A simple, reliable quantitative score for grading chest X-ray in adult asthma

The purpose of the present study was to rate the level of spread of the morphological changes on chest X-ray (CXR), using the modified Shwachman–Kulczycki (S–K) rating scale, in relation to changes in routinely measurable parameters in outpatient clinic, such as frequency of respiration (FR), heart rate (HR), wheeze (WHZ) and peak expiratory flow (PEF). Asthma patients were classified into 4 groups; Group-1 ⩽ 2 visits per week with reversible symptoms, Group-2 two visits per week with irreversible symptoms, Group-3: 3–4 visits per week with irreversible symptoms; Group-4: patients with severe shortness of breath in whom SaO2 was threatening, hence were admitted as inpatients. CXR for group-2 showed bilateral increase in perihelia marking, bronchovascular markings but normal lungs fields and ruled out for costophrenic angles. Group-3 showed hyperinflation, obvious perihelia marking associated with bronchial thickening and blocking as well as unfolding aorta, with significantly (p < 0.05) lower PEF, higher HR, FR and WHZ than group 1 and 2. There was also some evidence of bronchial edema with clearly observed fleeting terminal bronchial opacities. CXR for Group-4 showed, extensive atelectasis secondary to obstruction and infection due to bronchiolitis and/or signs of right heart failure. Intra-classcorrelation coefficient showed a significant (p < 0.05) reliability among evaluators of CXR, implying its consistent applicability. Based on the results of the present study it can be concluded that monitoring PEF, FR, WHZ and HR parameters in outpatient clinic can be an objective estimate of the S–K score in order to classify the severity of asthma-induced-morphological changes in CXR.