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Brief Reports Indian Pediatrics 2002; 39: 75-78 |
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Peak Expiratory Flow Rate of School Going Rural Children Aged 5-14 Years from Ajmer District |
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Rajesh Sharma Anil Jain Achala Arya B.R. Chowdhary
Ventilatory function studies in adult population from different parts of India are well documented(1-4). Similar data in children is limited(5-8). Except one earlier study(9), information on ventilatory function among children of Rajasthan is not available in the Indian literature. In the present communication, we evaluated the peak expiratory flow rate (PEFR) in a group of rural school going children from Ajmer district of Rajasthan state and compared the values with that available from Northern India. Subjects and Methods The schools situated in various villages of Ajmer district selected randomly were included in the study. Children with major medical illness and those having acute respiratory infection within 7 days of study were excluded(3) and all of them denied any history of smoking. Records of age were noted in each case. Height was measured without any shoes and weight was recorded only with light clothing. The children were categorized in various socio-economic groups based on per capita income of their family as per updated Prosad’s classification(10). PEFR was obtained with the help of a Wright’s mini peak flow meter (Clement Clarke). The instrument was calibrated initially and in between study period. Prior to recording PEFR of students, the use of the instrument was repeatedly demonstrated and explained. Daily check of the instrument was done by recording the PEFR of two healthy adults conducting the study. Three readings were taken in each case and highest reading was taken as the representative value. All the results were subjected to standard statistical evaluation and a regression equation for PEFR was obtained based on height. Student "t" test was applied to evaluate statistical significance. Results There were 163 boys and 140 girls aged 5-14 years, mostly (76%) from a lower socioeconomic group. The mean age of the boys was 9.2 ± 2.6 years, mean height was 128 ± 3.8 cm (range 95 to 170 cm) and mean weight was 25.61 kg (range 10-56 kg). The mean age of the girls was 9.7 + 3.2 years, mean height was 127 + 8.9 cm (range 93-158 cm) and mean weight was 23.9 + 6.4 kg (range 9-61 kg). The PEFR measured ranged from 92 to 460 L/min. Table I gives the PEFR values in relation to height. The PEFR values increased in linear relation to age, weight and height. The coefficient of correlation obtained for all the three variables was significant (p <0.001). The highest correlation was obtained between PEFR and height (r = 0.87 for girls, r = 0.85 for boys). The regression equation based on height for both sexes were: Boys: PEFR (L/min) = 4.33 × Ht (cm) – 320.32, SE 4.5 L/min. Girls: PEFR (L/min) = 4.36 × Ht (cm) – 336.51, SE 6.4 L/min. Discussion Our aim was to establish normal values of PEFR for healthy rural children of Ajmer district (Rajasthan), so that local reference standards are available when this measurment is being used for assessment of bronchospasm or its reversal in day-to-day management of asthmatic children(11). A standardized comparison of predicted PEFR values from the present study for 3 different heights was done with the PEFR values for the same height from 3 previous studies (Table II).
Table I__PEFR (l/min) in Relation to Height
On comparing our data with previously published values, we found that PEFR meausrements in rural children are lower than those reported for Caucasian and urban Indian children of same height (Table II). The majority of children from rural background in our study belonged to low socio-economic group. PEFR of children in our study was lower, when compared with data on well-nourished children(5-7,13). The family size is large, most of them do not have access to good nutrition and are living in unhygienic surroundings, resulting in lower body proportions when compared with that of urban and well-nourished children. PEFR values increased in linear relation to age, weight and height. The correlation coefficient for height was the highest, although cor-relation for all three variables was significant, which is in conformity with other studies(5-7). It will also be possible to predict PEFR for a given height by calculating it from our equation. We used height for constructing the regression equation for predicting PEFR because it is a convenient measurement and its assessment is accurate, if proper technique is used. Assessment of correct age in rural area in many instances is not possible and accurate weight measurement in field studies may sometimes pose a problem. It has been shown that pulmonary function, especiality lung volume show racial and ethnic differences(14,15). Within India also, ethnic differences have been shown to account for the variations in the pulmonary functions(13). Therefore, it is important to establish reference values for this region. The regression equations obtained in the present study can be used to calculate the expected value of PEFR, which can serve as reference value. We would like to state that a data from few villages is not representative of characteristics of a region. Therefore, the findings of the present study should be considered preliminary and call for further studies with a large sample size based on random selection. In conclusion, this study has generated preliminary reference values for PEFR for rural children of Ajmer District. Contributors: BRC conceived the idea and co-ordinated the study. AA drafted the manuscript and will act as the guarantor. AJ and RS did the data collection, prepared the initial draft and helped in data analysis and interpretation. Funding: None. Competing interests: None stated.
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