DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20184296

Peak expiratory flow rate assessment to screen for asthma in children with allergic rhinitis

Krithika A. P., Arunkumar T., Sundari S.

Abstract


Background: Allergic rhinitis is a common disease affecting around 10-25% of the population worldwide. There is a temporal relationship between the onset of allergic rhinitis and asthma and the ‘unified airway hypothesis’ explains this. Many researchers have demonstrated bronchial hyper-responsiveness prior to onset of asthma symptoms further validating this hypothesis. Further many studies favour treating allergic rhinitis may prevent the onset of asthma. So, detecting allergic rhinitis earlier and treating it adequately is of vital importance. The aims and objectives of this study is to identify bronchial hyper responsiveness in children with allergic rhinitis, prior to the onset of asthmatic symptoms, by measuring PEFR and its clinical correlates.

Methods: A prospective observational study was conducted in Department of Paediatrics in Sree Balaji Medical College and Hospital. Inclusion and Exclusion Criteria were defined, and the study was conducted on a total of 85 children. After taking informed consent from parents, the children coming under the study population were analyzed for their baseline characteristics and PEFR is measured using a low reading Mini Wright peak flow meter and compared with mean value of south Indian children using the formula, PEFR= {(HEIGHT IN CM-100) X5} +100.

Results: The mean PEFR as expressed in percentage of expected PEFR is 77.28% in males and 83.34% in females. The mean percentage of expressed PEFR does not vary significantly between different age groups. Of the 85 children,48(56.5%) have mild intermittent allergic rhinitis,28(32.9%) have mild persistent allergic rhinitis,5(5.9%) have moderate-severe intermittent allergic rhinitis and 4(4.7%) have moderate-severe persistent allergic rhinitis. There were 37(43.5%) blockers (with predominant nose block) and 48(56.5%) runners (with predominant rhinorrhea).

Conclusions: PEFR is abnormal in 41.2% of children with allergic rhinitis. PEFR reduces linearly as the severity of allergic rhinitis increases. PEFR decreases as the number of cardinal symptoms increases. PEFR increases significantly after treatment of allergic rhinitis alone.


Keywords


Allergic rhinitis, Asthma screening, Peak expiratory flow rate

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References


Khaltaev N, Bousquet J. Allergic rhinitis and its impact on asthma update (ARIA 2008). The perspective from Spain. J Investig Allergol Clin Immunol. 2008;18(5):327-34.

Wright AL, Holberg CJ, Halonen M, Martinez FD, Morgan W, Taussig LM. Epidemiology of physician-diagnosed allergic rhinitis in childhood. Pediatrics. 1994;94(6):895-901.

Linna O, Kokkonen J, Lukin M. A10 year prognosis for childhood allergic rhinitis. Acta Paediatr. 1992;81:100-2.

Vignola AM, Chanez P, Godard P, Bousquet J. Relationships between rhinitis and asthma. Allergy. 1998;53(9):833-9.

Laitinen LA, Laitinen A. Innervation of airway smooth muscle. The American review of respiratory disease. 1987;136(4):S38.

Reddel HK, Taylor DR, Bateman ED, Boulet LP, Boushey HA, Busse WW. An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. Am J Resp Critical care Med. 2009;180(1):59-99.

Grootendorst DC, Rabe KF. Mechanisms of bronchial hyperreactivity in asthma and chronic obstructive pulmonary disease. Proceedings of the American Thoracic Society. 2004;1(2):77-87.

Cirillo I, Pistorio A, Tosca M, Ciprandi G. Impact of allergic rhinitis on asthma: effects on bronchial hyperreactivity. Allergy. 2009;64(3):439-44.

Choi SH, Yoo Y, Yu J,Rhee CS, Min YG, Koh YY. Bronchial hyperresponsiveness in young children with allergic rhinitis and its risk factors. 2007;62(9):1051-6.

Modrzyński M, Zawisza E. Seasonal asymptomatic lower airway hyperresponsiveness in patients with allergic rhinitis. Med Sci Monitor. 2006;12(9):CR372-7.

Ciprandi G, Cirillo I, Tosca MA, Vizzaccaro A. Bronchial Hyperactivity and spirometric impairment in patients with seasonal allergic rhinitis. Respir Med. 2004;98(9):826-31.

González SD, Arias AC. Allergic rhinitis and ashtma: 2 illnesses. The same disease? Revista alergia Mexico (Tecamachalco, Puebla, Mexico: 1993). 2002;49(1):20-4.

Moller C, Dreborg S, Ferdousi HA, Halken S, Host A, Jacobsen L, et al. Pollen immunotherapy reduces the development of asthma in children with seasonal rhinoconjuctivitis (the PAT study). J Allergy Clin Immunol. 2002;109:251-6.

Arshad SH, Bateman B, Matthews SM. Primary prevention of asthma and atopy during childhood by allergen avoidance in infancy: a randomized control study. Thorax. 2003;58(6):489-93.

Higgins BG, Britton JR, Chinn S, Lai KK, Burney PG, Tattersfield AE. Factors affecting peak expiratory flow variability and bronchial reactivity in a random population sample. Thorax. 1993;48(9):899-905.

Higgins BG, Britton JR, Chinn S, Cooper S, Burney PG, Tattersfield AE. Comparison of bronchial reactivity and peak expiratory flow variability measurements for epidemiologic studies. Am Rev Respir Dis. 1992;I45;588-93.

Bjorksten B, Clayton T, Ellwood P, Stewart A, Strachan D. ISAAC Phase 3 Study Group. Worldwide time trends for symptoms of rhinitis and conjunctivitis: phase 3 of the International Study of Asthma and Allergies in Childhood. Pediatr Allergy Immunol. 2008;19(2):110-24.

Linneberg A, Nielsen NH, Frølund L, Madsen F, Dirksen A, Jørgensen T. The link between allergic rhinitis and allergic asthma: a prospective population‐based study. The Copenhagen Allergy Study. Allergy. 2002;57(11):1048-52.

Leynaert B, Neukirch C, Kony S, Guénégou A, Bousquet J, Aubier M. European Community Respiratory Health Survey. Association between asthma and rhinitis according to a topic sensitization in a population-based study. J Allergy Clin Immunol. 2004;113(1):86-93.

Downie SR, Andersson M, Rimmer J, Leuppi JD, Xuan W, Akerlund A, Peat JK. Association between nasal and bronchial symptoms in subjects with persistent allergic rhinitis. Allergy. 2004;59(3):320-6.

Leuenberger P, Künzli N, Ackermann-Liebrich U, Schindler C, Bolognini G, Bongard JP, et al. Swiss study on air pollution and lung diseases in adults (SAPALDIA). Schweizerische medizinische Wochenschrift. 1998;128(5):150-61.

O'connell EJ. The burden of atopy and asthma in children. Allergy. 2004; 59:7-11.

Shaaban R, Zureik M, Soussan D, Antó JM, Heinrich J, Janson C, et al. Allergic rhinitis and onset of bronchial hyperresponsiveness: a population-based study. Am J Resp Critical Care Med. 2007;176(7):659-66.

Modrzyński M, Zawisza E, Mazurek H. The influence of medical treatment of the perennial allergic rhinitis on the adenoid size in children. Otolaryngologia polska= The Polish otolaryngology. 2006;60(4):543-50.

Cibella F, Cuttitta G, La Grutta S, Hopps MR, Passalacqua G, Pajno GB, et al. Bronchial hyperresponsiveness in children with atopic rhinitis: a 7‐year follow‐up. Allergy. 2004;59(10):1074-9.

Mete N, Sin A, Gulbahar O, Erdinc M, Sebik F, Kokuludag A. The determinants of bronchial hyperresponsiveness in patients with allergic rhinitis. Annals of Allergy, Asthma Immunol. 2004;93(2):193-9.

Prieto L, Gutierrez V, Linana J, Marin J. Bronchoconstriction induced by inhaled adenosine 5′-monophosphate in subjects with allergic rhinitis. Eu Resp J. 2001;17(1):64-70.

Braman SS, Barrows AA, DeCotiis BA, Settipane GA, Corrao WM. Airway hyperresponsiveness in allergic rhinitis: a risk factor for asthma. Chest. 1987;91(5):671-4.

Pawankar R. Analysis of the New ARIA classification; an example of Asian countries. EAACI Paris. 2003.

Leynaert B, Bousquet J, Neukirch C, Liard R, Neukirch F. European community respiratory Health Survey. Perennial rhinitis: an independent risk factor for asthma in nonatopic subjects: results from the European Community Respiratory Health Survey. J Allergy Clin Immunol. 1999;104(2):301-4.

Riccioni G, Vecchia DR, Castronuovo M, Di Pietro V, Spoltore R, Benedictis DM, et al. Bronchial hyperresponsiveness in adults with seasonal and perennial rhinitis: is there a link for asthma and rhinitis? Int J Immunopathol Pharmacol. 2002;15(1):69-73.

Wang DY, Niti M, Smith JD, Yeoh KH, Ng TP. Rhinitis: do diagnostic criteria affect the prevalence and treatment? Allergy. 2002;57(2):150-4.