Assessment of Asthma Exacerbation in Children by Modified Pulmonary Index Score
Assessment of Asthma Exacerbation in Children by Modified Pulmonary Index Score
Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It
 is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest
 tightness and cough that vary over time and in intensity, together with variable expiatory
 airflow limitation. This definition was reached by consensus, based on consideration of the
 characteristics that are typical of asthma and that distinguish it from other respiratory
 conditions .

 Asthma is a problem worldwide, with an estimated 300 million affected individuals .It appears
 that the global prevalence of asthma ranges from 1% to 18% of the population in different
 countries .
Over the past years, an increase in the number of emergency department (ED) visits for asthma
 exacerbation has been reported. Most of these visits are for preschool children.

 Although pulmonary function tests are commonly used to assess the severity of acute asthma in
 adults, they are difficult to perform in children, especially those who are younger than five
 years old .

 spirometry measures pulmonary markers such as vital capacity and maximal forced expiatory
 volume in 1 second. Well-trained personnel are required to perform these tests, and they are
 not routinely available in the ED. Peak flow has been used in the ED to measure the degree of
 respiratory obstruction .This technique is difficult to perform in children less than 6 years
 of age because of their lack of coordination and comprehension .

 Adequate evaluation of the severity of asthma exacerbation is important for the initial
 management of patients, as well as for assessing the clinical response. However, severity is
 more difficult to assess in children. The clinical evaluation and physician's experience are
 often not enough to determine the degree of respiratory obstruction .

 In the emergency room setting, the most critical issue facing the attending physician is,
 deciding the adequacy of outpatient therapy of acute asthma, or when hospitalization is
 indicated. Traditionally, this decision is used to be made according to the clinical history,
 physical examination, laboratory results and response to therapy of the patient .

 A number of asthma severity measures or scoring systems have been established to estimate the
 degree of airway obstruction for children in whom the standard measurements cannot be
 performed. These systems combine a number of physical signs, such as respiratory rate and
 accessory muscle use, to form an aggregate score that estimates the severity of an acute
 asthma exacerbation .no scoring system is perfect, but some method of assessing severity in
 children is needed when spirometry testing is not obtainable.

 modified the pulmonary index was reported by adding 2 scoring items, namely heart rate and
 SpO2 at room temperature, and by dividing the method of heart rate and respiratory rate
 scoring depending on which of 2 age groups the patient belong to. Modified Pulmonary Index
 Score is a quantitative method of evaluating respiratory conditions in asthmatic subjects
 modified and consists of 6 evaluation items, which are important for the assessment of
 dyspnea and are relatively easy to assess in clinical practice, namely heart rate,
 respiratory rate, accessory muscle use, inspiratory to expiatory flow ratio, degree of
 wheezing, and oxygen saturation in room air.

 the predictive validity and reproducibility of the Modified Pulmonary Index Score for asthma
 exacerbation was reported in 30 children with a mean age of 7.6 ± 5.5 years in 2005. They
 found good correlations of the Modified Pulmonary Index Score with clinical outcomes such as
 ICU admission. The Modified Pulmonary Index Score appears to be suitable for measuring the
 severity of acute asthma exacerbation, and was applied as primary outcome measurement in some
 clinical trials .

 A significant correlation between Modified Pulmonary Index Score at hospitalization and
 hospitalization period in children above 5 years old, suggesting that Modified Pulmonary
 Index Score was useful for predicting the clinical course after hospitalization. However, its
 applicability to preschool children has not yet been fully elucidated.

 The Modified Pulmonary Index Score can be a useful tool for several aspects during acute
 asthma attacks, including the determination of a treatment plan, and prediction of the period
 of hospitalization in admitted patients .
Inclusion Criteria:

 -  children with acute asthma exacerbation

 -  children with acute asthma aged 1-17 years old

 -  background history of asthma

 -  this study will deal with the protocols applied in Assiut university children hospital

 Exclusion Criteria:.

 -  children below age of 1 year and more than 17 years old

 -  Known Tuberculosis exposure

 -  concurrent stridor

 -  use of oral corticosteroids in the previous four weeks

 -  Significant co-morbid disease : lung ,cardiac ,immune , liver , endocrine
 ,neurological or psychiatric

 -  children with other causes of respiratory distress

 -  Children with mild or controlled asthma.