Vondeling, S. (Sanne) (2014) Kan de Childhood Asthma Score worden gebruikt voor het meten van het effect van bronchusverwijders bij kinderen met een astmaexacerbatie? thesis, Medicine.
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Abstract
Introduction: In western countries, asthma is the most common chronic disease in children. A uniform treatment is not always achievable, because treatment with bronchodilators is adjusted based on the clinical assessment of the respiratory status of the patient. The clinical assessment is dependent on the availability of a physician and may be affected by subjective interpretation of the respiratory status by individual physicians. Implementation of a clinical pathway may provide a more uniform treatment of acute asthma and shorten length of admission. Until now, clinical pathways have always used asthma scores that comprise auscultation of the lungs. Auscultation of the lungs implies availability of a physician before an adjustment of treatment can be made. Therefore we would like to know if an asthma score without auscultation (Childhood Asthma Score(CAS) correlates well with the clinical assessment of the physician. In this study we evaluate if the effect of administration of bronchodilators, measured in WheezeRatepercent(Wz%) by the Pulmotrack® is associated with a change in CAS. Material and methods: This is a prospective, observational study. Children, 2 to 18 years of age, admitted at the paediatric department of the Medical Centre Leeuwarden with acute asthma, were included en treated according to current guidelines. The decision whether or not to administer bronchodilators was registered after each clinical assessment. At time of admission and subsequently at 15 minute intervals, the CAS score was registered. Lung sounds were continuously registered and analysed by the Pulmotrack®(a mobile device performing digital analysis of lung sounds). The total percentage of wheezing and the inspiratory/expiratory ratio was calculated with software of Karmelsonix. Results: Data of the 7 patients included so far was used for preliminary analysis. We found no significant association between a change in CAS score and percentage of wheezing after administration of bronchodilators. Clinical assessment not leading to treatment with bronchodilators was associated with lower CAS scores and percentage of wheeze compared to clinical assessment leading to bronchodilator nebulization(mean CAS score respectively 5,2(SD 2,4) vs. 7(SD 2,2) and mean percentage of wheeze respectively 0,4(SD 0,7) vs. 2,1(SD 2,5). Also, the CAS score gradually decreased during course of admission, Conclusion: The preliminary results of this study demonstrate that there is no association between a change in CAS and percentage of wheeze after administration of bronchodilators. CAS scores, however, correlate well with the clinical assessment of the patient’s respiratory status. Association between the CAS and the clinical assessment by the physician suggest that the CAS could possibly be implemented in a clinical pathway.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Kamps, Arvid W. A. and Medisch Centrum Leeuwarden |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:03 |
| Last Modified: | 25 Jun 2020 11:03 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2313 |
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