scholarly journals Impact of inaccuracy of peak flowmeters with Wright scale on asthma severity assessment in children

2008 ◽  
Vol 61 (7-8) ◽  
pp. 354-358 ◽  
Author(s):  
Dragana Stamatovic ◽  
Nada Bokan-Erdeljan ◽  
Milan Gajic ◽  
Zorica Vujnovic-Zivkovic
Keyword(s):  
European Union ◽  
Asthma Management ◽  
Asthma Severity ◽  
Study Group ◽  
Severity Assessment ◽  
Objective Method ◽  
Predictive Equation ◽  
Asthmatic Children ◽  
Before And After ◽  
Daily Variability

Introduction Measurement of daily variability of peak expiratory flow (PEF) is widely accepted as an objective method to assess asthma severity. Recent investigations have proved nonlinearity of original Wright scale of peak flowmeter. All country members of European Union have been obliged to implement a new scale according to standard EN 13826 since 2005. This study examined whether the correction of PEF values for the inaccuracy of the scale would affect asthma management based on their daily variability. Material and methods We analyzed PEF values (2352) in 34 children, aged 5-16, during 3-5 weeks of monitoring in order to establish the diagnosis of asthma by using peak flowmeters with Write scale. The correction of measured values for inaccuracy was managed with original Dr M. Miller's predictive equation. The daily variability of PEF (amplitude percent mean) up to 20% was considered as 'normal', 20-29.9% as 'raised', and 30% and above as 'high'. The assessment of daily variability was performed before and after correction. Results There was no significant change in the number of days with airway liability as regarding the assessed whole study group (p=0.475). However, 22 (64.7%) of children had at least one false clinical message about daily variability during the monitoring. It was overestimated in 12 (7%) days in younger (6.6?0.8 years) or of shorter stature (122.6?3.6cm) and underestimated in 13 (4%) days in older (11.1?2.7) or taller ones (150.9?12.5 cm) (p<0.001). Conclusion Usage of peak flowmeters with Wright scale may lead to an error in asthma severity assessment based on daily variability of PEF. It may cause overtreatment or undertreatment of asthmatic children.

Controlled Trial of a Home and Ambulatory Program for Asthmatic Children

PEDIATRICS ◽  
1991 ◽  
Vol 87 (1) ◽  
pp. 54-61
Author(s):  
Daniel M. Hughes ◽  
Marjorie McLeod ◽  
Barry Garner ◽  
Richard B. Goldbloom
Keyword(s):  
Controlled Trial ◽  
Asthma Management ◽  
Asthma Severity ◽  
Asthmatic Children ◽  
Control Subjects ◽  
Medical Visits ◽  
Airway Function ◽  
Regular Care ◽  
One Year ◽  
The Impact

Care of asthmatic children is often episodic and more therapeutic than preventive. A 2-year randomized, controlled trial involving 95 children measured the impact of a comprehensive home and ambulatory program for pediatric asthma management using objective outcome measures. Interventions for the study group during the first year included 3-month clinic visits, education, and home visits by a specially trained research nurse. Control subjects continued to receive regular care from a family physician or pediatrician. Eighty-nine subjects (93%) completed the study. Study subjects had less school absenteeism than control subjects (10.7 vs. 16.0 days, P = .04) and showed significantly better small airway function after 1 year. Asthma severity improved in 13 study subjects and worsened in 5. The reverse was true for control subjects. Study subjects exhibited better metered aerosol technique than control subjects (P = .0005). Fewer days were spent in hospital by the study subjects admitted compared with control subjects (3.67 vs 11.2 days, P = .02). After 1 year, more study than control families (72.1% vs 33.1%, P = .006) reported that their asthmatic child took responsibility for the asthma management. The intervention failed to reduce exposure to secondhand smoke or to household pets. There were no significant differences in medical visits, theophylline levels, or records of asthma symptoms. One year after discontinuing the intervention, a marked "washout" effect was observed. Comprehensive ambulatory programs of childhood asthma management can improve objective measures of illness severity but must be sustained.

scholarly journals Management of Acute Asthmatic Attacks in a Local Emergency Department before and after the Introduction of Guidelines

2002 ◽  
Vol 9 (3) ◽  
pp. 131-138
Author(s):  
Sh Tsui ◽  
Ask Sham ◽  
M Chan-Yeung ◽  
Hk Tong
Keyword(s):  
Emergency Department ◽  
Discharge Planning ◽  
Acute Asthma ◽  
Objective Assessment ◽  
Asthma Management ◽  
Admission Rate ◽  
Asthma Severity ◽  
Age Group ◽  
Hospital Admission Rate ◽  
Before And After

Introduction Objective assessment and management of acute asthma is often sub-optimal in busy emergency departments. This study examined the effect of the introduction of guidelines on asthma management in the emergency department. Materials & Methods All patients (>2 years old) presented to the emergency department for acute asthmatic attacks over a period of 1 year were included. Guidelines for the management of acute asthma were introduced after the first quarter of the study year. Analysis was made to compare the assessment, treatment and discharge planning of patients presenting with acute asthma to the emergency department before and after the introduction of the guidelines. Results After the introduction of the guidelines, there was a significant increase in the measurement of peak expiratory flow rate (PEF) and oxygen saturation as part of patient assessment for asthma severity. Such an improvement did not result in a change in hospital admission rate. There was a significant increase in the proportion of patients discharged with a course of oral corticosteroids, a significant reduction in the use of oral bronchodilators in the younger age group and antibiotics in the older age group. Conclusions The introduction of guidelines for the management of acute asthma and education of the clinicians in the emergency department has resulted in improvement in the overall management and discharge planning for asthma patients.

scholarly journals A method for evaluation of patient-specific lean body mass from limited-coverage CT images and its application in PERCIST: comparison with predictive equation

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Jingjie Shang ◽  
Zhiqiang Tan ◽  
Yong Cheng ◽  
Yongjin Tang ◽  
Bin Guo ◽  
...  
Keyword(s):  
Lean Body Mass ◽  
Body Mass ◽  
Whole Body ◽  
Patient Specific ◽  
Predictive Equation ◽  
Reference Standard ◽  
Pet Ct ◽  
Before And After ◽  
Percist 1.0 ◽  
Limited Coverage

Abstract Background Standardized uptake value (SUV) normalized by lean body mass ([LBM] SUL) is recommended as metric by PERCIST 1.0. The James predictive equation (PE) is a frequently used formula for LBM estimation, but may cause substantial error for an individual. The purpose of this study was to introduce a novel and reliable method for estimating LBM by limited-coverage (LC) CT images from PET/CT examinations and test its validity, then to analyse whether SUV normalised by LC-based LBM could change the PERCIST 1.0 response classifications, based on LBM estimated by the James PE. Methods First, 199 patients who received whole-body PET/CT examinations were retrospectively retrieved. A patient-specific LBM equation was developed based on the relationship between LC fat volumes (FVLC) and whole-body fat mass (FMWB). This equation was cross-validated with an independent sample of 97 patients who also received whole-body PET/CT examinations. Its results were compared with the measurement of LBM from whole-body CT (reference standard) and the results of the James PE. Then, 241 patients with solid tumours who underwent PET/CT examinations before and after treatment were retrospectively retrieved. The treatment responses were evaluated according to the PE-based and LC-based PERCIST 1.0. Concordance between them was assessed using Cohen’s κ coefficient and Wilcoxon’s signed-ranks test. The impact of differing LBM algorithms on PERCIST 1.0 classification was evaluated. Results The FVLC were significantly correlated with the FMWB (r=0.977). Furthermore, the results of LBM measurement evaluated with LC images were much closer to the reference standard than those obtained by the James PE. The PE-based and LC-based PERCIST 1.0 classifications were discordant in 27 patients (11.2%; κ = 0.823, P=0.837). These discordant patients’ percentage changes of peak SUL (SULpeak) were all in the interval above or below 10% from the threshold (±30%), accounting for 43.5% (27/62) of total patients in this region. The degree of variability is related to changes in LBM before and after treatment. Conclusions LBM algorithm-dependent variability in PERCIST 1.0 classification is a notable issue. SUV normalised by LC-based LBM could change PERCIST 1.0 response classifications based on LBM estimated by the James PE, especially for patients with a percentage variation of SULpeak close to the threshold.

scholarly journals Introduction of standardised packaging and availability of illicit cigarettes: a difference-in-difference analysis of European Union survey data 2015–2018

Thorax ◽  
2020 ◽  
Vol 76 (1) ◽  
pp. 89-91 ◽  
Author(s):  
Anthony A Laverty ◽  
Christopher Millett ◽  
Nicholas S Hopkinson ◽  
Filippos T Filippidis
Keyword(s):  
European Union ◽  
Survey Data ◽  
Tobacco Industry ◽  
Difference In Difference ◽  
Tobacco Products ◽  
Difference Analysis ◽  
Illicit Trade ◽  
European Union Countries ◽  
Before And After ◽  
The Uk

Standardised packaging of tobacco products is intended to reduce the appeal of smoking, but the tobacco industry claims this increases illicit trade. We examined the percentage of people reporting being offered illicit cigarettes before and after full implementation of standardised packaging in the UK, Ireland and France and compared this to other European Union countries. Reported ever illicit cigarette exposure fell from 19.8% to 18.1% between 2015 and 2018 in the three countries fully implementing the policy, and from 19.6% to 17.0% in control countries (p for difference=0.320). Standardised packaging does not appear to increase the availability of illicit cigarettes.

THE DECREASE IN SEVERITY OF ASTHMA IN CHILDREN OF PARENTS WHO SMOKE SINCE THE PARENTS HAVE BEEN EXPOSING THEM TO LESS CIGARETTE SMOKE

PEDIATRICS ◽  
1994 ◽  
Vol 94 (2) ◽  
pp. 255-255
Author(s):  
Martin I. Sachs
Keyword(s):  
Cigarette Smoke ◽  
Secondhand Smoke ◽  
Marked Reduction ◽  
Asthma Severity ◽  
Asthmatic Children ◽  
Asthma In Children ◽  
Harmful Effects

Since 1986 an increasing awareness of the harmful effects of secondhand smoke has caused parents to smoke fewer cigarettes in the presence of their asthmatic children. This has been associated with a marked reduction in asthma severity of the smokers' children.

The effects of breathing exercises on respiratory functions, functional capacity and quality of life in vehicle spray painters

2021 ◽  
Vol 28 (12) ◽  
pp. 1-8
Author(s):  
Burak Yilmaz ◽  
Cagtay Maden ◽  
Begümhan Turhan
Keyword(s):  
Quality Of Life ◽  
Functional Capacity ◽  
Control Group ◽  
Study Group ◽  
Breathing Exercises ◽  
Sf 36 ◽  
Significant Difference ◽  
Before And After ◽  
Respiratory Exercises

Background/aims Workers engaged in vehicle spray painting are at a risk of developing respiratory problems because of the solvents in the spray paints. Changes in respiratory functions and functional capacities caused by spray painting can be improved with respiratory exercises. The aim of this study was to examine the effects of respiratory exercises on the respiratory functions, functional capacity and quality of life in vehicle spray painters. Methods A total of 70 volunteers with similar characteristics participated in the study. The groups were divided into two groups randomly (35 study group, 35 control group). Respiratory functions (value of forced expiratory volume percentage in 1 second [FEV1]), forced vital capacity percentage [FVC], FEV1/FVC percentage, peak expiratory flow percentage [PEF (%)] and maximum voluntary ventilation percentage [MVV (%)]), functional capacity (6-Minute Walk Test) and quality of life (Short Form Health Survey [SF-36]) were evaluated. The study group undertook supervised breathing exercises 3 days a week for 6 weeks. The same exercises were given to the control group as a home programme. Home programmes were followed up by telephone calls. Evaluations were performed again after 6 weeks. Results In the study group, FEV1 (%) increased more than in the control group (P<0.05). The increase in PEF (%) was similar in both groups (P>0.05). In the study group, FEV1/FVC (%) and MVV (%) were significantly different before and after the intervention (P<0.05), but there was no difference in the control group (P>0.05). There was a greater increase in the study group than in the control group (P<0.05). 6-Minute Walk Test distance (m) before and after the intervention in both groups were similar (P>0.05). Before and after the intervention, a significant difference was found in the vitality and the social function domains of the SF-36 in the study group. In the comparisons of groups, a significant difference was found in the study group in the role-emotional, social function and bodily pain domains of the SF-36 after the intervention (P<0.05). Conclusions Breathing exercises can be recommended for vehicle spray painters to avoid an increase in respiratory resistance and to improve their quality of life.

scholarly journals Assessment and prediction of asthma and its severity in the pediatric community

1990 ◽  
Vol 24 (6) ◽  
pp. 437-444 ◽  
Author(s):  
Julio Cesar R. Pereira ◽  
Fleming Carswell ◽  
Anthony O. Hughes
Keyword(s):  
Severe Disease ◽  
Asthma Severity ◽  
Positive Skin ◽  
Asthmatic Children ◽  
Multiplicative Effect ◽  
Skin Allergy ◽  
Single Positive ◽  
Laboratory Investigations ◽  
Response To Exercise

Seventy four asthmatic children aged 7 to 11 years were examined along with controls matched by age and sex. Clinical and laboratory investigations preceded a 28-day follow-up where data about morning and evening peak expiratory flow rate (PEF), symptoms and treatment were recorded. The coefficient of variation of PEF was found to be an objective measurement of asthma severity that has statistically significant correlation with both symptoms (r s= .36) and treatment (r s= .60). Moreover, it separates mild and severe asthmatics, as confirmed by statistically significant differences (p= .008 or less) in symptoms, treatment, skin allergy and airways response to exercise. Skin allergy and airways responsiveness to exercise were found to be predictors of both disease and severity. By means of logistic regression analysis it was possible to establish the probabilities for both asthma and severe asthma when children presenting and not presenting these characteristics are compared. One single positive skin test represent a probability of 88% for the development of asthma and a probability of 70% for severe disease. A PEF reduction of 10% after an exercise test implies a probability of 73% for disease and a probability of 64% for severe disease. Increases in these variables imply geometrically increased risks and their presence together have a multiplicative effect in the final risk.

scholarly journals Acalculous gallbladder disease: the outcomes of treatment by laparoscopic cholecystectomy

2011 ◽  
Vol 93 (3) ◽  
pp. 209-212 ◽  
Author(s):  
M Ahmed ◽  
R Diggory
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Daily Living ◽  
Preoperative Diagnosis ◽  
Gallbladder Disease ◽  
Symptom Control ◽  
Study Group ◽  
Moderate Pain ◽  
State Of Health ◽  
Before And After ◽  
Results Of Surgery

INTRODUCTION The treatment of symptomatic patients with the presence of gallstones is well established, with laparoscopic cholecystectomy being the treatment of choice for symptomatic cholelithiasis. The results of surgery in symptomatic patients without gallstones are highly variable. These patients are often referred to as having acalculous gallbladder disease and represent between 5% and 30% of laparoscopic cholecystectomies performed annually. We retrospectively reviewed the outcomes of patients who underwent laparoscopic cholecystectomy for acalculous gallbladder disease in our institution. PATIENTS AND METHODS We retrospectively analysed the period from February 2005 to January 2006 where 20 laparoscopic cholecystectomies had been performed specifically for a preoperative diagnosis of acalculous gallbladder disease. The histology of all laparoscopic cholecystectomies performed during this year was analysed and it was found that a further 46 patients had histological specimens that demonstrated the absence of gallstones in the presence of an intact gallbladder specimen. These patients were therefore included in the study group for acalculous gallbladder disease. All patients were sent a questionnaire comparing their state of health before and after surgery. RESULTS After laparoscopic cholecystectomy, 66% of patients were completely pain free. The remainder, however, experienced infrequent, moderate pain with occasional pain on eating. Following surgery, all patients were able to conduct their activities of daily living without any limitation. CONCLUSIONS We therefore conclude that laparoscopic surgery for patients with acalculous gallbladder disease is effective in symptom control and allowing patients to return to their normal lifestyle.

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