Background Asthma and Viral Induced Wheeze (VIW) are common respiratory conditions in paediatrics. There are currently 1.1 million children in the UK suffering from asthma, which continues to cause a significant burden on the health care system. Viral induce wheeze is another common presentation to paediatric emergency departments with statistics showing around 1 in 3 children having at least one episode prior to the age of 3. Studies have shown that respiratory physiotherapy decreases severity of disease in patients with asthma and viral induce wheeze. This has been demonstrated by an improvement in Asthma Control Test and Nijmegen scores. However, the role of respiratory physiotherapy in the emergency department has never been investigated, despite asthma and viral induced wheeze being common presentations.
Objectives To investigate the impact of a physiotherapy service in an emergency department on patients diagnosed with viral induced wheeze or asthma
Methods Patients were referred to physiotherapy if they met the diagnostic criteria for asthma or viral induced wheeze. Referrals all received a screening telephone consultation to determine eligibility for a face-to-face review. Assessments included detailed history and examination followed by spirometry and clinically relevant blood tests to determine any allergens or triggers for respiratory decompensation. Interventions included education on inhaler technique, breathing exercises and trigger avoidance, initiation and optimisation of existing medical therapy and development of individualised action plans. Interventions were dependent on each patients’ clinical needs. Patients seen by the respiratory team in last 3 months were excluded.
During physiotherapy sessions the patients were asked to fill age appropriate questionnaires at the start and the end of the course. Severity of disease was assessed using asthma control test and Nijmengen score and quality of life through a paediatric quality of life questionnaire. Where patients were too young, quality of life questionnaires were completed by the parent. Only completed pairs of questionnaires were included in the final analysis and paired t-test was used to assess the statistical significance of any differences. Patients were also given a satisfaction surveys at the end of the session. Data was collected on consecutive referrals from June 2019 to January 2020.
Results There was a statistically significant improvement across the 3 questionnaires. In total 60 sets of Asthma control test (ACT) questionnaires were completed. The mean ACT score was 16.5 before physiotherapy and 22.5 after (p<0.001). 13 sets of Nijmengen scores were calculated. The mean score was 26.0 before physiotherapy and 12.5 after (P <0.001). 108 quality of life (QoL) questionnaires were completed. The mean QoL score when completed by patients improved from 64.6 to 78.7 (P<0.001). The mean QoL score when completed by parents similarly improved from 65.5 to 82.1 (P<0.001). Satisfaction surveys showed positive experiences of the service provided
Conclusions This retrospective analysis suggests that patients presenting to an emergency department with asthma or viral induced wheeze may benefit from a decrease in severity of disease and improvement in quality of life if they attend physiotherapy. Larger, prospective studies in different settings are needed to evaluate this finding.
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