|Year : 2022 | Volume
| Issue : 1 | Page : 25-27
Evaluation of pulmonary function tests in allergic rhinitis patients attending a rural tertiary care hospital in South India
S Waheeda1, S Syed Liyakath Ali1, K Sathyamurthy2
1 Department of Physiology, VMKV Medical College, Salem, Tamil Nadu, India
2 Department of Pathology, VMKV Medical College, Salem, Tamil Nadu, India
|Date of Submission||30-Jan-2022|
|Date of Acceptance||14-Mar-2022|
|Date of Web Publication||22-Apr-2022|
Department of Physiology, VMKV Medical College, Salem, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: Pulmonary function tests (PFTs) include a variety of tests such as spirometry, the volume of lung measurement, and diffusing capacity of lung quantification. Allergic rhinitis (AR) is a kind of rhinitis related to complex symptomatology characterized by rhinorrhea, obstruction of the nasal cavity, attacks of sneezing, and irritation of the nose, palate, and eyes. PFT could be deranged in AR patients, as they sustain anomalous airway function, determined by obstruction. Hence, assessing PFT's are a crucial part of the patient workup with AR. Aim: The current study evaluated the variations in pulmonary function among AR patients. Materials and Methods: A sum of 100 people were included in the study, of which 50 people were with AR meeting inclusion criteria, whereas the same age- and gender-matched 50 persons were regarded as a “control group.” PFTs were performed after getting informed consent from both groups. Data were charted and analyzed for statistical significance by the Student's t-test. Results: P value of maximal voluntary ventilation (MVV) has been observed to be the most significant, pointing toward a marked reduction of MVV in the AR patients in comparison to the control group. The P value of forced expiratory volume 1 (FEV1) is moderately significant, depicting a mild decrease in FEV1 among the study group. The P value of FEV1% has been highly significant, pointing toward a marked decrease in FEV1% among the study group participants. The P value of peak expiratory flow rate (PEFR) has been highly significant, denoting a substantial decrease in PEFR in the study group. Conclusion: Alterations in the pulmonary function were evaluated by applying the PFT's among the AR patients of Salem. It was observed that PFT values such as “FEV1, FEV1%, MVV, and PEFR” demonstrated a notable reduction in the allergic patients compared to control.
Keywords: Allergic rhinitis, lungs, pulmonary function test
|How to cite this article:|
Waheeda S, Ali S S, Sathyamurthy K. Evaluation of pulmonary function tests in allergic rhinitis patients attending a rural tertiary care hospital in South India. J Sci Soc 2022;49:25-7
|How to cite this URL:|
Waheeda S, Ali S S, Sathyamurthy K. Evaluation of pulmonary function tests in allergic rhinitis patients attending a rural tertiary care hospital in South India. J Sci Soc [serial online] 2022 [cited 2022 Jun 25];49:25-7. Available from: https://www.jscisociety.com/text.asp?2022/49/1/25/343705
| Introduction|| |
Pulmonary function test (PFT) includes a variety of tests such as spirometry, the volume of lung measurement, and evaluation of the diffusing lung capacities. Assessment of the highest respiratory flow volume and pressure curves that document the “inspiratory and expiratory flow rates” can be helpful in some clinical circumstances. Spirometers can be used to measure the slow vital capacity (SVC), which is useful in cases where the “forced vital capacity” is decreased in addition to the airway obstruction. A minor degree of airway narrowing resulting from slow exhalation can pose a chance of exhaling larger volumes. Divergently, the vital capacity among the patients is decreased with the restrictive disease in the course of both the fast and slow maneuvers. Hence, a restrictive disorder that is significant primarily could be virtually excluded when the forced or SVC falls within the normal limits, and it is needless to assess the “static lung volumes” in such cases.
Rhinitis refers to a wide range of annoying symptoms of the nasal cavity, which include sneezing, itching, discharge, pressure, and congestion. Allergic rhinitis (AR) is a kind of rhinitis related to complex symptomatology characterized by rhinorrhea, nasal cavity obstruction, sneezing attacks, and irritation of the nose, palate, and eyes. AR is a disease having a high prevalence, observed to be exceedingly familiar with an estimated effect on 40% of children and 15%–30% of adults, and AR is related to postnasal drip, fatigue, irritability, and cough. AR is also related to severe morbidity and expenses of health care, accounting for a minimum of “2.5%” of the total patient visits to a hospital and over 2 million lost days per year by the school-going children, 6 million workdays lost, and 28 million of workdays per year restricted.
PFT's could be deranged in patients with AR, as they may have anomalous airway function denoted by large or small airway obstruction. Hence, assessing PFT's are a crucial part of the AR patient workup. The main type of the PFT uses “spirometry” to measure lung volume and diffuse lung capacity quantification. Measuring extreme respiratory pressure and flow volume curves that record the forced expiratory and inspiratory flow rates are helpful in particular clinical circumstances. Many diseases can be slow or insidious in onset and manifest themselves with the atypical symptoms of exertional dyspnea later on. In such instances, the PFT's could have an essential role in the workup to arrive at the diagnosis cost-effectively.
| Materials and Methods|| |
The current study was a prospective observational study that was taken forward to assess the effect of AR on PFT among the patients attending a rural tertiary care setting in a South Indian town. A sum of 100 people belonging to the 18–45 years age group were enrolled, of which 50 people were the AR patients, who were selected based on the symptoms characterized by rhinorrhea, bouts of sneezing, postnasal drip, and itching of the eyes, nasal obstruction, and palate when exposed to allergens. After obtaining the necessary permissions and Institutional Ethical Committee Clearance, 50 people of a similar age group were considered a control group from the attendees of patients and the technical staff of the same setting. Subjects who are sustaining any cardiorespiratory illness such as hypertension, obesity, tuberculosis, bronchial asthma, or any other drug dependency states such as alcohol, tobacco chewing, or smoking were excluded from the study.
A concise clinical history from the subjects with elaborate questionnaire regarding the AR was collected from every subject. A modified “Medical Research Council” questionnaire was used to elicit the respiratory symptoms. Clinical examination and anthropometry were performed on all the study participants included. Age, weight, height, and body mass index were the anthropometric parameters included.
The PFT was performed using computerized spirometry-version 4.02 (Model Spirometry) under standard conditions. PFT's including forced expiratory volume 1 (FEV1), FEV1%, peak expiratory flow rate (PEFR), and maximal voluntary ventilation (MVV) were performed. Protocol and procedures of the study were briefly explained to the study groups after making them familiar with the instrument working.
“Mann–Whitney U-test' has been applied for analyzing the significance of FEV1%. A descriptive kind of statistical analysis was carried out in this study, where the observations on uninterrupted measurement were denoted on the mean + standard deviation, and the results on categorical assessments were presented in the form of a number (%). The statistical significance of observations was evaluated at the “95% confidence interval”, where the “P < 0.05 is regarded as significant. The Student's t-test was applied to determine the significance of study variables among the two study groups.
| Results|| |
From the sum of 100 participants constituted in this study, most of them (around 50%) belonged to the <30 years age group [Table 1]. Smoking history was found in 12 (24%) of the patients with AR, with 8 (16%) being active smokers, 4 (8%) being passive smokers, and 26 (52%) being nonsmokers. The majority of the patients (64%) were from a lower socioeconomic category. The absolute eosinophil count was elevated in 18 (36%) individuals, whereas the rest were normal. The most prevalent symptoms among the patients with AR were watering, sneezing, and watering nose in 42 individuals (84%), followed by a nasal blockage in 38 cases (76%). FEV1 values were mildly significant, with a P = 0.013, denoting a mild decrease in FEV1 among the study group. PEFR values are highly significant, with a P value of 0.006, showing a marked reduction of PEFR among the study group. MVV values were highly effective, with a P = 0.009, indicating a substantial reduction of MVV among the study group compared to the control [Table 2].
|Table 2: Comparison of pulmonary function test among the study group and the control groups|
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| Discussion|| |
In this current study, the pulmonary functions such as the “FEV1, PEFR, and MVV” were assessed among the AR patients and then compared with the attenders and technical staff (normal individuals). The purpose of this study is to reevaluate whether AR can lead to a premature or aggravated loss of lung function. The PFT parameters, including the FEV1, FEV1%, PEFR, and MVV, were predominantly decreased in AR patients. There is no significant change in the anthropometric parameters among the two study groups included. The parameters pertaining to circulation such as the “pulse rate, blood pressure, and respiratory rate” were also insignificant among the two study groups.
Forced expiratory volume 1
This study observed a reduction in the FEV1% among the AR patients compared to the normal people included, where a decrease in lung volume among the minute airways was observed in these patients. A study by “Giorgio” demonstrated a predominant decline in the FEV1 and FEV1% among perennial AR patients, which was statistically significant (P < 0.001). A study by Gian LM et al. found that both FEV1 and FEV1% decreased by up to 25% among AR patients, suggesting this significant decrease could be an early marker for the impairment in the minute airways among AR patients. Our study observed that FEV1% has reduced to 68.77% among the people of a study group compared to the control group (86.13%), and FEV1 is 2.47 L in the study group and 2.29 L among the controls indicating an obstructive lung disease.
Peak expiratory flow rate
In this study, PEFR showed a drift toward a lesser mean value of the measured parameter among patients with AR. A survey by Giorgio et al. observed a significant reduction in the PEFR among perennial AR patients (P < 0.001), which is statistically significant.
PEFR has reduced to 380.87 L/min in our study among the AR patients compared to 462.77 L/min in the controls, which could probably indicate obstructive lung disease.
Maximal voluntary ventilation
A study by Giorgio et al. demonstrated that seasonal AR was found to have a marked decrease in MVV, which is statistically significant with P < 0.001. This study observed that the MVV in the study groups had been decreased drastically, denoting the variations such as emphysema or airway obstruction, which can result from immunological mechanisms or insufficient respiratory muscle strength.
The potential limitations of this study include the small sample size due to the difficulty in following the patient as this study is from a rural setting and is a first of its kind. Our research found no significant risk factors for abnormal PFT outcomes in AR patients. Additional research is required to look at other possible risk factors for an increased incidence of AR.
| Conclusion|| |
This study evaluated the variations in the pulmonary function among AR patients where the PFT parameters, including the “FEV1, FEV1%, PEFR, and MVV,” denoted a significant and definite reduction among the patients with AR when compared with the controls. The study emphasizes the importance of PFT in AR for distinguishing upper and lower airway disease as a unified disease process and that history of chest symptoms in AR patients should be included when checking for latent asthma.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Aaron SD, Dales RE, Cardinal P. How accurate is spirometry at predicting restrictive pulmonary impairment? Chest 1999;115:869-73.
Ng ML, Warlow RS, Chrishanthan N, Ellis C, Walls R. Preliminary criteria for the definition of allergic rhinitis: A systematic evaluation of clinical parameters in a disease cohort (I). Clin Exp Allergy 2000;30:1314-31.
Settipane RA. Demographics and epidemiology of allergic and nonallergic rhinitis. Allergy Asthma Proc 2001;22:185-9.
Marseglia GL, Cirillo I, Vizzaccaro A, Klersy C, Tosca MA, La Rosa M, et al.
Role of forced expiratory flow at 25-75% as an early marker of small airways impairment in subjects with allergic rhinitis. Allergy Asthma Proc 2007;28:74-8.
Ciprandi G, Cirillo I, Tosca MA, Vizzaccaro A. Bronchial hyperreactivity and spirometric impairment in patients with seasonal allergic rhinitis. Respir Med 2004;98:826-31.
Cirillo I, Vizzaccaro A, Tosca MA, Negrini S, Negrini AC, Marseglia G, et al.
Bronchial hyperreactivity and spirometric impairment in patients with allergic rhinitis. Monaldi Arch Chest Dis 2005;63:79-83.
Skiepko R, Zietkowski Z, Tomasiak-Lozowska MM, Tomasiak M, Bodzenta-Lukaszyk A. Bronchial hyperresponsiveness and airway inflammation in patients with seasonal allergic rhinitis. J Investig Allergol Clin Immunol 2011;21:532-9.
[Table 1], [Table 2]