치를 구하였고 PEF의 $FEV_1$ 및 FEFmax에 대한 설명력을 회귀분석을 통해 구하였다. 결 과: PEF(L/min)의 추정정상치는 남자가 -2.45 $\times$ Age(year) + 1.36 $\times$ Height(cm) + 427였고 ( $R^2=0.28$ ), 여자에서는 -0.96 $\times$ Age(year) + 2.01 $\times$ Height(cm)+129였다( $R^2=0.12$ ). 최대호기류량곡선에서 산출한 FEFmax는 PEF보다 납자에서는 $125{\pm}74.0$ (L/min), 여자에서는 $118{\pm}52.2$ (L/min) 적었다. PEF로 예측할 수 있는 $FEV_1$ (ml)값은 남자에서 5.98 $\times$ PEF(L/min) + 303 이고 ( $R^2=0.43$ ), 여자에서는 4.61 $\times$ PEF(L/min) +291 이었다( $R^2=0.33$ ). 결 론: 건강한 성인 254명(남자 129명, 여자 125명)을 대상으로 peak flow meter로 측정한 PEF의 추정정상치를 연령과 신장을 변수로 하여 구하였다. 여기서 측정한 PEF로 $FEV_1$ 및 FEFmax를 어느 정도 예측할 수 있었다. 그리고 측정기계 및 방법에 따라서 PEF 값이 달라짐을 확인하였는데 이런 점을 유의한다면 PEF의 측정은 향후 환자 진료에 많은 도움이 될 것으로 생각한다. 【Background: For the diagnosis or evaluation of airway obstruction in bronchial asthma and chronic obstructive lung disorders, various parameters derived from the forced expiratory volume curve and maximal expiratory flow volume curve have been used. Recently the peak expiratory flow(PEF) measured by the peak flow meter is widely used because of its simplicity and convenience. But there were still no data of the predicted normal values measured by the peak flow meter in Korea. This study was to obtain the predicted normal value of PEF and to know the accuracy of this value to predict $FEV_1$ . Method: The measurements of PEF by the MiniWright peak flow meter and several parameters derived from the forced expiratory volume and maximal expiratory flow volume curves by the Microspiro HI 501(Chest Co.) were done in 129 men and 125 women without previous history of the respiratory diseases. The predicted normal values of parameters according to the age and the height were obtained, and the regression equation of $FEV_1$ by PEF was calculated. Results: The predicted normal values of PEF(L/min) were -2.45 $\times$ Age(year) +1.36 $\times$ Height(cm)+427 in men, and -0.96 $\times$ Age (year) + 2.01 $\times$ Height (cm) + 129 in women. FEFmax derived from the maximal expiratory flow volume curve was less than by 125 L/min in men and 118 L/min in women respectively compared to PEF. $FEV_1$ (ml) predicted by PEF was 5.98 $\times$ PEF(L/min) + 303 in men, and 4.61 $\times$ PEF(L/min) + 291 in women respectively. Conclusion : The predicted normal value of PEF measured by the peak flow meter was calculated and it could be used as a standard value of PEF while taking care of patients with airway obstruction. $FEV_1$ , the gold standard of ventilatory function, could be predicted by PEF to a certain extent.】

Standard flow-time waveforms for testing of PEF meters.

The American Thoracic Society (ATS) has recommended the use of 24 volume-time waveforms for the testing of spirometers. Although these waveforms include values of peak expiratory flow (PEF), they were not originally intended to test PEF meters, but, rather, volume parameters for spirometers. In addition, the practice of using ATS volume-time Waveform 24 with varying multiplying factors does not provide the range of flow-time waveform shapes (rise times) needed to evaluate PEF meters. Accordingly, we have developed a set of 26 flow-time waveforms specifically selected to evaluate PEF meters. PEF and other flow parameters (rise time and time to PEF) can be directly measured from these flow-time waveforms. When PEF determined directly from the flow-time curve was compared with PEF determined indirectly from a volume-time curve (ATS-recommended algorithm with an 80 ms time segment), as much as a 10.7% difference between the two methods was observed using a waveform with a fast rise time. In contrast, there was very little difference between the various methods of deriving PEF for waveforms with slower rise times. These 26 flow-time waveforms provide a means of defining PEF for the testing of software algorithms and the testing of PEF meters with computer-driven mechanical pumps.

Analysis of expiratory pattern for monitoring bronchial obstruction in school‐age children

This study was designed to assess the validity of the percent of volume expired at tidal peak flow (dV/Vt) as an indicator of bronchial obstruction in school-age children. We analyzed 126 dV/Vt ratios and compared them with spirometric and plethysmographic results measured in 24 healthy (14 males) and 60 asthmatic (41 males) children; 42 of them underwent measurements before and after bronchial challenge with histamine. The two groups differed in resistance, forced expiratory volume in 1 sec (FEV1), and forced expiratory flows, as percents of predicted (FEV1: 94.6 +/- 2.4% in controls vs 86.7 +/- 1.6% in asthmatics; P less than 0.001). They did not differ in peak expiratory flow (PEF), forced vital capacity, functional residual capacity, measured by body plethysmography, and in dV/Vt. The dV/Vt was found to correlate with FEV1 (r = 0.58, P less than 0.001), PEF (r = 0.57, P less than 0.001), and other lung function parameters. Forty-two of the asthmatic children performed a bronchoprovocation histamine test. The fall of dV/Vt after histamine was significantly correlated (r = 0.61, P less than 0.001) with the variation in FEV1 and other lung function parameters. We conclude that dV/Vt is a good indicator of bronchial obstruction, as useful in school-age children as in adults and infants, with no need for the subject's cooperation.

Diffuse Pleural Mesothelioma: Report of a Case in an Adolescent

The purpose of the present study was to rate the level of spread of the morphological changes on chest X-ray (CXR), using the modified Shwachman–Kulczycki (S–K) rating scale, in relation to changes in routinely measurable parameters in outpatient clinic, such as frequency of respiration (FR), heart rate (HR), wheeze (WHZ) and peak expiratory flow (PEF). Asthma patients were classified into 4 groups; Group-1 ⩽ 2 visits per week with reversible symptoms, Group-2 two visits per week with irreversible symptoms, Group-3: 3–4 visits per week with irreversible symptoms; Group-4: patients with severe shortness of breath in whom SaO2 was threatening, hence were admitted as inpatients. CXR for group-2 showed bilateral increase in perihelia marking, bronchovascular markings but normal lungs fields and ruled out for costophrenic angles. Group-3 showed hyperinflation, obvious perihelia marking associated with bronchial thickening and blocking as well as unfolding aorta, with significantly (p < 0.05) lower PEF, higher HR, FR and WHZ than group 1 and 2. There was also some evidence of bronchial edema with clearly observed fleeting terminal bronchial opacities. CXR for Group-4 showed, extensive atelectasis secondary to obstruction and infection due to bronchiolitis and/or signs of right heart failure. Intra-classcorrelation coefficient showed a significant (p < 0.05) reliability among evaluators of CXR, implying its consistent applicability. Based on the results of the present study it can be concluded that monitoring PEF, FR, WHZ and HR parameters in outpatient clinic can be an objective estimate of the S–K score in order to classify the severity of asthma-induced-morphological changes in CXR.