Comparative study of seasonal variability in peak expiratory flow rate amongst school children in rural and urban areas

Bharat Bhushan, Leena Chopra, Surinder P. Singh, Shivam Bhalla, Heena Bharti


Background: Peak Expiratory Flow (PEF) is a value test for lung function and can be conveniently measured by using relatively inexpensive and portable Peak Flow Meter, identifying and assessing the degree of airflow limitation of individuals. While PEFR is obviously related to factors like age, weight, height, race, gender, it may also be additionally affected by seasons and climate. The purpose of study being to observe seasonal variation in PEFR amongst school going children and to observe peak expiratory flow rate in school going children in urban and rural areas.

Methods: This prospective and comparative study was carried out on total 600 children; with 300 each from rural and urban schools, of age group 10-14 years, both sexes. Peak expiratory flow meter was used for the measurements in the seasons of summer (April to June) and winter (December to February) of the year. The results thus obtained were compiled and analysed.

Results: The mean PEFR value (Litres/min) during summers in the rural children was 243.50(S.D.=16.050) while during winters was 253.63(S.D.=16.934), highly significant (p<0.001);  mean PEFR summers in the urban  children was 241.50(S.D.=20.530)and during winters  was 249.93(S.D.=21.685), again highly significant (p<0.001).

In both rural and urban groups PEFR values increased with increase in height and weight of the children which was found to be highly significant (p<0.001). Girls representation proportion in rural vs urban schools being 49% vs 45%; whereas boys being 51% vs 55% respectively.

Conclusions: Peak expiratory flow rate decreased during summer season of the year in both rural and urban school attending children. In both the groups PEFR values had a direct correlation with height and weight of the children. Rural schools showed more girl student representation than their urban counterparts indicating more awareness for girl child education amongst rural population.


Airflow limitation, Children, Peak expiratory flow rate, Rural, Seasonal variability, Urban

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Gardner RM, Hankinson JL, Clausen JL, Crapo RO, Johnson Jr RO, Epler GR. American Thoracic Society standardization of spirometry: 1987 update. Am Rev Respir Dis. 1987;136:1285-98.

Składanowski M, Jarosz P, Mackiewicz B. Variations of Peak Expiratory Flow Rate Associated with Various Factors Among Healthy Adults in a City Setting. Polish J Pub Health. 2016 Jun 1;126(2):91-4.

Carson JW, Hoey H, Taylor MR. Growth and other factors affecting peak expiratory flow rate. Archi Dis Childhood. 1989 Jan 1;64(1):96-102.

Primhak R, Coates FS. Malnutrition and peak expiratory flow rate. Euro Resp J. 1988 Oct 1;1(9):801-3.

Thomas PS, Harding MR, Milledge JS. Peak expiratory flow at altitude. Thorax. 1990;45(8):620-2.

Frischer T, Kühr J, Meinert R, Karmaus W, Forster J, Urbanek R. Relation between response to exercise and diurnal variability of peak expiratory flow in primary school children. Thorax. 1993 Mar 1;48(3):249-53.

Rosa AM, Ignotti E, Botelho C, Castro HA, Hacon SD. Respiratory disease and climatic seasonality in children under 15 years old in a town in the Brazilian Amazon. J Pediatr. 2008 Dec;84(6):543-9.

Swaminathan S, Venkatesan P, Mukunthan R. Peack expiratory flow rate in South Indian Children. Indian Pediatr. 1993;30(2):207-11.

Pfaff JK, Morgan WJ. Pulmonary function in infants and children. Pediatr Clini North Am. 1994 Apr 1;41(2):401-24.

Adeniyi BO, Erhabor GE. The peak flow meter and its use in clinical practice. Africa J Resp Med. 2016.

Singh V, Mathur US, Bhandari VM, Jain NK. Peak expiratory and inspiratory flow rates: comparative study of pink city flow meter with wright peak flow meter. Lung Ind. 1987 Nov 1;5(4):171-4.

Paramesh H. Epidemiology of asthma in India. Ind J Pediatr. 2002 Apr 1;69(4):309-12.

Manjunath CB, Kotinatot SC, Babu M. Peak expiratory flow rate in healthy rural school going children (5-16 years) of Bellur region for construction of nomogram. J Clin Diag Res. 2013 Dec;7(12):2844-6.

Vieira SE, Stein RT, Ferraro AA, Pastro LD, Pedro SS, Lemos M, et al. Urban air pollutants are significant risk factors for asthma and pneumonia in children: the influence of location on the measurement of pollutants. Arch Bronconeumologia. 2012 Nov 1;48(11):389-95.

Sonnappa S, Lum S, Kirkby J, Bonner R, Wade A, Subramanya V, et al. Disparities in pulmonary function in healthy children across the Indian urban-rural continuum. Am J Respiratory Crit Care Med. 2015 Jan 1;191(1):79-86.

Burt PJ, Sharma P. Effects of aeroallergens on the lung function of primary school children at two contrasting sites in South-East England. Aerobiol. 2002 Jun 1;18(2):125-34.

Sahoo D, Harsoda JM. An appraisal on spirometry in three peak seasons in normal population. Int J Sci Res. 2019;81-2.

Ferdousi HA, Munir AKM, Zetterström O, Dreborg SKG. Seasonal differences of peak expiratory flow rate variability and mediators of allergic inflammation in non‐atopic adolescents. Paediatr Allergy Immunol. 2002.

Strachan PM, Medarov BI. Long Island Jewish Medical Center, New Hyde Park, NY. Seasonal variation in lung function. Chest. 2005;128:173S.

Gultyaeva VV, Shishkin GS, Grishin OV. Seasonal variations in respiratory system in healthy inhabitants of west Siberia. Int J Circump Health. 2001 Apr;60(2):334-8.

Kaur H, Singh J, Makkar M, Singh K, Garg R. Variations in the peak expiratory flow rate with various factors in a population of healthy women of the malwa region of Punjab, India. J Clin Diag Res: JCDR. 2013 Jun;7(6):1000-3.