Spirometry findings among children presenting with a wheeze and or nocturnal cough at Moi Teaching and Referral Hospital, Eldoret Kenya

Abstract

Background: Wheeze and nocturnal cough are common symptoms of various disease conditions including bronchial asthma, whose diagnosis can be confirmed by spirometry. Challenges of diagnosis of bronchial asthma in children have been associated with overreliance on clinical symptoms, resulting in inappropriate management. Spirometry is the gold standard for diagnosis of asthma in children. This study sought to determine the spirometry findings among children presenting with a wheeze and or nocturnal cough at Moi Teaching and Referral Hospital (MTRH). Objective: To determine socio-demographic and clinical characteristics, spirometry findings and to describe factors associated with abnormal spirometry findings among children aged 6-14 years, presenting with a wheeze and or a nocturnal cough at MTRH. Methods: Cross-sectional study design was conducted in MTRH at the outpatient clinic during the period between June 2019 to February 2020.A census was conducted and 114 participants were recruited. Interviewer administered questionnaire was used to obtain socio demographic and clinical characteristics. Spirometry was performed using an MIR Spiro lab III spirometer device. Descriptive statistics was applied to explore and summarize variables. Categorical variables were summarized in frequencies, proportions and reported in tables, while numeric variables were summarized in median, interquartile ranges and presented in tables. Chi square test was used to test for association between abnormal spirometry findings and other categorical variables such as gender, while Mann Whitney U test was used to compare median age among those who had abnormal spirometry findings. Results: The median age was 9.7 years, majority were aged between 6-9 years at 60(52.63) with a male: female ratio of 1.1:1.Urban dwellers were 59(51.75%), versus rural 55(48.725%). The participants who came from households that used charcoal for cooking were 74(64.04%).Allergens included household cigarrete smoke at 23(20.8%) and household pets 69(60.53%). The participants who presented with cough were 21(18%), those who presented with wheeze were 13(11.40%) and 80(70.18 %) had presented with both cough and wheeze. Duration of cough, median IQR 5(3, 7) and wheeze median IQR 4 (3, 7). Among the study participants who presented with wheeze and or nocturnal cough, 28(24.6%) demonstrated positive reversibility test. Male gender was associated with abnormal spirometry findings at (P=0.022). Conclusion :Majority of the participants were aged between six to nine years of age, more than half resided in an urban set up and three quarters of them presented with both wheeze and nocturnal cough. Asthma was confirmed in a quarter of the participants who presented with both wheeze and or nocturnal cough. Being male was associated with abnormal spirometry findings. Recommendations: Spirometry should be done for all children presenting with wheeze and or nocturnal cough (considered to have asthma) since not all participants were found to have abnormal spirometry findings.