| 1. Introduction |
Spirometry is known as the most common lung function test performed to date. [1] It measures the amount of air that moves in and out of the lungs and the way and speed with which the air moves.
To induce more effective results, the child is asked to follow very specific instructions. Most young people can do spirometry by age 6, although some preschoolers can do it at an earlier age. [2]
Asthma can be a chronic respiratory disease characterized by bronchial hyperreactivity and reversible airway obstruction. [3]
However, the majority of asthmatic children, regardless of the severity of the disease, usually have normal forced expiratory volume (FEV) values, especially when they are asymptomatic. [4-6] Therefore, the essential role of pulmonary function tests in short- and long-term evaluations of childhood asthma remains controversial until now. [7]
Another issue to note is that consistent spirometric measurements depend largely on the patient’s ability or inability to perform a forceful expiratory maneuver that is often strenuous in young children. Therefore, the clinical picture in terms of signs and symptoms is also of utmost importance. [8]
Lung function measurements provide objective information about patients’ physiology, while symptoms give more information about how the disease affects them. It is known that both symptoms and measures of lung function improve with treatment, although the degree of improvement in each of the parameters is still unclear.
The objective of this study was to observe clinical improvement and therefore changes within spirometric measurements with treatment in newly diagnosed childhood asthma cases and relate the change to the symptom.
We sought to quantify progress and changes in spirometric measurements with treatment in children newly diagnosed with asthma and to test for deviations within symptom scores and spirometric measurements. [9]
| 2. Materials and methods |
This was a prospective cross-sectional study conducted at the Department of Pediatrics, Dhaka Shishu Hospital, Dhaka, Bangladesh, during the period from January to December 2019.
This study included 50 children between 5 and 15 years of age who were diagnosed with asthma based on their symptoms and medical history.
Baseline symptom scores and spirometric measurements were determined at the first visit. The children were treated and followed up 3 and 6 months after starting treatment.
Symptom scores and spirometry were repeated at each visit. The patient’s monthly profile was compiled and data were presented in tables using Microsoft Excel and SPSS.
| 3. Results |
The average age of the patients was 5-7 years. Of the total, 33 (66.67%) were men and 17 (33.33%) were women. The male:female ratio was almost 2:1.
At the time of follow-up, 36% of respondents were 7-9 years old (n = 18), 26% 9-12 years old (n = 13), 22% 5-7 years old (n = 11) and the remaining 16% were 12-15 years old (n = 8), with a mean ± SD of 11 ± 3.56.
84% (n = 42) of patients had mild persistent asthma and 16% (n = 8) moderate persistent asthma. A P < 0.05 was considered significant compared to baseline.
Mean ± SD values (n = 50) were considered for: forced expiratory volume in 1 second (FEV1); forced vital capacity (FVC); and peak expiratory flow rate (PEF).
In the symptom score, mean FEV1 values of 1.61 ± 0.8 at 3 months and 1.79 ± 0.83 at 6 months, FVC of 1.74 ± 0.83 at 3 months and 1.74 ± 0.83 at 6 months, FEV1/FVC of 90.67 ± 8.96 at 3 months and 91.8 ± 6.49 at 6 months and FEP of 2 .79 ± 0.76 at 3 months and 3.32 ± 0.92 at 6 months, with improvement in the different parameters compared to baseline values.
A significant improvement in symptom score and lung function parameters FEV1 and FVC was observed at three months, and FEP showed improvement at six months. The FEV1/FVC ratio did not show significant improvement during the study period. A general improvement was observed in all spirometric parameters at six months of follow-up.
| 4. Discussion |
Spirometry can be considered a widely used method to determine a person’s lung capacity and function.
It is a uniquely valuable tool, often used to determine whether or not a patient has asthma, chronic obstructive pulmonary disease (COPD), or other conditions that impair breathing, by measuring the amount of air that can be inhaled and exhaled and with how quickly you exhale. [9] But this can be an irritating process for younger patients who need to sit still for a long time to get an adequate reading. [1]
Asthma and COPD are common diseases throughout the world, which can cause considerable difficulties for patients and society. These are harmful diseases that can cause significant problems in daily life and can also cause morbidity and death as they can affect both the young and the elderly. [10] This study was conducted to understand the impact of spirometry on both diagnosis and treatment, focusing primarily on children with asthma.
The data collected show that at the time of the study, the ratio of male and female patients undergoing spirometry was almost 2:1. The average age of the patients can be considered 11 years, although a large part of the patients belonged to the group of age of 7-9 years, with patients ≥ 12 years being the smallest group in the sample.
84% of the patients were in the mild persistent asthma category and the remaining 8 patients were in the moderate persistent asthma category. These categories were determined using guidelines established by NAEPP. [eleven]
Follow-up was carried out 3 months and 6 months after the initial evaluation, with contributions from both patients and their parents. Of interest was the fact that parents’ and children’s reports differed depending on the age of the patients. This may be explained by examining another study, where the original report was more likely to correlate with parental reports if the patient was younger than 11 years. [12]
This implies that in cases of patient-based information, it is more reliable to focus on parental reports of patients between 6-11 years of age. In the age group 12–18 years, both parent and patient reports may be comparable to the original reports. [12]
From the follow-up reports, some positive results could be observed from the third month of follow-up, with a mean FEV1/FVC reduced by 3 points. This brings to light the change in the mean total symptom score from 19.28 ± 4.18 to 24.31 ± 2.46. Further improvements were seen at 6-month follow-up.
Mean FVC did not change after the initial 3-month follow-up. The 6-month follow-up showed that mean FEV1/FVC increased by more than 1 point compared to control at 3 months, while still being below the baseline baseline score.
The change in other aspects at the 6-month follow-up was comparatively lower than that at the 3rd month of follow-up. The mean score of total symptoms was 26.09 ± 2.14 after the 6th month control.
When put into parameters, it was observed that after 3 and 6 months of control, the P value rose at a rate of 0.02 in the symptom score. Quality of life also improved at each follow-up visit and at the end of the study, determined by a P value <0.05.
The magnitude of the improvement in quality of life was similar to the improvement in objective measures of lung function; although these changes were not similar to changes in asthma symptom scores. [13]
This study can conclude that spirometry is a valid method for the treatment of patients with asthma, and can provide visible results.
Regarding limitations, this was a single-center, unblinded study with a small sample size. The tutors’ lack of prior knowledge about the study topic also played a role in manipulating the results. For the reasons mentioned above, the results may not be reflected throughout the community.
| 5. Conclusion and recommendations |
The study showed that spirometry is a valid and preferred method for treating asthma patients, and is also a primary resource of most medical institutes to determine any lung-related diseases.
It is recommended to increase knowledge regarding spirometry in both the general population and the medical community to spread its use.
The primary knowledge that requalifies spirometry and its appropriate uses should be taught to both doctors and nurses, and the number of spirometry devices should be increased. Patients need to be more aware of the complications and advantages of spirometry to make more informed decisions.
