OBJECTIVE: To determine the frequency with which children >or=6 years with acute asthma can perform peak expiratory flow rate measurements (PEFR) in an emergency department (ED). DESIGN/ METHODS: Data were obtained from a prospective cohort study of children with acute asthma. All children (age 2-18 years old) treated in an urban pediatric ED for an acute exacerbation during randomly selected days over a 12-month period were prospectively evaluated. According to treatment protocols, PEFR was to be measured in all children age 6 years and older before therapy and after each treatment with inhaled bronchodilators. Registered respiratory therapists obtained PEFR and evaluated whether patients were able to perform the maneuver adequately. RESULTS: Four hundred and fifty-six children, 6 to 18 years old (median 10 years), were enrolled; 291 (64%) had PEFR measured at least once. Of those in whom PEFR was attempted at least once, only 190 (65%) were able to perform adequately. At the start of therapy, 54% (142/262) were able to perform PEFR. Of the 120 who were unable to perform initially, 76 had another attempt at the end of the ED treatment, and 55 (72%) were still unable to perform. A total of 149 patients had attempts at PEFR both at the start and end of treatment, of these, only 71 (48%) provided valid information on both attempts. Patients unable to perform PEFR were younger (mean +/- SD = 8.7 +/- 2.8 years) than those who were able to perform successfully (11.2 +/- 3.2 years) and those with no attempts (10.0 +/- 3.4 years). Children admitted to the hospital were more likely to be unable to perform PEFR (58/126 = 46%) than those discharged from the ED (43/330 = 13%, P < 0.0001). CONCLUSION: Adequate PEFR measurements are difficult to obtain in children with acute asthma. Treatment and research protocols cannot rely exclusively on PEFR for evaluation of severity.
OBJECTIVE: To determine the frequency with which children >or=6 years with acute asthma can perform peak expiratory flow rate measurements (PEFR) in an emergency department (ED). DESIGN/ METHODS: Data were obtained from a prospective cohort study of children with acute asthma. All children (age 2-18 years old) treated in an urban pediatric ED for an acute exacerbation during randomly selected days over a 12-month period were prospectively evaluated. According to treatment protocols, PEFR was to be measured in all children age 6 years and older before therapy and after each treatment with inhaled bronchodilators. Registered respiratory therapists obtained PEFR and evaluated whether patients were able to perform the maneuver adequately. RESULTS: Four hundred and fifty-six children, 6 to 18 years old (median 10 years), were enrolled; 291 (64%) had PEFR measured at least once. Of those in whom PEFR was attempted at least once, only 190 (65%) were able to perform adequately. At the start of therapy, 54% (142/262) were able to perform PEFR. Of the 120 who were unable to perform initially, 76 had another attempt at the end of the ED treatment, and 55 (72%) were still unable to perform. A total of 149 patients had attempts at PEFR both at the start and end of treatment, of these, only 71 (48%) provided valid information on both attempts. Patients unable to perform PEFR were younger (mean +/- SD = 8.7 +/- 2.8 years) than those who were able to perform successfully (11.2 +/- 3.2 years) and those with no attempts (10.0 +/- 3.4 years). Children admitted to the hospital were more likely to be unable to perform PEFR (58/126 = 46%) than those discharged from the ED (43/330 = 13%, P < 0.0001). CONCLUSION: Adequate PEFR measurements are difficult to obtain in children with acute asthma. Treatment and research protocols cannot rely exclusively on PEFR for evaluation of severity.
Authors: Nidhya Navanandan; Katharine L Hamlington; Rakesh D Mistry; Stanley J Szefler; Andrew H Liu Journal: Ann Allergy Asthma Immunol Date: 2020-07-09 Impact factor: 6.347
Authors: Kathleen T Berg; Michael G O'Connor; Richard D Lescallette; Donald H Arnold; Lawrence B Stack Journal: Acad Emerg Med Date: 2015-09-09 Impact factor: 3.451
Authors: Michael D Johnson; Flory L Nkoy; Xiaoming Sheng; Tom Greene; Bryan L Stone; Jennifer Garvin Journal: J Asthma Date: 2016-11-10 Impact factor: 2.515
Authors: Anab R Lehr; Martha L McKinney; Serge Gouin; Jean-Guy Blais; Martin V Pusic; Francine M Ducharme Journal: Can Respir J Date: 2013-09-17 Impact factor: 2.409