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Pulmonary diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Leah Lande, Abraham Sanders, Dana Zappetti
Once the diagnosis of asthma has been established, the cornerstone of asthma assessment is patient self-monitoring with a portable peak flowmeter. Patients should be instructed to measure their peak expiratory flow on a regular basis at different times of day to establish a baseline, and then to use the meter when experiencing new or changing respiratory symptoms, in order to facilitate early detection of an acute asthma exacerbation. The peak flowmeter is a particularly helpful objective assessment of pulmonary function in distinguishing between the normal dyspnea of pregnancy and worsening of asthma symptoms.
Pediatric Asthma
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Michael Teik Chung Lim, Mahesh babu Ramamurthy, Daniel Yam-Thiam Goh
Peak expiratory flow readings can be used to identify airflow obstruction as well as increased variability in airflow dynamics over time. By itself, it is not a reliable way to confirm or rule out asthma in children. It can however be useful to obtain an objective assessment of asthma control over time.
Medicine
Published in Seema Khan, Get Through, 2020
For each presentation below, choose the SINGLE most appropriate treatment from the list of options. Each option may be used once, more than once or not at all. A 12-year-old boy with cystic fibrosis presents with a chest infection. The boy also has mild renal failure.A 40 year old who is an inpatient on a psychiatric ward presents with dry cough and confusion. Blood tests reveal lymphopenia and hyponatraemia. A chest radiograph shows right-sided lobar shadowing.A 10-year-old boy presents with wheezing attacks and episodic shortness of breath. Peak expiratory flow rate is 400 L/min.A 40-year-old man presents with rhinorrhoea, cough, haemoptysis and pleuritic pain. A chest radiograph shows multiple nodules.A 60-year-old farmer presents with fever, cough and shortness of breath. He had been forking hay that morning. A chest radiograph shows fluffy nodular shadows in the upper zones.
Validation of an app-based portable spirometer in adolescents with asthma
Published in Journal of Asthma, 2021
Brian Ring, Allison J. Burbank, Katherine Mills, Sally Ivins, James Dieffenderfer, Michelle L. Hernandez
The development of app-based, portable spirometry systems has created an opportunity to leverage on the popularity of smartphone devices amongst teenagers to improve self-management of asthma. The simplest comparison to the utility of portable spirometry for the adolescent with persistent asthma is the measurement of PEFR variability with a peak flow meter. With peak expiratory flow monitoring, patients are restricted to only one objective metric of lung function which is highly dependent on user effort and does not correlate well with other asthma control assessments (17). PEFR has shown poor concordance with actual signs and symptoms of asthma control when compared to FEV1 measurements and degree of airway hyperresponsiveness (18). Furthermore, it is the burden of the participant to accurately record results, utilize recall for proper technique of the maneuver, and retain this tabulation for future clinic visits (9,18,19). EPR-3 guidelines suggest that PEFR alone is not sufficient to act as objective data measure for reporting variations in asthma control (8).
Assessing the impact of a remote digital coaching engagement program on patient-reported outcomes in asthma
Published in Journal of Asthma, 2018
Mazi Rasulnia, Billy Stephen Burton, Robert P. Ginter, Tracy Y. Wang, Roy Alton Pleasants, Cynthia L. Green, Njira Lugogo
In addition to improvements in asthma outcomes, many participants subjectively indicated that the emphasis on diet and exercise was positive. There was a decrease in the mean BMI from baseline (34.9 kg/m2) to post-study (33.8 kg/m2) that was approaching statistical significance (p = 0.056). However, the decrease in body weight from baseline (97.3 kg) to post-study (93.0 kg) was significant (p = 0.034). Among 35 subjects reporting adherence, 11 (31.4%) indicated that the program improved their asthma medication compliance. Among the five patients who were current smokers, 1 (16.7%) successfully quit tobacco with the aid of the Pack Health program. Twenty-one subjects reported that they had established their best peak expiratory flow rate during the study.
Reference values of inspiratory spirometry for Finnish adults
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2018
Annette Kainu, Kirsi L. Timonen, Esko Vanninen, Anssi R. Sovijärvi
Studies on inspiratory spirometry date mostly to early 1970 s and is thus influenced by technical development of measuring equipment. Earlier studies used separate peak expiratory flow (PEF) measurements using a Wright peak flow meter adapted also to measure peak inspiratory flow (PIF) [2,6]. Since flow-values were mostly measured from the tracings, values such as mid-vital capacity (mid-VC) flow ratio, measured from the flow-volume tracing at the volume corresponding to 50% of slow vital capacity, were used [2–4,11]. These values are not readily available from modern computerized spirometry systems, in which the ratio of PIF/PEF or forced inspiratory volume in one second (FIV1)/forced expiratory volume in one second (FEV1) are readily available and could have diagnostic value in different types of central airway obstructions [2,8,12]. The European Respiratory Society (ERS)/American Thoracic Society (ATS) Task Force in 2005 referred to the use of maximum inspiratory flow at 50% of FVC (MIF50) to maximum expiratory flow at 50% of FVC (MEF50) with values below one signaling variable extrathoracic obstruction and values above one intrathoracic obstruction [13]. In some other studies, however, the use of MEF50/MIF50 has also been evaluated, but found to have high variability, low repeatability and poor diagnostic predictive value [9,11,14]. However, reference values of inspiratory spirometry are lacking for Caucasian people hence determining what constitutes normal is essential.