Reduction In Peak Expiratory Flow Rate Research Articles

ASSESSING THE IMPACT ON PEFR AMONG SMOKERS AND PASSIVE SMOKERS–A COMPARATIVE STUDY

Objective: The purpose of this study was to monitor the intensity and difference in Peak Expiratory Flow Rate (PEFR) between smokers and passive smokers.
 Methods: A total of 1000 participants were enrolled in two groups as smokers and passive smokers who are living closely with smokers. Their PEFR values were measured with Wright’s mini peak flow meter. The influence of smoking on the lung function among smokers and passive smokers were assessed with a suitable statistical test.
 Results: Among the study participants, most of the smokers were in the age group of 31 to 60 and 31 to 50 in passive smokers. Based on the lung function smokers (31%) and passive smokers (19.2%) were in the red zone, PEFR was decreased in both smokers as well as passive smokers, and the magnitude of decline was higher in passive smoking elderly individuals. The impact of passive smoking was significantly observed in all the categories of smoking history they are living with.
 Conclusion: Smokers and passive smokers have equally deleterious effects on PEFR. Where passive smoking emerged as the main variable to influence airway obstruction in smokers that caused a greater reduction in PEFR.

Ipsilateral hemidiaphragmatic paresis after a supraclavicular and costoclavicular brachial plexus block: A randomised observer blinded study.

The costoclavicular brachial plexus block (BPB) produces faster onset of sensory motor blockade than the lateral sagittal approach. However, the incidence of phrenic nerve palsy (PNP) after a costoclavicular BPB is not known. The current study compared the incidence of ipsilateral hemidiaphragmatic paresis, and thus PNP, between a supraclavicular and costoclavicular BPB. Randomised observer blinded study. Operating room. Forty patients undergoing right-sided upper extremity surgery. All patients received either a supraclavicular group or costoclavicular group BPB using 20 ml of an equal mixture of 0.5% bupivacaine and 2% lidocaine with 1 : 200 000 epinephrine. Measurements included ipsilateral hemidiaphragmatic excursion and peak expiratory flow rate (PEFR) taken before and at 30 min after the BPB. Diaphragmatic excursion was measured using M-mode ultrasound during normal breathing, deep breathing and with the sniff manoeuvre. Ipsilateral PNP was defined as a reduction in hemidiaphragmatic excursion by at least 50% during deep breathing at 30 min after the BPB. The incidence of ipsilateral PNP was lower (P = 0.008) in the costoclavicular group (5%) than in the supraclavicular group (45%). Fewer (P = 0.04) patients in the costoclavicular group [1(5%)] exhibited a positive sniff test, with paradoxical movement of the diaphragm, than in the supraclavicular group [7(35%)]. PEFRs were similar (P = 0.09) between the groups. When ipsilateral hemidiaphragmatic paresis was present, the median reduction in PEFR was 32% (interquartile range 23.6 to 45.5%). Costoclavicular BPB produces a lower incidence of ipsilateral PNP than a supraclavicular BPB. Clinical Trial Registry of India. CTRI/2017/09/009763.

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.

Effect of rice mill dust on peak expiratory flow rate among rice mill workers of Mysore district

Background: Inhalation of different pollutants exposed from the industries cause damage to the membrane structure and mechanical efficiency. This leads to an alteration in the functional properties of the lungs resulting in various respiratory diseases. Aims and Objectives: The present study was undertaken to assess the effect of exposure of rice husk dust on peak expiratory flow rate (PEFR) among rice mill workers in Mysore District. Materials and Methods: The comparative cross-sectional analytical study was conducted during December 2013–December 2014 in various rice mills in Mysore district. The study was conducted on 50 non-smoking rice mill workers aged 18–45 years were selected as a study group and 50 healthy, age, sex, and anthropometrically matched subjects of same socioeconomic status who were not exposed to rice mill industries were selected as control group. Computerized spirometer (RMS-Helios 401 and Transducer No.400-666) was used to measure PEFR. The data were analyzed using SPSS 20, and the level of significance was set at P < 0.05, applying unpaired t-test, ANOVA, and Pearson’s correlation coefficient. Results: The mean PEFR was significantly (P < 0.001) lower among rice mill workers (5.65 ± 1.84) than the controls (8.11 ± 1.41). The PEFR was found to significantly decrease with an increase in the length of exposure to rice mill dust (P = 0.03). Conclusion: Our study showed that duration of exposure has a direct relationship with the reduction in PEFR.

Effect of Reduction in Peak Expiratory Flow Rate on Blood Pressure of Sand Stone Mine Workers

Peak Expiratory Flow Rate (PEFR) measures the airflow through the bronchi and thus the degree of obstruction in the airways. Exposure to high concentration of respirable suspended particulate matter (RSPM) decreases the PEFR and the decrease depends upon the exposure concentration of particles and exposure duration. The decrease in PEFR is found to be responsible for increase in blood pressure (BP). Relationship between increase in BP and reduction in PEFR is not exactly linear but it can be considered as liner. It is noticed that if PEFR is reduced to about 50% to 60% in that case sudden increase in BP is recorded and behaviour of BP rise has complex pattern. It is also an established fact that if PEFR is reduced more than 50%, this is treated as severe respiratory problem. There are many factors (i.e. smoking habits, medical treatment, physiology, etc.) which may govern the increase of BP in this condition. Estimated relationship is found as: ISBP = 0.213 + 0.263 IPEF, IDBP = 0.102 + 0.176 IPEF.

Effects of Airborne Metals on Lung Function in Inner Mongolian Schoolchildren

To evaluate the effects of particles and their components on lung function. A panel study was conducted on 107 primary schoolchildren. The peak expiratory flow rate (PEFR) for each subject was measured three times a day for 40 days continuously. Particulate air concentrations were measured every day. The concentrations of Pb, Ni, Fe, Mn, Cr, As, Cd, and Zn in particles were measured. Linear mixed-effect models were used to estimate the associations between particles, metal elements, and PEFR. We found that the increase in particles in air was associated with a significant reduction in PEFR. Its effects lasted 2 to 5 days. Pb, Ni, Fe, Mn, and Cr in particles also reduced PEFR. As and Cd increased PEFR. Zn showed inconstant effects on PEFR. This study suggested that most metal components in particles have negative effects on children's lung function.

Safety of Sputum Induction With Hypertonic Saline Solution in Exercise-Induced Bronchoconstriction

The safety of sputum induction (SI) is well described in stable asthma, but the safety of SI in exercise-induced bronchoconstriction (EIB) has not been established. Our goals were to examine the relationship between the severity of EIB and bronchoconstriction during SI, and to determine if SI conducted after exercise challenge increases the risk of excess bronchoconstriction during SI. SI was conducted in 32 patients with mild-to-moderate asthma (baseline FEV(1), 86 +/- 9% of predicted [mean +/- SD]) with EIB (15 to 63% reduction in FEV(1) following exercise challenge) following pretreatment with albuterol using 3% saline solution and repeated on a separate day 30-min after exercise challenge. There was a reduction in peak expiratory flow rate (PEFR) during SI without exercise (mean maximum reduction vs baseline, 4.0% at 10 min; 95% confidence interval [CI], 1.0 to 7.1; p = 0.02) and during SI 30 min following exercise (mean maximum reduction vs baseline, 5.2% at 8 min; 95% CI, 1.0 to 7.5; p < or = 0.01); however, there was no difference between the PEFR reductions during SI without or following exercise challenge. The best predictor of reduction in PEFR during SI was the preprocedure FEV(1), while the severity of EIB was not associated with bronchoconstriction during SI. We conclude that SI can be performed safely following exercise challenge in asthmatics with EIB, and that the severity of EIB prior to SI is not a major determinant of bronchoconstriction during SI.

Effect of &lt;i&gt;Garcinia Conrauana&lt;/i&gt; Ingestion in Adult Nigerian Asthmatics

In the light of the widespread use of Garcinia Conrauana (popularly known as ‘bitter kola') in the treatment of various respiratory tract diseases, including asthma, in traditional African medicine practice, the effect of its ingestion on airway reactivity was assessed in 162 asthmatic adult males and females, using Peak Expiratory Flow Rate (PEFR) measurement as the index of change. There were fluctuations in PEFR with respect to age in the subjects. Garcinia Conrauana ingestion resulted in a mild increase in PEFR, and hence a fall in airway resistance, in the asthmatic males, but a mild reduction in PEFR in the asthmatic females at 60 minutes and 90 minutes after its ingestion. Garcinia Conrauana ingestion causes a mild improvement in airflow in asthma adult males, 1hr to 1.5 hrs after its ingestion, but it may not do that in asthmatic adult females. KEY WORDS: Garcinia Conrauana, PEFR, Asthmatic adults. Nig. Jnl Health & Biomed. Sciences Vol.3(1) 2004: 24-27

Long-acting bronchodilators in premenstrual exacerbation of asthma

Premenstrual exacerbation (PME) of asthma occurs during the 5–10 days leading up to the menses and can be demonstrated in about 40% of asthmatic females. Peak expiratory flow rate (PEFR) andβ2 -agonist consumption were recorded during three menstrual cycles in 67 females with mild–severe asthma. All were treated with inhaled glucocorticosteroids (IGC) and β2-agonists, as required. Following, the patients with a premenstrual reduction in PEFR>20%, received either salmeterol, 50 μg×2 day−1or placebo, in the 10 days leading up to the menses, in a randomized, double-blind, cross-over design. Thirteen patients (19·4%) showed PME (mean±SEM decrease in PEFR 27±2·2%) in association with a significant increase in the mean daily β2-agonist consumption. Following administration of salmeterol, there was a complete ablation of the PME in seven patients, a partial ablation in two patients and no effect in the remaining four patients. Only one patient showed a partial ablation of the PME following placebo. There was also a significant decrease in the β2-agonists consumption in the responders. About 20% of the women with asthma, under chronic IGC treatment, had PME of asthma. In 54% of them, it could be prevented by the use of long-acting bronchodilators (LABD) during the 10 days leading up to the menses, and partially prevented in another 15%.

Prospective evaluation by computed tomography and pulmonary function tests of children with mediastinal masses

Our ability to predict respiratory compromise during general anesthesia in a child with an anterior mediastinal mass is limited. Two prior reports have found a correlation between adequacy of ventilation during general anesthesia and the tracheal cross-sectional area obtained from computed tomograms (computed tomography [CT] scans). These and other reports have suggested that pulmonary function tests may provide additional information regarding anesthetic risks, but no studies have evaluated the extent of respiratory compromise in children with an anterior mediastinal mass. We prospectively evaluated 31 children with mediastinal masses before 34 surgical procedures. At each evaluation the tracheal area (as a percent of the predicted area on the basis of age and gender) was determined by CT. Pulmonary function tests were performed in the sitting and supine positions. The eleven children with either a tracheal area or peak expiratory flow rate (PEFR) of less than 50% of predicted received only a local anesthetic; the majority of children above these levels (17 of 22) received a general anesthetic. Eleven of 31 patients had significant pulmonary restriction as defined by total lung capacity of less than 75% of predicted. Eight patients had a PEFR in the supine position of less than 50% of predicted. PEFR was lower in the supine than the upright position in all patients (median value of decrease, 12%). In 28 of 34 evaluations the child had a tracheal area greater than 50% of predicted, a criterion proposed for safe utilization of general anesthesia. This latter guideline, however, did not identify all patients with significant impairment of pulmonary function; five patients had a PEFR of less than 50% of predicted but tracheal areas of greater than 50% of predicted. All children were administered anesthetics uneventfully with these guidelines. Although the tracheal area can be accurately measured with the CT scan, this does not identify all children with mediastinal masses and abnormal pulmonary function. A large mass may produce significant restrictive impairment and hence reduction in PEFR by the intrathoracic volume it occupies and yet not cause tracheal compression. It may also reduce the PEFR by narrowing the bronchi distal to the carina. Currently no CT standards exist for measuring bronchial areas in children. Our study did not evaluate whether impaired pulmonary function as measured by PEFR would be predictive of respiratory collapse during general anesthesia because all were excluded and operated on under local anesthesia. General anesthesia was well tolerated in children with tracheal area and PEFR greater than 50% of predicted. Pulmonary function tests in children with anterior mediastinal masses may add valuable information to the anatomic evaluation obtained by CT scan.

A Comparison of the Analgesic Effect of Transcutaneous Electrical Nerve Stimulation and Entonox

<h2>Summary</h2> Entonox and TENS have both been used for the management of patients with surgical wound pain during physiotherapy. A prospective randomised placebo controlled study was performed to compare the efficacy of these two treatments. Thirty-one post-abdominal surgical patients were involved in the study. Each of these patients received, in random order, three respiratory physiotherapy treatment sessions with analgesia: either Entonox via a face mask (Entonox group), para-incisional TENS (TENS group), or TENS applied to the leg (TTL group). Pain was quantified using a visual analogue scale and efficacy of physiotherapy was assessed by peak expiratory flow rate (PEFR). Both variables were measured before, immediately post, and 30 minutes after each treatment in the half-lying position, by the same physiotherapist. Our study showed that TENS and Entonox were both equally effective in pain relief and in improving peak expiratory flow rate in patients after upper abdominal surgery. This improvement was maintained for 30 minutes after treatment. Non-specific factors influenced the assessment of subjective pain relief immediately after physiotherapy treatment, but this effect lasted for less than 30 minutes. However, PEFR was not significantly influenced by psychological factors. Physiotherapy without analgesia (with placebo TENS) caused a reduction in PEFR and may be detrimental in patients with post-operative wound pain. TENS was free from any side-effects and has sufficient practical advantages to make it the preferred choice of supplementary analgesia during chest physiotherapy.

Peak expiratory flow rate and the acute chest syndrome in homozygous sickle cell disease.

The peak expiratory flow rate (PEFR) was studied in 20 matched pairs of children with homozygous sickle cell disease with either no episodes or six or more episodes of acute chest syndrome. The pairs were carefully matched for height and a highly significant reduction in PEFR was observed in children with multiple episodes of acute chest syndrome. Lateral and anteroposterior chest diameters and chest circumference correlated with PEFR but did not differ between index and control cases. The most likely cause of the reduced PEFR in children with multiple episodes of acute chest syndrome is an accumulating pulmonary fibrosis that decreases lung compliance.