FEV1 (FORCED EXPIRATORY VOLUME IN THE 1ST SECOND) REVERSIBILITY AFTER NEBULISATION WITH SABA (SHORT ACTING BETA AGONIST) AS A MARKER OF CONTROL OF ASTHMA

ABSTRACT

INTRODUCTION: Variable expiratory air flow due to bronchoconstriction, airway wall thickening and increased mucus is an obvious feature in asthma. Variable air flow obstruction is evidenced by reversibility of FEV1 following a bronchodilator inhalation. PFT (Pulmonary Function Testing) using spirometry is often used for the estimation of FEV1. Reversibility is not uniform in all cases and vary with respect to severity and control of asthma. AIMS & OBJECTIVES: 1) To determine the control of asthma in 5-15-year-old children using GINA checklist and estimate FEV1 before and after SABA nebulisation. 2) To find out the association between FEV1 reversibility and control of asthma. MATERIALS & METHODS: This cross-sectional study included 90 consecutive 5-15-year-old-children with a clinical diagnosis of asthma attending the Paediatric OPD of a teaching hospital from October-May 2021. The symptoms, signs, comorbidities, treatment, compliance and assessment of control of asthma into 2 subgroups Well-controlled and Partly-controlled/Uncontrolled asthma, as per GINA 2020 were recorded. All were subjected to spirometry for assessment of FEV1 before and 20 minutes after nebulisation with SABA. Depending upon FEV1, they were grouped as those with >12% reversibility and <12% reversibility. Data analysed using SPSS 20.0, Paired t test for comparison of means, Chi-square test for statistical difference in proportion, and post hoc tests. The RESULTS: MF ratio was 1.21, 52.2% were 10-15 years and 47.8% 5-10 years. 68.9% had partly/uncontrolled, the rest well-controlled asthma (38.1%). The difference between mean FEV1 before (67.9±10.6) and after nebulisation (80.6±9.7) was statistically significant (p<0.00*). Among those with >12 reversibility, 64.5% were in partly/uncontrolled and 35.5% in well-controlled asthma and the difference was statistically significant (p -0.013*). The CONCLUSION: finding in the study that 68.9% had partly/uncontrolled asthma is an eye-opener to optimise protocol-based treatment among children. The statistically significant difference of >12% before and after nebulisation a marker of poor control was observed in 64.5% of partly/uncontrolled asthma compared to 35.5% of well controlled asthma. Hence, the persistence of a significant degree of bronchodilator response noted in those with partly/uncontrolled asthma is recommended as an objective surrogate of poor asthma control in children who can co-operate for a PFT in order to optimise protocol-based treatment.