Hoesel, M. van (Maaike) (2015) Improving clinical assessment of asthma by studying the relation between spirometry and assessment of EIB : ‘Never judge a book by its cover’. thesis, Medicine.
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Abstract
Background Exercise induced bronchoconstriction (EIB) is a highly specific symptom of asthma in childhood and a strong sign of uncontrolled asthma. The diagnosis of EIB from a medical history is difficult; perception of EIB by children and recognition by others can be low. EIB can be identified with an exercise challenge test (ECT), however these tests are time-consuming and expensive. There is a need for objective tools to diagnose EIB in asthmatic children. Video evaluation of asthma symptoms could be a potential low-end and objective addition for diagnosis and monitoring of EIB, improving asthma treatment, reducing cost and increasing efficiency. Objective The aim of this study is to investigate whether paediatricians can predict the severity of EIB as measured with an ECT from the medical history, physical examination and pre-exercise video, and if the addition of pre-exercise lungfunction can improve this prediction. The second aim of this study is to investigate the relation between asthma dyspnoea scores, as assessed by pediatricians from videos, and the severity of airway obstruction as measured with pulmonary function. Methods 20 asthmatic children (age 4-17 years) performed an ECT. Pulmonary function testing was measured before and after exercise. Children with a fall of ≥ 10% in FEV1 were considered to have EIB. A fall of <10% but >25% was considered mild, >25% but <50% moderate and >50% or >30% if treated with inhaled corticosteroids (ICS) was considered severe EIB. Before and after exercise video recordings were made. Pediatricians predicted the severity of EIB, based on a pre-exercise video, medical history and physical examination, and again predicted the severity of EIB when they were informed about the pre-exercise pulmonary function. Further they assessed dyspnoea from a post-exercise video and their assessment was compared with the severity of EIB as categorised above. Results 20 children (11 male, 9 female) with a mean age of 11.6 ± 3.4 had a median fall in FEV1 of 15.1% (1.2-65.1) after exercise. 9 children showed no EIB, 4 children showed mild, 2 children showed moderate and 5 children showed severe EIB. Pediatrician’s prediction of the severity of EIB from the medical history, physical examination and pre-exercise video was poor. This poor prediction was not improved when pediatricians were informed about the pre-exercise pulmonary function. Pediatrician’s assessments of dyspnoea on post-exercise videos correlated fairly well with the severity of EIB. Conclusion There still seems to be a substantial need of an ECT to identify EIB. Pediatricians have a fair ability to assess EIB from post-exercise videos. This provides opportunities to diagnose EIB from home made post-exercise videos.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Thio, Dr. B. Pediatrician and Department of Pediatrics, Medisch Spectrum Twente |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:53 |
| Last Modified: | 25 Jun 2020 10:53 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1440 |
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