A Study to assess the effectiveness of Oxygen Aided Nebulization Therapy on the Respiratory status among the Children with respiratory difficulty in Selected Hospitals of Punjab

 

Ms. Sonu Kumari¹, Mr. Sunil Kumar Garg², Dr. Harshavardhan Gupta³

¹Staff Nurse, M.Sc. (Paediatric Nursing) GGSMCH, Faridkot, Punjab

²Associate Professor, M.Sc. (Paediatric Nursing) SINPMS, Badal, Sri Muktsar Sahib, Punjab

³Associate Professor M.D. Paediatrics, GGSMCH, Faridkot, Punjab

 

ABSTRACT:

 

 

INTRODUCTION:

Respiratory infections are prevalent worldwide and are directly responsible for morbidity and a significant proportion of mortality, especially in children. The most common respiratory conditions include acute respiratory tract infections, asthma, pneumonia and bronchitis. In India, about 26.3 million cases of ARI were reported in 2011, with an incidence rate of about 2,173 cases per lakh population.¹ A child constitutes the most priority and vulnerable group in terms of survival, growth, and development.² Around 35 per cent of school-going children (ages of 8-14 years) in India suffer from poor lung health.³ A health survey of schoolchildren in Punjab has revealed an alarming factor that 8% children are suffering from bronchial asthma.⁴ According to India’s National Health Profile 2015, there were almost 35m reported cases of acute respiratory infection (ARI) last year, a 140,000 increase on the previous year and a 30% increase since 2010.⁵ ARIs also impose a significant economic burden on health systems and individual families in developing countries.⁶ The burden of ARIs in developing countries is considerably higher than that in developed countries.⁷ Recent estimates suggest that about 0.41 million young children died of ARIs in India in 2010.In India in 2010, 24% of the total deaths among children under five was due to ARIs.⁸ Due to their greater respiratory rates, children breathe a proportionately greater volume of air than adults. As a result, children inhale more pollutants per pound of body weight. They also spend more time engaged in vigorous activity than adults. In addition, because of young children's height and play habits (crawling, rolling) they are more likely to be exposed to pollutants or aerosols that are heavier than air and tend to concentrate in their breathing zone near ground level. Children's physiological vulnerability to air pollution arises from their narrower airways and the fact that their lungs are still developing. Irritation caused by air pollutants that would produce only a slight response in an adult can result in potentially significant obstruction in the airways of a young child.⁸

 

Nebulization is one of the easiest and most efficient ways to administer respiratory medications in children. Nebulization involves administration of liquid medicinal drugs, saline or distilled water directly into the respiratory tract. The drugs for nebulization are converted to aerosol particles or mist which can then be inhaled. It has the advantages of reduced drug requirement, rapid onset of therapeutic effect, decreased systemic side effects and better patient compliance.⁹ The main advantage of nebulized drugs is that they are deposited directly into the respiratory tract and thus higher drug concentrations can be achieved in the bronchial tree and pulmonary bed with fewer adverse effects. ¹⁰

 

The study was conducted with the objective to assess effectiveness of oxygen aided nebulization therapy on the respiratory status among the children with respiratory difficulty.

 

MATERIAL AND METHODS:

Research design:

Quasi experimental quantitative approach in which non-randomized control group design is used to carry out the present study.

 

Setting:

The present study was conducted at Guru Gobind Singh Medical College and Hospital, Faridkot and Women and Children Hospital Bathinda.

 

Sample:

The target population of the present study consists of 120 children who were having respiratory problems in Guru Gobind Singh Medical College and Women and Children Hospital Bathinda. 120 children were selected based upon the inclusion and exclusion criteria. Purposive Sampling Technique was used as a sampling technique while selecting samples for the study.

 

 

 

The study includes the children who were between age group of 6 to 14 years, willing to participate, diagnosed with respiratory difficulty and present at the time of data collection. The study excludes the children who were having cardiovascular diseases, unconscious, cannot understand command and other medical emergencies.

 

Instrumentation:

The tool used for data collection consists of two sections. Part-A consists of demographic data of the subjects which comprised of items seeking information pertaining to the selected variables such as age, gender, any smoker in the family and family history. Part-B consist of Pulmonary score index which is an aggregate of following three criteria:

a)       Respiratory rate

b)       Wheezing

c)       Accessory muscle use

 

Each criterion is assessed on 0-3-point scale. Pulmonary score index composite of objective clinical observations that compose a score from 0-9. The pilot study was conducted in the month of February, 2016 at Women and Children Hospital, Bathinda, after getting the administrative approval for conducting the pilot study. The size of sample selected for the pilot study was 1/10^th of the total sample size (N=120) i.e.12 i.e. 6 in experimental group and 6 in control group using purposive sampling technique. Both groups were taken from Women and Children Hospital, Bathinda. Reliability of tool was done using inter rater method.

 

Pulmonary Score Index was used to assess the pre-interventional respiratory status. After taking Pre-interventional PSI the experimental group was provided with oxygen aided nebulization with solution (asthalin) and Control group was provided nebulization with solution (asthalin) only. The intervention was given for 15 minutes. Post-interventional PSI of both the groups was taken to assess the post-interventional respiratory status. After conducting of the pilot study, the tool was found appropriate and reliable and the post test mean is higher than pre test which indicated that the oxygen aided nebulization is effective in improving the respiratory status of children, so the study was feasible.The findings of the pilot study revealed that it was feasible to conduct the main research.

 

RESULTS:

Table 1: Comparison of post interventional mean PSI score

Group	Observation Mean PSI score ± S. D.	Unpaired ‘t’ test
Experimental (n=60)	2.05 ± 0.92	3.71**       df = 118
Control  (n=60)	2.65± 0.84

** - significant at level of 0.05

 

Table 1 depicts that mean PSI score in experimental group was 2.05 ± 0.92 and 2.65± 0.84 in control group. On statistical analysis, using unpaired ‘t’ test the calculated value found was 3.71 which was higher than table value at 0.05 level of significance. Hence it was interpreted that there is statistically significant difference in the post interventional mean PSI score between experimental group and control group.

 

Table 2 depicts that during the post test, among 60 Subjects of control group, majority 49(81.7%) had mild and 11(18.3%) had moderate difficult in respiratory status. In experimental group, majority 58(96.7%) children had mild and 2(3.3%) had moderate difficult respiratory status. On comparison of post interventional respiratory status in Experimental and Control group, the Chi square value was found to be 6.98 which was  higher than table value  at 0.05 level of significance and it was interpreted that there is statistically significant difference in the post interventional  respiratory dificult status  between experimental and control group .

 

DISCUSSION:

In experimental group majority of the subjects 58 (96.7%) had mild and 2(3.3%) had moderate difficult respiratory status, whereas in control group majority of subjects 49(81.7%) had mild and 11(18.3%) had moderate respiratory difficult status. In the experimental group, the mean post-interventional PSI score was 2.05 ± 0.92 whereas in the control group, the mean post-interventional PSI score was 2.65 ± 0.84. The findings are supported by Memon B et al (2013) a randomized controlled trial was conducted from October 2012 to March 2013, comprised children 2-14 years of age, 4 parameters: heart rate (HR), respiratory rate (RR), wheezing, accessory muscle usage. Pre-intervention Mean clinical score in group A was 8.4 ± 2.3 and in group B was 8.6 ± 3.1 whereas post-intervention mean respiratory score in group A was 4.9 ± 2.1 and in group B was 4.4 ± 2.4.¹¹

 

On comparison of post-interventional respiratory status of experimental and control group the unpaired ‘t’ value was 3.71 at df = 118 and Chi-square (χ²) value was 6.98, df=1, Which was found significantly different in both the groups. As the calculated value is more than the table value at 0.05 level of significance. The null hypothesis is rejected i.e. there is a statistically significant difference in mean post interventional respiratory status of experimental and control group. The above objective and findings are supported by Sharma A, Madaan A (2004). In a small, poor-quality, open-label trial set in India, Fifty asthmatic children in the age range of 6-14years were divided into two equal groups. Group I children were nebulized with three doses of Salbutamol alone (0.03 ml/kg/dose) and Group II children were given combined nebulization of Salbutamol (dose as in group I) and Ipratropium bromide (250 microgm/dose for three doses) at 20 minutes interval. Oxygen was administered; Dyspnea, wheeze, and accessory muscle scores decreased from baseline more with combination therapy than with monotherapy.¹²

 

This study findings were also supported by a quasi experimental study results showing significantly improved mean respiratory status in experimental group from pre-intervention (8.33 ±2.84) to post-intervention 3rd (3.30 ±1.26) as compared to mean respiratory status of control group during pre-intervention (8.23±2.45) and postintervention 3rd (5.46±1.40) assessment. Respiratory status of children improved significantly in experimental group where breathing exercises as therapeutic play was administered along with Nebulization therapy as compared to control group.¹³

 

 

Table 2: Comparison of respiratory status of children in experimental and control group during post-test N=120

Level of respiratory status	PSI score (min- Max) (0-9)	Experimental group (n=60)		Control group (n=60)		Chi square test
		Frequency (f)	Percentage (%)	Frequency (f)	Percentage (%)
Mild	0-3	58	96.7	49	81.7	6.98* Df = 1
Moderate	4-6	2	3.3	11	18.3
Severe	>6 (6-9)	0	0.00	0	0.0
Total		60	10	60	100

** - significant at level of 0.05

 

 

LIMITATIONS AND FUTURE PRESPECTIVE:

Limitations of the Study:

·       Small number of sample subjects leads to limit the generalization of the study.

·       Short availability of time for data collection limits the area under research.

·       The study was limited to subjects attending the selected settings.

 

RECOMMENDATIONS:

On the basis of the findings of the study following recommendations are-

·       A similar study can be replicated on large sample to generalize the findings.

·       Oxygen aided nebulization can be used as a treatment of children with respiratory difficulty.

·       The study can be replicated in different settings as well as sample.

·       True experimental study can be conducted in order to see the effectiveness of oxygen aided nebulization.

·       Similar studies can be done using other inhaler devices.

·       Comparative study can be conducted among children living in rural and urban areas.

 

ACKNOWLEDGEMENT:

The authors are grateful to the authorities of SINPMS, Badal and BFUHS, Faridkot for the facilities.

 

REFERENCES:

1.      Central Bureau of Health Intelligence. National Health Profile (NHP) of India – 2011

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3.      Perappadan B. Gasping Little Hearts. The Hindu [Internet]. 2015 [cited 29 April 2016];:5. Available from: http://www.thehindu.com/todays-paper/tp-in-school/more-than-one-third-of-children-in-india-suffer-from-poor-lung-health/article7171334.ece

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9.      Wardlaw TM, Johansson EW, Hodge MJ. UNICEF; 2006. World Health Organization. Pneumonia: The Forgotten Killer of Children. URL:http://www.who.int/maternal_child_adolescent/documents/9280640489/en.

10.   Unicef; 2008.The State of Asia-Pacific's Children 2008: Child Survival. URL: http://www.unicef.org/sapc08/report/report.php.

11.   Memon B, Parkash A, Khan K, Gowa M, Bai C. Response to nebulized salbutamol versus combination with ipratropium bromide in children with acute severe asthma. JPMA. 2013; 66:243.

12.   Sharma A, Madaan A. Nebulized salbutamol vs salbutamol and ipratropium combination in asthma. Indian J Pediatr. 2004 Feb;71(2):121-4.

13.   Shally, Kumar Y, Kaur P. Effectiveness of breathing exercises as therapeutic play on respiratory status among children undergoing nebulization therapy with lower respiratory tract disorders. International Journal of Applied Research 2017; 3(11): 101-107

 

 

 

Received on 07.12.2018          Modified on 21.01.2019

Accepted on 18.02.2019     © A&V Publications all right reserved