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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 20  |  Issue : 1  |  Page : 15-25

Role of the lung function test in asthmatic children admitted to Al-Azhar University (Assiut)


Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Assiut, Egypt

Date of Submission20-Mar-2021
Date of Decision21-Mar-2021
Date of Acceptance30-Mar-2021
Date of Web Publication4-Mar-2022

Correspondence Address:
Yousry A.A.H Abdel-Rahman
Department of Pediatrics, Assiut, Manflout, Bany Ady, Essam Makhloof St, Bani Adeyat, Manflout, Assiut, Bani Adeyat 71622
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/azmj.azmj_42_21

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  Abstract 


Background and aim Lung function, especially spirometry, is an important investigatory tool in the evaluation of asthma in children. This study aimed to compare the clinical condition of asthmatic children using the lung function test before and after treatment and after 3 months as a follow-up of asthmatic patients admitted to Al-Azhar Assiut University Hospital.
Patients and methods This clinical study was a prospective study that included 60 asthmatic children aged 6–16 years with bronchial asthma plus 30 children matched for age, sex and nutritional status as a control group over a period of 13 months from December 1, 2019 to December 31, 2020.
Results The age of the children included in this study was found to be mean±SD 9.033±2.843, with a male predominance (male : female ratio 58% : 42%) and a positive family history of asthma (61%) and other allergic disorders (65%). There was a statistically significant change in forced expiratory volume at first second (FEV1), forced vital capacity (FVC), and the FEV1/FVC ratio that showed considerable improvement in both age groups at admission, after receiving the suitable treatment and at follow-up 3 months after discharge.
Conclusion Pediatric asthma is a major clinical concern and represents a huge burden on the family and society, hence the importance of prompt and early diagnosis that includes lung function testing, especially FEV1, FVC, and FEV1/FVC ratio, in not only diagnosis but also for monitoring the efficacy of treatment and follow-up.

Keywords: Al-Azhar University, childhood asthma, hospital in Assiut, pediatric lung function


How to cite this article:
Hamed AM, Mohammed MF, Awad KH, Abdel-Rahman YA. Role of the lung function test in asthmatic children admitted to Al-Azhar University (Assiut). Al-Azhar Assiut Med J 2022;20:15-25

How to cite this URL:
Hamed AM, Mohammed MF, Awad KH, Abdel-Rahman YA. Role of the lung function test in asthmatic children admitted to Al-Azhar University (Assiut). Al-Azhar Assiut Med J [serial online] 2022 [cited 2022 Jun 29];20:15-25. Available from: http://www.azmj.eg.net/text.asp?2022/20/1/15/339074




  Introduction Top


Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined as the history of respiratory symptoms such as wheezes, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable respiratory airway limitation [1].

Bronchial asthma is the most common chronic disease in children. The prevalence of asthma in childhood is 10–30%. It is the leading cause of hospitalization in children less than 15 years of age, and the leading cause of school absence [2].

Worldwide, childhood asthma appears to be increasing in prevalence, despite considerable improvements in our management and treatment of asthma. Numerous studies carried out in different countries have reported an increase in the prevalence of asthma of ∼50% per decade [3].

A study of childhood asthma prevalence in 233 centers in 97 countries found a wide range in the prevalence of current wheeze in 6–7-year-old children, 2.4–37.6%, and 13–14-year-old children, 0.8–32.6% [4].

Making the initial diagnosis is based on identifying both a characteristic pattern of respiratory symptoms of wheezes, shortness of breath, chest tightness, and cough variable respiratory airway limitation. The pattern of symptoms is important as respiratory symptoms may be due to acute or chronic conditions other than asthma. If possible, the evidence supporting the diagnosis of asthma should be documented when the patient first presents. As a result, it is often more difficult to confirm a diagnosis of asthma once the patient has been started on controller treatment [5].

Asthma is characterized by variable respiratory airway limitation. Lung function may vary between completely normal and severely obstructed in the same patient. Poorly controlled asthma is associated with greater variability in lung function than well-controlled asthma [6].

The lung function test, to be reliable in the diagnosis of asthma, should be carried out by well-trained operators with well-maintained and regularly calibrated equipment. Forced expiratory volume at first second (FEV1) from spirometry is more reliable than peak expiratory flow (PEF). If PEF is used, the same meter should be used every time, as measurement may differ from meter to meter by up to 20% [7].

A reduced FEV1 may be found with many other lung diseases (or poor spirometric technique), but a reduced ratio of FEV1 to forced vital capacity (FVC) indicates airflow limitations. From population studies, the FEV1 to FVC ratio is usually greater than 0.75–0.80 in adults, and usually greater than 0.90 in children. Any value less than this suggests airflow limitation. Many spirometers do not include multiethnic age-specific predicted values [8].

The diagnosis of asthma in patients already taking controller treatment can be confirmed if the basis of the patient’s diagnosis has not previously been documented; confirmation with objective testing should be sought. Many patients (25–30%) with a diagnosis of asthma in primary care cannot be confirmed as having asthma [9],[10],[11].

Once the diagnosis of asthma is made, short-term PEF monitoring may be used to assess response to treatment, to evaluate triggers (including at work) for worsening symptoms or to establish a baseline for action plans. After starting inhaled corticosteroids (ICS), the personal best PEF (from twice-daily readings) is reached on average within 2 weeks. The average PEF continues to increase, and diurnal PEF variability continues to decrease, for about 3 months. Excessive variation in PEF suggests suboptimal asthma control and increases the risk of exacerbations [12],[13],[14].

Lung function should be assessed at diagnosis or start of treatment and after 3–6 months of controller treatment to assess the patient’s personal best FEV1 and periodically thereafter. For example, in most adult patients, lung function should be recorded at least every 1–2 years, but more frequently in higher risk patients, including those with exacerbations and those at risk of decline in lung function. Lung function should also be recorded more frequently in children based on asthma severity and clinical course [13].


  Aim of the work Top


This study aimed to compare the clinical condition of asthmatic children using the lung function test before and after treatment and after 3 months as a follow-up of asthmatic patients admitted to Al-Azhar Assiut University Hospital from December 1, 2019 to December 31, 2020.


  Patients and methods Top


This clinical study was a prospective study that included 60 asthmatic children 6–16 years of age with bronchial asthma who presented as outpatients or were attending the emergency department or were admitted to the Pediatric Department of Al-Azhar University Hospital in Assiut plus 30 children matched for age, sex, and nutritional status as a control group over a period of 13 months from December 1, 2019 to December 31, 2020.

Spirometry testing was performed on patients three times: on admission, on discharge and 3 months afterward after nebulization of a rapid-acting bronchodilator such as 200–400 μg salbutamol as part of the treatment regimen.

Inclusion criteria

Children between the ages of 6 and 16 years diagnosed with bronchial asthma were included in this study.

Exclusion criteria

  1. Children below the age of 6 years or above 16 years.
  2. Children with wheezy chest due to any chest or cardiological disease other than bronchial asthma.


Ethical consideration

  1. Oral consent was obtained from parents or guardians of the patients.
  2. The aim of this work was explained to the parents before collection of the data.
  3. The privacy of all data collected was assured.


All children enrolled in this study were subjected to the following:
  1. A thorough history should be obtained including the following:
    1. Personal history (name, age, sex, address, and birth order of siblings).
    2. History of present illness: onset, course, duration, associations, and related symptoms.
    3. Family history: thorough history of other members affected by asthma or allergies from both sides of the patient’s family.
    4. Perinatal history: (i) prenatal history: condition during pregnancy including drug intake, smoking, seizures in pregnancy, hospitalization in early pregnancy, severe anemia frequency of mother, prenatal visits, previous fetal death, and birth interval. (ii) natal history: labor and delivery (spontaneous or induced), onset and duration of labor, methods of delivery (normal veginal delivery or cesarean section), signs of fetal distress, problems during pregnancy or delivery, medicines administered to the mother, for example, pethidine. (iii) Postnatal history: Apgar score and any resuscitation needed or any abnormalities detected.
    5. Nutritional history.
    6. Vaccination history.
  2. Full clinical examination:
    • General examination: build, height, weight, complexion, and any visible anomalies. Systemic examination and detailed chest examination: hyperexpansion of the chest cavity, prolonged expiratory time, expiratory wheezing, decreased air movement and use of accessory respiratory muscles.
  3. Investigations:


Respiratory function test, complete blood count, and C-reactive protein, blood gas analysis, and chest radiography.

Statistical analysis

The collected data were coded, analyzed, and computed using the statistical package for social sciences (SPSS) version 2016 [(IBM-SPSS), version 23.0 IBM- Chicago, USA was used for statistical data analysis].

The collected data were revised, organized, tabulated, and statistically analyzed using the statistical package for social sciences (SPSS) version 23.0 for windows. Data are presented as the mean±SD, frequency, and percentage. Categorical variables were compared using the χ2 and Fisher’s exact tests (if required).
  1. Descriptive analysis of the results in the form of percentage distribution for qualitative data (minimum, maximum, mean, and SD) and calculations for quantitative data.
  2. Cross-tabulation test: for comparison between percentages values (χ2).
  3. Student’s t-test: for comparison between the mean of two groups.
  4. Binary logistic regression: to identify independent prognostic factors, multiple regression analysis was carried out with outcome (discharged and died).



  Results Top


[Table 1] shows the sociodemographic characteristics of children admitted to the Al-Azhar Assiut Pediatric Department with a diagnosis of asthma including age distribution, patient age group, sex, residence, family history of asthma, presence, and type of the other allergies among asthmatic patients and precipitating factors.
Table 1 Sociodemographic characteristics of children admitted to the Al-Azhar Assiut Pediatric Department (N=60)

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[Table 2] shows the clinical characteristics of children admitted to the Al-Azhar Assiut Pediatric Department with a diagnosis of asthma including age of onset, of asthma symptoms, daily and seasonal variation, type of asthma attack, asthma grade at diagnosis, treatment, course of therapy among the studied asthmatic cases and type of controller treatment among the studied asthmatic cases.
Table 2 Clinical characteristics of children admitted to the Al-Azhar Assiut Pediatric Department (N=60)

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[Table 3] shows the lung function values among the studied asthmatic cases (N=44) and controls (N=20) at admission including FEV1, FVC, and the FEV1/FVC ratio in 6–10-year-old children according to three grades, mild, moderate and severe, before and after treatment.
Table 3 Lung function values of 6–10-year-old children among the studied asthmatic cases (N=44) and controls (N=20) at admission

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[Table 4] shows the lung function values among the studied asthmatic cases (N=16) and controls (N=10) at admission including FEV1, FVC, and the FEV1/FVC ratio in 11–16-year-old children according to three grades, mild, moderate, and severe, before and after treatment.
Table 4 Lung function values of 11–16-year-old children among the studied asthmatic cases (N=16) and controls (N=10) at admission

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[Table 5] shows the lung function values among the studied asthmatic cases (N=44) and controls (N=20) at discharge including FEV1, FVC and the FEV1/FVC ratio in 6–10-year-old children according to three grades, mild, moderate, and severe, before and after treatment.
Table 5 Lung function values of 6–10-year-old children among the studied asthmatic cases (N=44) and controls (N=20) at discharge

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[Table 6] shows the lung function values among the studied asthmatic cases (N=16) and controls (N=10) at discharge including FEV1, FVC and the FEV1/FVC ratio in 11–16-year-old children according to three grades, mild, moderate, and severe, before and after treatment.
Table 6 Lung function values of 11–16-year-old children among the studied asthmatic cases (N=16) and controls (N=10) at discharge

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[Table 7] shows the lung function values among the studied asthmatic cases (N=44) and controls (N=20) at follow-up 3 months after admission including FEV1, FVC and the FEV1/FVC ratio in 6–10-year-old children according to three grades, mild, moderate, and severe, before and after treatment.
Table 7 Lung function values of 6–10-year-old children among the studied asthmatic cases (N=44) and controls (N=20) at follow-up 3 months after discharge

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[Table 8] shows the lung function values among the studied asthmatic cases (N=16) and controls (N=10) at follow-up 3 months after discharge including FEV1, FVC, and the FEV1/FVC ratio in 11–16-year-old children according to three grades, mild, moderate, and severe, before and after treatment.
Table 8 Lung function values of 11–16-year-old children among the studied asthmatic cases (N=16) and controls (N=10) at follow-up 3 months after discharge

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  Discussion Top


In terms of the sociodemographic characteristics of our cases, [Table 1] shows that the mean age of our studied children was 9.033±2.843 years after excluding patients younger than 6 years of age and older than 16 years of age.

It was found that patient age groups varied: 6–10-year-olds representing 73% and 10–16-year-olds representing 27%; there was no statistically significant difference in the studied group (P>0.05).

In the present study, asthma was more common among males; 58% of the studied asthmatic children were males, while 42% were females, and the difference was statistically insignificant. This is in agreement with other studies that report that childhood asthma is more common in males, which is in agreement with the work of Al Ghobain et al. [14] and Halim et al.[15].

In terms of area of residence, 47% lived in rural communities, while the rest (53%) lived in urban communities; there was no statistically significant difference in the studied group (P>0.05). This was similar to other studies, Alaa et al. [16] and Abdallah et al. [17].

The patients showed a positive family history of asthma (61%); there was a statistically significant difference in the studied group (P<0.001). Other allergies were present in 65% of the studied group; there was a statistically significant difference in the studied group (P<0.001), and this is in agreement with Arshad et al. [18] and Abdallah et al. [17].

The types of other allergies among asthmatic cases included allergic rhinitis (46%), atopic dermatitis (28%), and food allergies (26%); there was a statistically significant difference in the studied group (P<0.001), which is similar to the results of Gustafsson et al. [19].

The common precipitating factors among asthmatic cases included noxious fume inhalation (75%), exposure to house dust (63%), viral upper respiratory tract infections (63%), parental smoking (55%), physical effort (62%), irritating odors (37%), insecticides (30%), food allergies (23%), psychological factors (30%) and drugs like sulfonamides and aspirin (17%), in agreement with other studies, Abdallah et al. [17] and Surdu et al. [20].

The clinical characteristics of our cases are shown in [Table 2]. In this study, it was found that asthma symptoms began to develop in 70% of the patients before the age of 3 years. It was reported that ∼25% of children with persistent asthma developed wheezing before 6 months of age and 75% by the age of 3 years [21].

In the present study, the most common symptoms of asthma among the studied cases were wheeze (85%), cough (77%), dyspnea (52%), and chest tightness (60%), which is similar to the results of other studies [17],[22],[23],[24],[25].

About 48% of the asthmatic children had asthma attacks at night (nocturnal asthma), while about 38% had asthma attacks in the day, in agreement with other studies [17],[24],[26].

Seasonal variations were reported among 68% of asthmatic patients, and the attacks were commonly reported in winter (40%), in agreement with other studies[17],[26].

The grades of asthma attacks were mild (75%), moderate (19%), and severe (6%).

On classifying our patients according to severity of asthma, we found that 48% of asthmatic children had intermittent asthma, 27% had mild persistent asthma, 18% had moderate persistent asthma, and 7% had severe persistent asthma. The level of asthma severity used in our study was based on the asthma symptom frequency (daytime, night time, and exertional) as estimated by the National Asthma Education and Prevention Program (NAEPP) Guidelines [27].

In terms of treatment, we found that patients were treated with short acting beta agonists (SABA) nebulization (100%), short courses of oral CS (70%), anticholinergic nebulization (58%), short courses of parental CS (20%), O2 therapy (13%), and CS nebulization (7%).

In the present study, 30% of the children were on controller treatment. Various types of controller treatment including leukotriene receptors antagonists (LTRA) (13%), theophylline (3%), ICS only (5%), ICS+LABA (5%), ICS+LTRA (2%), and oral steroids (2%) were being used.

The most common parameters measured in spirometry are vital capacity (VC), forced vital capacity (FVC), forced expiratory volume (FEV) at timed intervals of 0.5, 1.0 (FEV1), 2.0 and 3.0 seconds, forced expiratory flow 25–75% (FEF 25–75) and maximal voluntary ventilation, also known as the maximum breathing capacity. Other tests may be performed in certain situations as stated by Surgeryencyclopedia.com [28].A bronchodilator is also administered in certain circumstances and a pregraph/postgraph comparison is performed to assess the effectiveness of the bronchodilator, which was also reported by Perez [29].

FEV1 is the volume of air that can forcibly be blown out in the first second after full inspiration. The average values for FEV1 in healthy people depend mainly on the sex and age. Values between 80 and 120% of the average value are considered normal. Predicted normal values for FEV1 depend on the age, sex, height, mass, and ethnicity as well as the research study that they are based on, lung function [30].

We found that a low FEV1 percent identifies patients at risk of asthma exacerbations independent of symptom levels, especially if FEV1 is less than 60%, predicted much like the work of Kitch et al. [31] and Osborne et al. [32].

In the present study, we found that with regular ICS or SABA treatment, FEV1 starts to improve within days and reaches a plateau after around 2 months, which is in agreement with the work of Reddel et al. [33].

In our study, we found that the follow-up visit after 3 months from discharge showed considerable improvement in most cases, as shown by increased mean FEV1 values (in children 6–10 years: pre 70% vs post 82% at admission and pre 83% vs post 92% at follow-up) and mean FVC values (in children 6–10 years: pre 72% vs post 77% at admission and pre 82% vs post 87% at follow-up), which is similar to the work of Quanjer et al. [8].

[Table 3] shows FEV1 recorded in 6–10-year-old children at admission in the studied asthmatic patients (N=44), and controls (N=20) showed variations in the form of 71% pre greater than 84% post in mild asthmatic cases, 70% pre greater than 83% post in moderate asthmatic cases and 70% pre greater than 81% post in severe asthmatic cases versus 92% in the controller group of the same age, sex, and ethnic group. There was a statistically significant difference in the studied group in pre versus control (p=0.01), post versus control (p=0.01) and pre versus post (P=0.05).

FVC was 72% pre greater than 78% post in mild asthmatic cases, 71% pre greater than 77% post in moderate asthmatic cases and 70% pre greater than 77% post in severe asthmatic cases versus 87% in the controller group. There was a statistically significant difference in the studied group in pre versus control (P=0.01), post versus control (P=0.01), and pre versus post (P=0.05).

The FEV1/FVC ratio was 84.3% pre greater than 91.89% post in mild asthmatic cases, 85.1% pre greater than 92.7% post in moderate asthmatic cases and 86.6% pre greater than 91.8% post in severe asthmatic cases versus 93.54% in the controller group. There was a statistically significant difference in the studied group in pre versus control (P=0.01) and pre versus post (P=0.01), and there was no statistically significant difference in the studied group in post versus control (P=0.1).

[Table 4] shows FEV1 recorded in 11–16-year-old children at admission among the studied asthmatic cases (N=16), and controls (N=10) showed variations in the form of 80% pre greater than 90% post in mild asthmatic cases, 79% pre greater than 90% post in moderate asthmatic cases and 78% pre greater than 88% post in severe asthmatic cases versus (94%) in the controller group of the same age, sex, and ethnic group. There was a statistically significant difference in the studied group in pre versus control (P=0.01), post versus control (P=0.01), and pre versus post (P=0.05).

FVC was 79% pre greater than 87% post in mild asthmatic cases, 78% pre greater than 86% post in moderate asthmatic cases and 76% pre greater than 85% post in severe asthmatic cases versus (90%) in the controller group. There was a statistically significant difference in the studied group in pre versus control (P=0.01), post versus control (P=0.01), and pre versus post (P=0.05).

The FEV1/FVC ratio was 84.3% pre greater than 86.6% post in mild asthmatic cases, 85.1% pre greater than 87.2% post in moderate asthmatic cases and 85.2% pre greater than 86% post in severe asthmatic cases versus 86.9% in the controller group. There was a statistically significant difference in the studied group in pre versus control (P=0.01) and pre versus post (P=0.01), and there was no statistically significant difference in the studied group in post versus control (P=0.1).

[Table 5] shows FEV1 recorded in 6–10-year-old children at discharge among the studied asthmatic cases (N=44), and controls (N=20) showed variations in the form of 80% pre greater than 91% post in mild asthmatic cases, 79% pre greater than 90% post in moderate asthmatic cases and 79% pre greater than 89% post in severe asthmatic cases versus 92% in the controller group of the same age, sex, and ethnic group. There was a statistically significant difference in the studied group in pre versus control (P=0.01) and pre versus post (P=0.05), and there was no statistically significant difference in the studied group in post versus control (P=0.1).

FVC was 78% pre greater than 88% post in mild asthmatic cases, 77% pre greater than 86% post in moderate asthmatic cases and 77% pre greater than 85% post in severe asthmatic cases versus 87% in the controller group. There was a statistically significant difference in the studied group in pre versus control (P=0.01) and pre versus post (P=0.05), and there was no statistically significant difference in the studied group in post versus control (P=0.1).

The FEV1/FVC ratio was 89.4% pre greater than 89.1% post in mild asthmatic cases, 89.1% pre greater than 90.2% post in moderate asthmatic cases and 89.7% pre greater than 90.5% post in severe asthmatic cases versus 93.54% in the controller group. There was a statistically significant difference in the studied group in pre versus control (P=0.01), and there was no statistically significant difference in the studied group in post versus control (P=0.1) and pre versus post (P=0.1).

[Table 6] shows FEV1 recorded in 11–16-year-old children at discharge among the studied asthmatic cases (N=16), and controls (N=10) showed variations in the form of 84% pre greater than 93% post in mild asthmatic cases, 83% pre greater than 92% post in moderate asthmatic cases and 82% pre greater than 92% post in severe asthmatic cases versus (94%) in the controller group of the same age, sex, and ethnic group. There was a statistically significant difference in the studied group in pre versus control (P=0.01) and pre versus post (P=0.05), and there was no statistically significant difference in the studied group in post versus control (P=0.1).

FVC was 80% pre greater than 89% post in mild asthmatic cases, 79% pre greater than 89% post in moderate asthmatic cases and 78% pre greater than 89% post in severe asthmatic cases versus 90% in the controller group. There was a statistically significant difference in the studied group in pre versus control (P=0.01) and pre versus post (P=0.05), and there was no statistically significant difference in the studied group in post versus control (P=0.1).

The FEV1/FVC ratio was 87.7% pre greater than 87% post in mild asthmatic cases, 87.3% pre greater than 85.6% post in moderate asthmatic cases and 87.1% pre greater than 87.5% post in severe asthmatic cases versus 86.9% in the controller group. There was no statistically significant difference in the studied group in pre versus control, post versus control, and pre versus post (P=0.01).

[Table 7] shows FEV1 recorded in 6–10-year-old children at follow-up 3 months after discharge in the studied asthmatic cases (N=44), and controls (N=20) showed variations in the form of 89% pre greater than 92% post in mild asthmatic cases, 88% pre greater than 91% post in moderate asthmatic cases and 88% pre greater than 91% post in severe asthmatic cases versus 92% in the controller group of the same age, sex, and ethnic group. There was a statistically significant difference in the studied group in pre versus control (P=0.05) and pre versus post (P=0.05), and there was no statistically significant difference in the studied group in post versus control (P=0.1).

FVC was 84% Pre greater than 88% post in mild asthmatic cases, 84% pre greater than 86% post in moderate asthmatic cases and 83% pre greater than 85% post in severe asthmatic cases versus 87% in the controller group. There was a statistically significant difference in the studied group in pre versus control (P=0.05) and pre versus post (P=0.05), and there was no statistically significant difference in the studied group in post versus control (P=0.1).

The FEV1/FVC ratio was 91.66% pre greater than 93.6% post in mild asthmatic cases, 90.75% pre greater than 92.7% post in moderate asthmatic cases and 92.3% pre greater than 92.56% post in severe asthmatic cases versus 93.54% in the controller group. There was no statistically significant difference in the studied group in pre versus control, post versus control, and pre versus post (P=0.01).

[Table 8] shows FEV1 recorded in 11–16-year-old children at follow-up 3 months after discharge in the studied asthmatic cases (N=16), and controls (N=10) showed variations in the form of 90% pre greater than 93% post in mild asthmatic cases, 89% pre greater than 92% post in moderate asthmatic cases and 88% pre greater than 92% post in severe asthmatic cases versus (94%) in the controller group of the same age, sex, and ethnic group. There was a statistically significant difference in the studied group in pre versus control (P=0.05) and pre versus post (P=0.05), and there was no statistically significant difference in the studied group in post versus control (P=0.1).

FVC was 87% pre greater than 89% post in mild asthmatic cases, 86% pre greater than 89% post in moderate asthmatic cases and 86% pre greater than 88% post in severe asthmatic cases versus 90% in the controller group. There was a statistically significant difference in the studied group in pre versus control (P=0.01) and pre versus post (P=0.05), and there was no statistically significant difference in the studied group in post versus control (P=0.1).

The FEV1/FVC ratio was 87% Pre greater than 87% post in mild asthmatic cases, 86.2% pre greater than 86.6% post in moderate asthmatic cases and 85.7% pre greater than 87.5% post in severe asthmatic cases versus 85.7% in the controller group. There was no statistically significant difference in the studied group in pre versus control, post versus control, and pre versus post (P=0.01).


  Conclusions Top


It is concluded that pediatric asthma is a major clinical concern and represents a huge burden on the family and society, hence the importance of prompt and early diagnosis that includes lung function testing, especially FEV1, FVC, and the FEV1/FVC ratio. Moreover, in many cases, lung function testing can demonstrate the effectiveness of reliever and controller drugs according to the findings in the follow-up visits.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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