S. Joshi1, S. Retharekar2
1Self-employed, Nashik, India, 2Self-employed, Swindon, United Kingdom

Background: Incidence of pulmonary diseases in urban children is on the rise. There are specific tests that help early diagnosis of compromised respiratory function. Pulmonary Function Tests (PFTs) are the gold standard for identifying those at risk. Peak Expiratory Flow Rate (PEFR) is a component of PFTs, measured using a peak flow meter. It is easily implementable on large population due to its simplicity. Studies show that PEFR is anthropometric, population and region specific. Therefore, different regions should have their own normative data of PEFR. Studies presenting such data for Indian children are severely lacking.

Purpose: India is geographically and culturally, a diverse country. Region specific normative values of PEFR for Indian children need to be available. Resulting accurate predictive regression equations shall help medical personnel at the tertiary centers. Ground level screenings based on these, can help in early diagnosis of pulmonary diseases in children. Therefore, the present study aims to establish such equation for urban children.

Methods: The cross-sectional study was done in Pune, Maharashtra, India. After local ethical committee approval children from different public and private schools were selected by cluster sampling. Permission letters were sent to randomly selected schools. Informed written consent was provided to school authorities & requested to be filled by parents of 2100 children fitting our age group criteria. The sample size of the study was finally 1760 after fall outs attributed to either parental non consent or acute illness of the child. Best of three readings of PEFR, was recorded for each child using EU Scale Peak Flow meter (Breathometer, Cipla). Anthropometric data like height, weight, waist circumference was measured and BMI was calculated for all.

Results: Mean PEFR values age wise were 
for 5 yrs - 106 ± 21.79 l/min; 
for 6 yrs - 123.4 ± 22.89 l/min;      
for 7 yrs - 143.5 ± 28.64 l/min;
for 8 yrs - 164.6 ± 33.21 l/min;                                       
for 9 yrs - 172.08 ± 36.86 l/min;  
for 10 yrs - 188.5 ± 39.83 l/min.
Out of 1760 children included in the study 933(53%) were boys and 827(47%) were girls. The anthropometric data and BMI of each age group was correlated with recorded PEFR. The correlation of PEFR with height was positively significant in all age groups. However with BMI, weight and waist circumference correlation was not consistently positive.

Conclusion(s): The stepwise regression analyses were derived using age, height, weight as predictor variables. Height was found most significant factor for predicting PEFR values for boys as well as for girls. Testing of the regression equation was done by comparison between the means of the predicted values for the control group derived from the equation and the measured values. Final predicted regression equation was formulated using height.

Implications: Predicted Regression Equation generated from this study shall form basis of guideline for medical practitioners in the region of Pune, Maharashtra, India.  Such benchmarking of PEFR value would detect nascent cases of pulmonary afflictions. It will promote PEFR assessment to be a part of fitness check-up for schools in Pune.

Funding, acknowledgements: No funding was received for this study.

Keywords: Peak Expiratory Flow Rate, Regression Equation, India

Topic: Paediatrics

Did this work require ethics approval? Yes
Institution: Sancheti Institute and College of Physiotherapy, Pune, India.
Committee: Institutional Review Board Sancheti Institute for Orthopedics and Rehabilitation, Pune, India.
Ethics number: IRB No. SIOR/Agenda 030/01-13

All authors, affiliations and abstracts have been published as submitted.

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