Evaluation of Utility of a Simple Clinical Scoring System for Diagnosis and Severity Assessment of Asthma in Children

Introduction: Asthma is a common respiratory problem in children, however, its severity assessment in objective terms is difficult. Objective: To compare the usefulness of Pulmonary Index Score (PIS) with spirometry. Methods: A total of 100 children aged 6-17 years with clinical diagnosis of asthma were enrolled after excluding children with congenital or acquired cardiovascular, respiratory problems, juvenile diabetes mellitus and those unable to undertake spirometry. Demographic and clinical evaluation of patients was done. PIS was calculated by evaluating respiratory rate, wheezing and sternocleidomastoid activity. PIS total scores 0, 1-3, 4-6 and 7-9 were categorized as No, mild, moderate and severe asthma. Pulmonary expiratory flow rates (PEFR) % of predicted values >1, 0.8 to 0.1, 0.6 to 0.8 and <0.6 were categorized as No, mild, moderate and severe asthma. PIS and PEFR diagnoses were compared. Kappa-statistic was used to measure agreement. Results: Majority of children were aged <13 years (85%) and were boys (60%). Cough (88%), wheezing (70%) and repeated cold (54%) were the most common presenting complaints. A total of 30% each had mild and moderate while 18% had severe asthma as per PIS. On spirometry, asthma was confirmed in 75% children. Mild, moderate and severe asthma was diagnosed in 26%, 33% and 16% children with the help of spirometry. Overall, there was agreement on 76% cases between PEFR and PIS (k=0.675; p<0.001), The sensitivity and specificity of PIS in detection of moderate/severe asthma was 87.8% and 90.2% respectively. Conclusion: PIS is a simple and effective evaluation tool for pediatric asthma. Key words: Pediatric asthma, Spirometry, Pulmonary Index Score, Pulmonary expiratory flow rate (PEFR).