Bronchial asthma is a chronic inflammatory condition of the airways characterized by reversible airflow restriction, bronchial hyper responsiveness, and recurrent respiratory symptoms such as wheezing, coughing, shortness of breath, and chest tightness. It is one of the most frequent chronic illnesses in children and continues to be a serious public health issue around the world [1]. Childhood asthma has increased significantly in recent decades, particularly in low- and middle-income countries, as a result of rapid urbanization, environmental pollution, and lifestyle changes [2]. Asthma affects a large number of school-aged children in India and is a major cause of morbidity [3]. Asthma has a significant impact on children's physical, emotional, and social development. Asthma that is not well controlled causes frequent school absences, poor academic performance, limited physical activity, and higher healthcare utilization [4]. Early diagnosis and continuous monitoring are critical components of asthma care because they avoid acute exacerbations and long-term airway remodeling [5]. However, relying solely on clinical symptoms may underestimate the severity of airway obstruction, particularly in children who have poor symptom perception [6]. Thus, objective assessment of lung function is an essential component of asthma evaluation. Pulmonary function tests are useful for verifying a diagnosis, measuring severity, tracking disease progression, and evaluating treatment response [7]. Peak expiratory flow rate (PEFR) assessment is a straightforward, affordable, and portable approach for assessing pulmonary function in school-aged children. PEFR measures major airway function and offers an objective estimate of airflow limitation [8]. Regular PEFR monitoring aids in the early detection of worsening asthma, evaluation of therapy response, and prevention of severe exacerbations [9]. In resource-constrained areas where spirometry is not readily available, PEFR is a viable and effective option for functional asthma assessment [10]. Aim: In view of the increasing burden of childhood asthma and the need for simple monitoring tools, this study was undertaken to evaluate the clinical and functional status of bronchial asthma in school-aged children using peak expiratory flow rate.

This hospital-based cross-sectional observational study was carried out in the Department of Pediatrics, at Ram Krishna Medical College, Hospital and Research Center, Bhopal, Madhya Pradesh, India. The study was conducted over a period of 2 year from August 2023 to July 2025. Inclusion Criteria • Children aged 5–12 years. • Clinically diagnosed cases of bronchial asthma as per standard guidelines. • Children who were clinically stable at the time of assessment. • Children who could understand and perform PEFR maneuver correctly. • Written informed consent obtained from parents or guardians. Exclusion Criteria • Children presenting with acute severe asthma or status asthmaticus • Children with chronic respiratory diseases (e.g., cystic fibrosis, bronchiectasis, pulmonary tuberculosis). • Children with congenital or acquired heart diseases. • Children with neuromuscular disorders or chest wall deformities. • Uncooperative children or those unable to perform PEFR reliably. Clinical Evaluation A detailed clinical history was obtained including: • Duration of symptoms • Frequency of cough, wheeze, and breathlessness • Nocturnal symptoms • Triggering factors • Family history of asthma or allergy • Previous treatment history A thorough general and systemic examination was performed in all children. Assessment of Asthma Severity Asthma severity was classified into: • Intermittent • Mild persistent • Moderate persistent • Severe persistent Based on standard clinical guidelines, taking into account symptom frequency and functional status Functional Evaluation (PEFR Measurement) • Peak expiratory flow rate was measured using a standardized peak flow meter. • The procedure was explained and demonstrated to each child • The child was asked to stand upright and perform maximal forced expiration after full inspiration • Three readings were taken at intervals • The highest value was recorded for analysis • PEFR values were expressed as: • Absolute values (L/min) • Percentage of predicted PEFR based on age, sex, and height Statistical Analysis Data were analyzed with the Statistical Package for Social Sciences (SPSS) software. Categorical variables were summarized as frequencies and percentages, whilst continuous variables were reported as mean ± SD. The categorical variables were compared using the Chi-square test. The independent sample t-test was used to compare means between two groups, and one-way analysis of variance (ANOVA) was used to compare peak expiratory flow rate (PEFR) values among asthma severity groups. A p-value of <0.05 was judged statistically significant.

A total of 150 school-aged children (5–12 years) with clinically diagnosed bronchial asthma were included in the study. Table 1: Socio-demographic Characteristics of Study Participants (n = 150) Variable Number Percentage (%) Age Group (In Years) 5–7 60 40% 8–10 55 36.7% 11–12 35 23.3% Gender Male 92 61.3% Female 58 38.7% Residential Area Urban 88 58.7% Rural 62 41.3% Socio-economic status Upper 18 12% Middle 96 64% Lower 36 24% Family history of asthma Present 54 36% Absent 96 64% Exposure to passive smoking Yes 47 31.3% No 103 68.7% The majority of children belonged to the 5–10 year age group, was males, resided in urban areas, and belonged to middle socio-economic status. A positive family history of asthma was present in 36% of cases. Table 2: Distribution of Clinical Symptoms Symptom Present n (%) Absent n (%) p-value Cough 135 (90.0) 15 (10.0) <0.001 Wheezing 129 (86.0) 21 (14.0) <0.001 Breathlessness 104 (69.3) 46 (30.7) 0.002 Chest tightness 72 (48.0) 78 (52.0) 0.61 Nocturnal symptoms (44.0) 84 (56.0) 0.38 *Chi-square test comparing symptom prevalence. Cough and wheezing were significantly associated with bronchial asthma (p <0.001). Table 3: Mean PEFR Values According to Asthma Severity Asthma severity Mean PEFR (L/min) ± SD % Predicted PEFR Intermittent 310 ± 28 88–95% Mild persistent 270 ± 30 75–85% Moderate persistent 220 ± 25 60–74% Severe persistent 170 ± 20 <60% One-way ANOVA showed a highly significant difference in mean PEFR values across asthma severity groups (p <0.001). Table 4: Comparison of Mean PEFR between Mild and Moderate–Severe Asthma Group Mean PEFR (L/min p-value Intermittent + Mild 290 ± 32 <0.001 Moderate + Severe 205 ± 27 Children with moderate to severe asthma had significantly lower PEFR values compared to those with intermittent and mild asthma.

The clinical and functional characteristics of bronchial asthma in school-aged children were assessed using peak expiratory flow rate (PEFR). Bronchial asthma is one of the most frequent chronic respiratory illnesses in children and a leading source of morbidity, particularly in poor nations. In the current study, the majority of the youngsters were between the ages of 5 and 10, with a male predominance. Previous studies have indicated similar findings, with asthma being more prevalent in males during childhood, probably due to anatomical and hormonal variations in airway structure and development [11, 12]. The larger proportion of urban children found in this study could be ascribed to increased exposure to air pollution, allergens, and urbanization-related risk factors [13]. Coughing and wheezing were the most prevalent presenting symptoms, and they were found to be strongly linked with bronchial asthma. These findings are consistent with previous Indian and worldwide research that have identified cough and wheeze as the primary symptoms of pediatric asthma [14, 15]. Nocturnal symptoms were evident in a significant number of children, indicating that some patients had inadequate asthma management. In terms of asthma severity, the majority of children had intermittent or mild persistent asthma, with moderate and severe asthma making up a smaller but clinically significant group. Previous investigations on pediatric asthma have revealed similar severity distribution trends [16]. The functional examination demonstrated a gradual and statistically significant decrease in mean PEFR values with increasing asthma severity. Children with moderate-to-severe asthma exhibited significantly lower PEFR values than those with intermittent and mild asthma. This finding is consistent with research by Kamps et al [17] and Bacharier et al [18], which found a robust link between airflow limitation and clinical severity of asthma in children. The current study also found a strong relationship between asthma severity and % predicted PEFR, demonstrating that PEFR is a valid indicator of airway blockage. Several studies have highlighted the importance of PEFR monitoring in assessing disease control, predicting exacerbations, and guiding treatment decisions, especially in settings where spirometry is not commonly available [19, 20]. Given its simplicity, cost, and accessibility of use, PEFR is an important tool for routine functional assessment and follow-up of bronchial asthma in school-aged children, particularly in resource-constrained healthcare settings.

Bronchial asthma is a prevalent chronic respiratory condition in school-age children, with coughing and wheezing being the most common clinical symptoms. The current study found that as asthma severity increased, peak expiratory flow rate decreased significantly, and there was a substantial relationship between clinical severity and functional impairment. Peak expiratory flow rate is a straightforward, dependable, and cost-effective method for evaluating bronchial asthma in children. Routine PEFR monitoring, combined with clinical evaluation, can aid in the early discovery of airway obstruction, guide proper medication, and improve overall asthma control, especially in resource-limited settings.

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