Journal articles on the topic 'Fractional exhaled nitric oxide (FENO) suppression test'
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Khurana, Sandhya. "Use of fractional exhaled nitric oxide to guide the treatment of asthma and chronic cough." Journal of Precision Respiratory Medicine 5, no. 1 (December 1, 2022): 1–4. http://dx.doi.org/10.2500/jprm.2022.5.220003.
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Fractional exhaled nitric oxide (FeNO) is a breath biomarker that is easy to perform at the point of care in individuals 5 years or older. Elevated FeNO levels indicate increased type 2 airway inflammation, specifically increased interleukin 4/13 activity. Recent guidelines have made recommendations on the utility of FeNO measurement in the diagnosis and management of asthma. Measurement of FeNO is recommended as an adjunct to the evaluation process in patients with suspected asthma in whom the diagnosis of asthma is uncertain based on clinical presentation, spirometry, and bronchodilator challenge testing. Elevated FeNO levels are associated with an increased risk of asthma exacerbation, and FeNO suppression test can help differentiate “difficult” from “severe” asthma. High FeNO levels can predict response to anti-inflammatory therapies, including corticosteroids and certain biologics. FeNO measurement also has value in evaluation of chronic cough with increased levels suggesting a corticosteroid responsive condition such as cough-variant asthma or eosinophilic bronchitis.
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Gemicioglu, Bilun, Benan Musellim, Ismail Dogan, and Kasim Guven. "Fractional Exhaled Nitric Oxide (FeNo) in Different Asthma Phenotypes." Allergy & Rhinology 5, no. 3 (January 2014): ar.2014.5.0099. http://dx.doi.org/10.2500/ar.2014.5.0099.
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Fractioned exhaled nitric oxide (FeNO) is a noninvasive marker of inflammation in asthmatic patients. FeNO can be used to monitor airway inflammation, but individual responses make tailored interventions based on FeNO difficult. The correlation between the asthma control test (ACT), FEV1, and FeNO was evaluated in this study to ascertain the correct usage of FeNO with different asthma phenotypes regarding their control, allergy, comorbidity, obesity, age, smoking status, and severity. ACT, pulmonary function, and FeNO in 416 asthmatic patients on combined therapy were retrospective evaluated. Correlations between these parameters and the FeNO levels in different asthma phenotypes were calculated. In the study population, FeNO was 31.8 ± 28.5 parts per billion (ppb), FEV1 was 83.4 ± 19% and ACT was 19 ± 5.2. ACT scores were negatively correlated with FeNO (r = −0.31; p = 0.002). FeNO was different in patients with positive and negative skin-prick test (p < 0.05), with and without allergic rhinitis (p < 0.01), and with and without allergic conjunctivitis (p < 0.01). Significantly higher FeNO levels were found with logistic regression analysis only in patients with a history of emergency room visits (ERVs) (p = 0.024). The rate of the ERV of the patients with an ACT score more than or equal to 20 and with a FeNO value of more than 35 ppb was 22.9%, but with a FeNO value of less than 35 ppb was 6.5% (p = 0.004). Allergy and allergic comorbidities may lead to an increase in FeNO levels. Patients with a history of ERV have markedly higher FeNO levels, although they have an ACT score more than or equal to 20.
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Jang, Yoon Young, and Ji Young Ahn. "Evaluation of Fractional Exhaled Nitric Oxide in Pediatric Asthma and Allergic Rhinitis." Children 8, no. 1 (December 23, 2020): 3. http://dx.doi.org/10.3390/children8010003.
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Fractional exhaled nitric oxide (FeNO) is a non-invasive test for evaluating the degree of airway inflammation and for the diagnosis, evaluation, and treatment of asthma. We attempted to measure FeNO levels in Korean children with asthma and determine its cutoff value for diagnosing asthma. We enrolled 176 children and adolescents between the ages of 5 and 18 years, who visited for the evaluation of chronic cough, shortness of breath, and wheezing. Among them, 138 patients who underwent skin prick tests or inhalation Immuno CAP (UniCAP; Pharmacia, Uppsala, Sweden) tests for allergy testing together with a pulmonary function test were included. FeNO was measured using a NIOX MINO (Aerocrine AB, Solna, Sweden) instrument according to the American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines. There were 29 patients with asthma, 43 with rhinitis, and 38 with asthma and allergic rhinitis. In the asthma group, FeNO levels significantly correlated with total immunoglobulin E (r = 0.572, p < 0.001), but did not show significant correlation with pulmonary function test parameters (forced vital capacity—FVC, forced expiratory volume in one second—FEV1, FEV1/FVC) or PC20 (provocative concentration of methacholine causing a 20% fall in FEV1). The FeNO cutoff values obtained in the asthma and asthma rhinitis groups were 16.5 ppb and 18.5 ppb, respectively. Hence, we provide a FeNO cutoff value according to the presence or absence of rhinitis in pediatric patients with asthma.
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Akbay, Nilay Orak, Zuleyha Bingol, Esen Kiyan, Ekrem Bilal Karaayvaz, Ahmet Kaya Bilge, Halim Issever, and Gulfer Okumus. "Fractional Exhaled Nitric Oxide Measurement in Pulmonary Hypertension: A Follow-Up Study." Clinical and Applied Thrombosis/Hemostasis 24, no. 3 (April 10, 2017): 483–88. http://dx.doi.org/10.1177/1076029617702243.
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Pulmonary hypertension (PH) is a fatal disease although significant improvements in treatment are achieved. Easily implemented and noninvasive prognostic techniques are needed while following-up these patients. The aim was to investigate the role of fractional exhaled nitric oxide (FeNO) in follow-up for patients with PH. In this longitudinal study, patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic PH (CTEPH) who were seen in PH Outpatient Clinic, Istanbul Faculty of Medicine, Istanbul University, were enrolled in the study. Echocardiography, 6-minute walking test, brain natriuretic peptide, and FeNO measurements were performed, and World Health Organization functional class was evaluated to all patients at baseline, and third, and sixth months. Right-heart catheterization and pulmonary function tests at the time of diagnosis were recorded. The study comprised 31 patients (23 women, 8 men; mean age: 53.4 ± 17.1 years) with PAH (n = 19) and CTEPH (n = 12) and 80 healthy controls. Patients with PH had lower FeNO values than the control group (16.5 ppb vs 19.8 ppb; P < .05). Fractional exhaled nitric oxide values did not change during follow-up and did not correlate with other follow-up measures except tricuspid annular plane systolic excursion values. Fractional exhaled nitric oxide was higher in the idiopathic PAH subgroup at baseline and at third month than patients with PAH associated with other diseases. Fractional exhaled nitric oxide did not change in patients who had clinical deterioration. As a conclusion; Patients with PH had lower FeNO values than healthy controls, but FeNO did not change significantly during follow-up. Large-scale studies with prolonged follow-up periods are needed to understand the role of FeNO in the follow-up of the patients with PH.
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Mosquera, Ricardo A., Cheryl L. Samuels, Tomika S. Harris, Aravind Yadav, S. Shahrukh Hashmi, Melissa S. Knight, and Mary Kay Koenig. "Decreased Exhaled Nitric Oxide Levels in Patients with Mitochondrial Disorders." Open Respiratory Medicine Journal 7, no. 1 (July 26, 2013): 67–70. http://dx.doi.org/10.2174/1874306401307010067.
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Background: Nitric oxide (NO) deficiency may occur in mitochondrial disorders (MD) and can contribute to the pathogenesis of the disease. It is difficult and invasive to measure systemic nitric oxide. NO is formed in the lungs and can be detected in expired air. Currently, hand-held fractional exhaled nitric oxide (FeNO) measurement devices are available enabling a fast in-office analysis of this non-invasive test. It was postulated that FeNO levels might be reduced in MD. Methods: Sixteen subjects with definite MD by modified Walker criteria (4 to 30 years of age) and sixteen healthy control subjects of similar age, race and body mass index (BMI) underwent measurement of FeNO in accordance with the American Thoracic Society guidelines. Results: Sixteen patient-control pairs were recruited. The median FeNO level was 6.5 ppm (IQR: 4-9.5) and 10.5 ppm (IQR: 8-20.5) in the MD and control groups, respectively. In 13 pairs (81%), the FeNO levels were lower in the MD cases than in the matched controls (p=0.021). Eleven (69%) cases had very low FeNO levels (≤7ppm) compared to only 1 control (p=0.001). All cases with enzymatic deficiencies in complex I had FeNO ≤7ppm. Conclusions: Single-breath exhaled nitric oxide recordings were decreased in patients with MD. This pilot study suggests that hand-held FeNO measurements could be an attractive non-invasive indicator of MD. In addition, measurement of FeNO could be used as a parameter to monitor therapeutic response in this population.
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Duong-Quy, Sy, Thuy Nguyen-Thi-Dieu, Khai Tran-Quang, Tram Tang-Thi-Thao, Toi Nguyen-Van, Thu Vo-Pham-Minh, Quan Vu-Tran-Thien, et al. "Study of Nasal Fractional Exhaled Nitric Oxide (FENO) in Children with Allergic Rhinitis." Sinusitis 5, no. 2 (October 8, 2021): 123–31. http://dx.doi.org/10.3390/sinusitis5020013.
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(1) Background: Exhaled nitric oxide (NO) has been considered as a biomarker of airway inflammation. The measurement of fractional exhaled NO (FENO) is a valuable test for assessing local inflammation in subjects with allergic rhinitis (AR). (2) Objective: To evaluate (a) the correlation between nasal FENO with anthropometric characteristics, symptoms of AR and nasal peak flows in children without and with AR; and (b) the cut-off of nasal FENO for diagnosis of AR in symptomatic children. (3) Methods: The study was a descriptive and cross-sectional study in subjects with and without AR < 18 years old. All clinical and functional characteristics of the study subjects were recorded for analysis. They were divided into healthy subjects for the control group and subjects with AR who met all inclusion criteria. (4) Results: 100 subjects (14 ± 3 years) were included, including 32 control subjects and 68 patients with AR. Nasal FENO in AR patients was significantly higher than in control subjects: 985 ± 232 ppb vs. 229 ± 65 ppb (p < 0.001). In control subjects, nasal FENO was not correlated with anthropometric characteristics and nasal inspiratory or expiratory peak flows (IPF or EPF) (p > 0.05). There was a correlation between nasal FENO and AR symptoms in AR patients and nasal IPF and EPF (p = 0.001 and 0.0001, respectively). The cut-off of nasal FENO for positive AR diagnosis with the highest specificity and sensitivity was ≥794 ppb (96.7% and 92.6%, respectively). (5) Conclusion: The use of nasal FENO as a biomarker of AR provides a useful tool and additional armamentarium in the management of allergic rhinitis.
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Barański, Kamil, Krzysztof Kocot, Edyta Melaniuk-Wolny, Elwira Zajusz-Zubek, and Małgorzata Kowalska. "The Effect of Physical Activity on Spirometry and Fractional Exhaled Nitric Oxide in Adolescents—Longitudinal Study." Sustainability 13, no. 11 (May 21, 2021): 5770. http://dx.doi.org/10.3390/su13115770.
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Highly intense and chronic physical activity may cause an inflammatory process in the airways. The inflammatory process in the respiratory system can be measured either by the spirometry test and exhaled nitric oxide. The aim of this study was to assess the effect of different levels of physical activity on fractional exhaled nitric oxide (FeNO) and spirometry parameters. Fifty healthy students (volunteers) who were participating in physical activity classes (low level of physical activity) and attending sports training (high and medium level of physical activity) completed two indoor exercise training two to three weeks apart. FeNO was measured twice, at baseline and after 45–60 min of exercise followed by spirometry. There was no significant difference in FeNO values and spirometry parameters between the groups with different physical activity. However, students with the highest level of physical activity presented a higher and significant variance of FeNO levels in comparison to students with lower physical activity. Healthy young adults (professional sportspersons) have a higher internal variability of FeNO. That suggests the initial ongoing inflammatory process in the airways. Any level of physical activity does not affect spirometry parameters before and after training in young healthy adults.
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Gao, Qingbo, Qiaozhen Wu, Fei Li, and Cheng Chen. "Fractional exhaled nitric oxide could identify early spirometry change in clinically suspected asthma patients without airway obstruction." European Journal of Inflammation 19 (January 2021): 205873922110041. http://dx.doi.org/10.1177/20587392211004110.
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Fractional exhaled nitric oxide (FeNO) has been proposed as a non-invasive biomarker for allergic inflammation seen in asthma. The aim of this study was to assess the ability of FeNO to discriminate spirometry and lung volume measurements between those with and without airway obstruction among subjects with clinically suspected asthma. A retrospective study was conducted. Diagnostic evaluations including spirometry and FeNO testing (NO electrochemical equipment: NIOX VERO; Aerocrine AB, Solna, Sweden) were performed in all subjects. Airway obstruction was defined according to the Standardization of Spirometry of the American Thoracic Society (ATS)/European Respiratory Society (ERS), and 2014 recommendations of the Chinese National Guidelines of Pulmonary Function Test. It was used the Student t test for analysis of continuous variables and the χ2 test for analysis of discrete variables including FeNO levels and lung function metrics. Of the 138 subjects with clinically suspected asthma, airway obstruction was found in 61. There was no significant difference in the mean FeNO levels among subjects with or without airway obstruction ( p = 0.241) among un-selected subjects. Likewise, there was no difference in the FeNO levels between aged (>50 years) and younger subjects (⩽50 years) ( p = 0.804). A significant proportion of subjects had a normal FeNO level (<25 part per billion, ppb) in spite of having airway obstruction (39/138), 25 had an elevated FeNO level (⩾25 ppb) in spite of having no airway obstruction (25/138). Additionally, the airway-obstructed subjects with increased FeNO level had comparable spirometry to those with normal FeNO level ( p > 0.05). However, among subjects without airway obstruction, the forced expiratory volume in 1 s (FEV1)/predicted (pred), maximal expiratory flow at 25% of forced vital capacity (FVC) (MEF25%)/pred, maximal expiratory flow at 50% of FVC (MEF50%)/pred and maximum mid-expiratory flow (MMEF)/pred were significantly lower in the FeNO ⩾ 25 ppb group compared to those in the FeNO < 25 ppb group. These analyses indicated that increased FeNO levels could help to determinate early spirometry change within clinically suspected asthma subjects without airway obstruction. It is highlighted the importance of FeNO as a phenotype associated with an increased risk of airway obstruction in some subjects in this study.
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Hetherington, KJ, RW Costello, and LG Heaney. "S2 Fractional exhaled nitric oxide (feno) suppression to identify non-adherence in difficult asthma." Thorax 71, Suppl 3 (November 15, 2016): A4.2—A5. http://dx.doi.org/10.1136/thoraxjnl-2016-209333.8.
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Galiniak, Sabina, David Aebisher, and Marta Rachel. "Exhaled nitric oxide in smokers and former smokers with chronic obstructive pulmonary disease." Medical Science Pulse 14, no. 1 (June 30, 2020): 1–16. http://dx.doi.org/10.5604/01.3001.0014.2399.
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Background: Measurement of fractional exhaled nitric oxide (FeNO) is a useful technique for detection of eosinophilic airway inflammation and assessment of efficiency of corticosteroid treatment in patents with respiratory disease. Generally studies agree that measurement of FeNO is a useful non-invasive biomarker in patients with chronic obstructive pulmonary disease (COPD), however, there are reports that do not confirm such a relationship between FeNO and COPD. Aim of the study: The main objective of this study was to investigate FeNO levels in Polish patients with COPD compared to healthy controls. As a secondary objective, we assessed the influence of smoking on FeNO levels in healthy patients, and patients with COPD. Material and methods: FeNO concentration was measured using an electrochemical analyzer in healthy non-smokers (n=21), healthy smokers (n=25), and former smokers with COPD (n=30) and smokers with COPD (n=38). General characteristics, hematological variables and serum biochemical parameters were also obtained and analyzed using the Kruskal-Wallis test. Results: FeNO measurement revealed significantly reduced NO levels in healthy smokers compared to healthy non-smokers, former smokers with COPD and smokers with COPD (median [range]: 14 [6–17] vs. 21 [15–29], 25 [15–53], and 19 [11–32] ppb, respectively, p<0.001). Moreover, we found increased FeNO levels in ex-smokers with COPD compared with smokers with COPD (p<0.05). No associations between FeNO and other analyzed parameters were found. Conclusions: Levels of FeNO, measured by with an electrochemical analyzer, were elevated among patients with COPD compared to healthy non-smoking controls. Moreover, our study confirms that smoking results in a reduction in FeNO concentration in both healthy patients and patients with COPD.
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Carpagnano, Giovanna Elisiana, Alessandro Radaeli, Donato Lacedonia, Michele Correale, Giuseppe Carpagnano, Antonio Palmiotti, Maria Pia Foschino Barbaro, et al. "Exhaled Nitric Oxide and Exhaled Breath Temperature as Potential Biomarkers in Patients with Pulmonary Hypertension." BioMed Research International 2018 (August 26, 2018): 1–9. http://dx.doi.org/10.1155/2018/7292045.
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Background. Pulmonary hypertension (PH) is a progressive fatal disease thus, noninvasive prognostic tools are needed to follow these patients. The aim of our study was to evaluate fractional exhaled nitric oxide (FeNO) and exhaled breath temperature (EBT) values in patients with PH from different causes and to correlate them with respiratory functional data. Methods. Twenty-four PH patients underwent spirometry, carbon monoxide diffusion (DLCO) test, transthoracic echocardiography, right-heart catheterization, and FeNO and EBT measurements. Results. We studied 3 groups according to the type of PH: 10 patients with pulmonary arterial hypertension (PAH) (group A), 11 patients with PH due to chronic obstructive pulmonary disease (COPD) (group B), and 3 patients with PH associated with left heart disease (group C). Mean FeNO values tend to be higher in group B (15.0 ± 9.3ppb) compared with other groups (respectively, 9.9 ± 5.7 and 8.5 ± 5.2 ppb in groups A and C; p = 0.271) but no statistical significance has been reached. Mean values of alveolar NO concentration (CANO) were higher in groups A and B compared to group C (respectively, 16.9 ± 12.6; 13.9 ± 6.8; and 6.7 ± 2.0 ppb) (p = 0.045). EBT mean values were significantly lower in group C when compared with other groups (group C: 29.0 +- 1.3°C, groups A and B: 30.9 ± 1.3 and 31.2 ± 1.2°C, respectively: p = 0.041). EBT levels were inversely correlated to mean pulmonary artery pressure (PAPm) levels (Spearman coefficient -0.481; p = 0.017). Conclusions. eNO, CANO, and EBT have been evaluated in three groups of PH patients. Interestingly EBT reduction was correlated with PAPm increase, whereas FeNO was higher in COPD patients and CANO in PAH and COPD groups. Further studies are needed to clarify EBT, FeNO, and CANO roles as biomarkers in the monitoring of patients with PH.
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Liu, Jiaxing, Rong Xu, Chen Zhan, Wei Luo, Kefang Lai, Nanshan Zhong, Wei Chen, and Ruchong Chen. "Clinical utility of ultrahigh fractional exhaled nitric oxide in predicting bronchial hyperresponsiveness in patients with suspected asthma." Postgraduate Medical Journal 95, no. 1128 (July 11, 2019): 541–46. http://dx.doi.org/10.1136/postgradmedj-2018-136333.
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BackgroundFractional exhaled nitric oxide (FeNO) is a non-invasive biomarker for airway eosinophilic inflammation. However, the clinical value of ultrahigh FeNO (≥100 parts per billion (ppb)) in predicting asthma is never explored. We aimed to investigate the value of ultrahigh FeNO as a predictor of bronchial hyperresponsiveness (BHR), an important index for asthma diagnosis.MethodsA retrospective cohort study was conducted on 259 patients with suspected asthma who received the examination of FeNO, spirometry, bronchial provocation test (BPT) and differential cell count of induced sputum. Patients were stratified by FeNO value: ultrahigh (group A:≥100 ppb), high (group B: 50–99 ppb), intermediate (group C: 26–49 ppb) and normal (group D:≤25 ppb). The positive rates of BPT and sputum eosinophils percentage (Eos%) were compared among four cohorts. The correlations between FeNO and sputum Eos% were measured.ResultsA significant higher positive rate of BPT was observed in group A (90.91%) than all others (B: 51.43%, C: 31.43%, D: 28.13%, all p<0.01). Referring to group D, the ORs of positive BPT in groups A, B and C were 26.84, 2.84 and 1.05. Sputum Eos% in group A (19.75 (7.00, 46.25)) is higher than that in others (B: 3.50 (1.00, 12.75), C: 1.13 (0.06,3.50), D: 0.50 (0.00, 2.13)). FeNO correlates with sputum Eos% in groups A and B, but not group C or D.ConclusionsUltrahigh FeNO correlates with BHR and could serve as a practical alternative to methacholine challenge to support an asthma diagnosis in patients with suspected asthma in primary care.
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Al-Hindy, Hayder Abdul-Amir Makki, Ali Jihad Hemid Al-Athari, Mazin J. Mousa, Safa Jihad Hameed, and Suhad Hafidh Obeed. "The Utility of Serum IL-1β and CRP Together with Fractional Exhaled Nitric Oxide in the Diagnosis of Asthma in Adults." NeuroQuantology 19, no. 8 (September 4, 2021): 119–24. http://dx.doi.org/10.14704/nq.2021.19.8.nq21122.
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Background: Bronchial asthma (BrA), recognized lately as an umbrella, covers various subtypes rather than only one disease. Asthma is a chronic inflammation of the airways, in which cytokines could play a crucial role in its pathogenesis. Hence, labors to progress noninvasive markers for asthma had centered through this era. Presently, the fractional exhaled nitric oxide (FeNO), serum C-reactive protein (CRP), and interleukin levels are emerging analytical biomarkers in this field. FeNO is a noninvasive and practical tool even in mild asthma. This study aimed to evaluate the utility of serum IL-1β and CRP together with fractional exhaled nitric oxide in the diagnosis of adult bronchial asthma. Method: The study was a case control, including 150-patients and 100-healthy controls. FeNO tests, measurements of plasma levels IL-1β and HS-CRP had undertaken for all the participants. The statistical data had examined by SPSS (V/27) for Windows. Descriptive data of the variables had compatibly used. A significance lower than or identical to 0.05 had intended. ROC curve examination of FeNO tests, IL-1β, and HS-CRP, to predict asthma from healthy control had applied. Results: there was a significant difference in the FeNo test, HS-CRP levels, and BMI, while no significant difference in all other variables between the groups. The FeNo results correlate positively, though not significantly, with the levels of IL-1β in asthmatic patients (> 0.05). There was a nonsignificant negative correlation between the FeNo results with the level of HSCRP. The accuracy, sensitivity, and specificity of the IL-1β to distinguish asthma were 68.6% and 58% at 95% CI [0.41-0.745], respectively, which was not significant (p>0.05). However, ROC analysis of HS-CRP revealed predictability for asthma patients (p-0.000), with higher accuracy, sensitivity, and specificity: 89.9%, and 68.1% at 95% CI [0.820-0.979], respectively. The FeNo tests revealed highly significant (0.000), high sensitivity, and specific (91% for both) with high 95% CI [0.938-1.000] predictability for asthma. Conclusion: The utility of circulating HS-CRP is more valuable than IL-1β when combined with fractional exhaled nitric oxide in the diagnosis of asthma. Novel biomarkers could improve the precision of this field.
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Choi, Juwhan, Jae Kyeom Sim, Jee Youn Oh, Young Seok Lee, Gyu Young Hur, Sung Yong Lee, Jae Jeong Shim, Ji-yong Moon, and Kyung Hoon Min. "Relationship between Particulate Matter (PM10) and Airway Inflammation Measured with Exhaled Nitric Oxide Test in Seoul, Korea." Canadian Respiratory Journal 2020 (March 17, 2020): 1–7. http://dx.doi.org/10.1155/2020/1823405.
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Purpose. Particulate matter (PM) is increasing every year in Asia. It is not fully understood how the airway is affected when inhaling PM. We investigated the correlation between particulate matter with a diameter of less than 10 μm (PM10) and fractional exhaled nitric oxide (FeNO) to determine whether PM causes airway inflammation. Material and Methods. We analyzed patients who visited our outpatient clinic and tested FeNO from January 2016 to December 2017 at the Korea University Guro Hospital. PM10 data were provided by the government of the Republic of South Korea, and measuring station of PM10 is located 800 meters from the hospital. We analyzed the correlation between PM10 and FeNO by a Pearson correlation analysis and by a multivariate linear regression analysis. To identify the most correlated times, we analyzed the correlation between the FeNO and PM10 daily average from the day of visit to 4 days before visit. Results. FeNO positively correlated with PM10 at two days before hospital visit in the Pearson correlation (Pearson correlation coefficient = 0.057; P-value = 0.023) and in the multivariate linear regression analysis (B = 0.051, P-value = 0.026). If the PM10 increased by 100 μg/m3, the FeNO result was expected to rise to 8.3 ppb in healthy people without respiratory disease. Conclusion. The positive correlation was found in both healthy people and asthmatic patients. Therefore, PM10 can increase airway inflammation.
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Wang, Yanqi, Lixuan Zhao, Fang Chen, Yufeng Guo, Hongxia Ma, Baofen Han, Jiang Yi, and Xiaomei Kong. "Diagnostic Value of Fractional Exhaled Nitric Oxide and Small Airway Function in Differentiating Cough-Variant Asthma from Typical Asthma." Canadian Respiratory Journal 2021 (August 20, 2021): 1–9. http://dx.doi.org/10.1155/2021/9954411.
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Purpose. To explore the diagnostic value of fractional exhaled nitric oxide (FeNO), small airway function, and a combined of both in differentiating cough-variant asthma (CVA) from typical asthma (TA). Methods. A total of 206 asthma subjects, including 104 CVA and 102 TA, were tested for pulmonary function, bronchial provocation test and FeNO. The correlation between FeNO, small airway function and other pulmonary indicators was analyzed by single correlation and multiple regression analysis. The receiver operating characteristic (ROC) curve was established to evaluate the diagnostic efficiency of FeNO, small airway function, and their combination and to predict the optimal cut-off point. Results. All the respiratory function parameters and small airway function indicators in TA group were significantly different from those in CVA group, and FeNO value was significantly higher than that in CVA group. In addition, the area under the ROC curve (AUC) was estimated to be 0.660 for FeNO, 0.895 for MMEF75%/25%, 0.873 for FEF50%, 0.898 for FEF25%, 0.695 for Fres, 0.650 for R5-R20, and 0.645 for X5. The optimal cut-off points of FeNO, MMEF75%/25%, FEF50%, FEF25%, Fres, R5-R20 and X5, were 48.50 ppb, 60.02%, 63.46%, 45.26%, 16.63 Hz, 0.38 kPa·L−1·s−1, and −1.32, respectively. And the AUC of FeNO combined with small airway function indexes FEF25%, Fres, R5-R20, and X5 were prior than single indicators. Conclusion. FeNO and small airway function indexes might have great diagnostic value for differentiating CVA from TA. The combination of FeNO and FEF25%, Fres, R5-R20, and X5 provided a significantly better prediction than either alone.
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Meo, Sultan Ayoub, Muhammad Abdullah Ansary, Fahad Rayan Barayan, Abdulaziz Sulaiman Almusallam, Abdulrahman Muteb Almehaid, Nawaf Saad Alarifi, Thamer Abdulnasir Alsohaibani, and Inam Zia. "Electronic Cigarettes: Impact on Lung Function and Fractional Exhaled Nitric Oxide Among Healthy Adults." American Journal of Men's Health 13, no. 1 (October 15, 2018): 155798831880607. http://dx.doi.org/10.1177/1557988318806073.
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Electronic cigarettes (e-cigarettes) are rapidly becoming an alternative form of nicotine consumption worldwide and a disruptive element in the global health diplomacy. This study aimed to investigate the impact of e-cigarettes on lung function and fractional exhaled nitric oxide (FeNO) among young healthy male adults. Sixty apparently healthy male volunteers were recruited and divided into two groups. Group 1 (e-cigarette-exposed group) consisted of 30 males who were daily e-cigarette users (age 27.07 ± 6.00 [mean ± SD] years). Group 2 (control group) consisted of 30 males who were not e-cigarette users (age 25.90 ± 7.72 [mean ± SD] years). Both groups were neither current nor former traditional tobacco users. Age, ethnicity, height, weight, and socioeconomic status were considered using a matched design to investigate the impact of e-cigarette use on lung function and FeNO. The lung function test parameters that were found to be significantly decreased in e-cigarette users compared to their control group were forced expiratory volume in the first second (FEV1), forced expiratory ratio (FEV1/FVC), forced expiratory flow—25% (FEF25%), forced expiratory flow—50% (FEF50%), forced expiratory flow—75% (FEF75%), forced expiratory flow—25%–75% (FEF25%–75%), and forced expiratory flow—75%–85% (FEF75%–85%). FeNO was also decreased in e-cigarette users, but it did not reach the level of significance. The use of e-cigarettes significantly impaired various lung function parameters and the pattern of impairment exhibited a peripheral obstructive airway involvement. These findings have a general message for the global health community on the potential harm of e-cigarettes on lung function.
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Zhao, Bo, Haiming Zheng, Xiaopan Li, and Rui Zheng. "Evaluation of the peripheral blood eosinophil count as a predictor for fractional exhaled nitric oxide or bronchodilator reversibility test outcome." Allergy and Asthma Proceedings 42, no. 3 (May 1, 2021): 228–34. http://dx.doi.org/10.2500/aap.2021.42.210016.
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Objective: This study aimed to explore the usefulness of the peripheral blood eosinophil count (PBEC) in assessing the level of fractional exhaled nitric oxide (FeNO) and predicting bronchodilation test results. Methods: We retrospectively analyzed the data of 384 outpatients who underwent FeNO measurement at our Department of Respiratory and Critical Care Medicine from March to June 2019. The FeNO level was compared among different PBECs to explore the association among them. Furthermore, the sensitivity and specificity of PBECs in predicting bronchodilation test results were assessed by using receiver operating characteristic (ROC) curve analysis. Results: There was a moderate correlation between PBECs and FeNO levels (r = 0.414; p < 0.05). In the subjects with PBECs ≥ 0.3 × 109/L, the median FeNO level was 39 ppb (interquartile range, 22.5‐65.5 ppb), significantly higher than in the subjects with PBECs < 0.3 × 109/L. The area under the ROC curve was 0.707 (p < 0.05). The maximum Youden index (0.348) was at PBECs = 0.205 × 109/L, which achieved sensitivity and specificity of 63% and 71.8%, respectively. Conclusion: PBECs ≥ 0.3 × 109/L can predict a positive bronchodilation test result and a high FeNO level, with a probability of 50% in the subjects with chronic cough and shortness of breath; in the absence of corresponding symptoms and a low PBEC, the predictive value was small. For hospitals not able to conduct FeNO measurements, for outpatients with poor economic conditions, and for patients with confirmed or suspected novel coronavirus disease 2019, the PBEC, in conjunction with a patient's clinical symptoms, can improve the diagnostic accuracy of allergic asthma and assessment of airway inflammation while reducing the risk of infection.
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Abbas, Amjed H., Muna Abdulridha Rasheed, Hayder Abdul-Amir Al-Hindy, Mazin J. Mousa, and Hadeel Abd Ameir Al-Shalah. "The Role of Serum IL-1β in Combination with Fractional Exhaled Nitric Oxide in the Diagnosis of Adult Bronchial Asthma." NeuroQuantology 19, no. 8 (September 4, 2021): 13–19. http://dx.doi.org/10.14704/nq.2021.19.8.nq21107.
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Background: Asthma is a chronic airway disorder, in which cytokines are probably contributing in the inflammation and in the pathophysiology of the disease. This study aimed to determine the benefit of measurement of FENO and IL-1β in the diagnosis of asthma. Method: The study was conducted in Merjan Medical City and Spiro private clinic in Babylon province in the period from March to June 2019, 127 asthmatic patients were compared with 60 healthy subjects as control group. The age ranged from 10 to 60 years old, fractional exhaled nitric oxide (FENO) test was performed to assess asthma by using (Medisoft® company, Belgium). Body mass index (BMI) was subtracted as weight (kg)/height (m2). Waist circumference/cm (WC) was calculated between the inferior margin of thoracic ribs and midline of the iliac-crest. Hip circumference/cm (HC) was calculated from the broadest hip eminent before the waist/hip ratio (W/H) computed. The FENO measures had classified into low (<25 ppb) or intermediate-high (⩾25 ppb) according to the ‘’American Thoracic Society recommendations’’. Iterleukine-1 beta (IL-1β) was measured in the sera by ELISA technique using Human IL-1β (Interleukin 1-Beta) ELISA Kit from Elabscience®. Results: there was no significant correlation between the levels of FENO and IL-1β with body weight as measured by the way of BMI and waist/hip ratio. There was no correlation between duration of asthma with the levels of FENO and IL-1β. ROC curve analysis of FENO test in BA patients showed significant (p-0.001) high sensitivity (92%) and specificity (90%). However, ROC curve analysis of IL-1β in BA patients revealed non-significant (p-0.53), lower accuracy (56.4%), sensitivity 962%) and specificity (57%) to distinguish BA patients). Conclusion: No relation between obesity and eosinophilic airways inflammation. The measurement of FENO level is more important in assessment of asthma inflammation than IL-1β.
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Acat, Murat, Yusuf Aydemir, Onur Yazıcı, Mahmut Turğut, Mustafa Çörtük, Murat Çakar, Zehra Yaşar, Sami Deniz, and Erdoğan Çetinkaya. "Comparison of the Fractional Exhaled Nitric Oxide Levels in Adolescents at Three Schools Located Three Different Distances from a Large Steel Mill." Canadian Respiratory Journal 2017 (2017): 1–6. http://dx.doi.org/10.1155/2017/6231309.
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Objectives. Exposure to ambient metals and air pollutants in urban environments has been associated with impaired lung health and inflammation in the lungs. Fractional exhaled nitric oxide (FeNO) is a reliable marker of airway inflammation. In this study, we aimed to compare the FeNO levels of three schools that have different distances from iron and steel industry zone for assessing the effects of heavy metals and air pollution on their respiratory health. Methods. Pulmonary function test and FeNO measurements were evaluated in 387 adolescents in three schools which have different distance from plant. Results. FeNO levels were significantly higher in School I (n=142; 18.89±12.3 ppb) and School II (n=131; 17.68±7.7 ppb) than School III (n=114; 4.28±3.9 ppb). Increased FeNO concentration was related to the distance of iron and steel industry zone in young adults. Conclusion. The FeNO concentrations in school children were inversely proportional to the distance from the steel mill. There are needed some studies that can evaluate the safe distance and legislation must consider these findings.
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Nguyen Nhu, Vinh, Pham Le An, and Niels H. Chavannes. "Combination of Fractional Exhaled Nitric Oxide (FeNO) Level and Asthma Control Test (ACT) in Detecting GINA-Defined Asthma Control in Treated Asthmatic Patients in Vietnam." Canadian Respiratory Journal 2020 (April 25, 2020): 1–9. http://dx.doi.org/10.1155/2020/5735128.
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Background. FeNO has been used as a marker for Th2-mediated airway inflammation in asthma. There is evidence which recommends the use of this biomarker in asthma management. Little is known about whether the FeNO test alone or in combination with the ACT score can reflect asthma control in Vietnamese patients. Materials and Methods. A cross-sectional study was conducted in asthmatic patients (≥18 years old) recruited at the University Medical Center, Ho Chi Minh City, Vietnam from March 2016 to March 2017. Asthma control levels were assessed following the GINA 2017 guidelines, and FeNO was measured by a Niox Mino device. FeNO cut-offs predicting asthma control status were determined using the ROC curve analysis. The combination of FeNO and ACT was investigated in detecting well-controlled and uncontrolled asthma. The results of the study are as follows: 278 patients with 68% females, mean age of 44 years, and mean asthma duration of 10 years were analyzed. All patients were treated following step 2 to 4 of GINA guidelines. Mean (SD) FeNO was 30.6 (24) ppb. Patients with uncontrolled (16%), partly controlled (29%), and well-controlled asthma (55%) had a median (IQR) FeNO of 50.0 (74), 25.0 (23), and 21.0 (22.3) ppb, respectively, and the mean of FeNO in the uncontrolled group was significantly higher than that in other groups (p<0.001). The area under the ROC curve (AUC) for FeNO detecting uncontrolled asthma was 0.730 with an optimal cut-off point of FeNO > 50 ppb, and this AUC increased to 0.89 when combining FeNO and ACT. The AUC for FeNO detecting well-controlled asthma was 0.601 with an optimal cut-off point of FeNO <25 ppb and this AUC increased to 0.78 if combining FeNO and ACT. Conclusions. FeNO can predict asthma control status with an estimated cut-off point of <25 ppb for well-controlled and >50 ppb for uncontrolled asthma. The combination of FeNO and ACT provides better information regarding asthma control than FeNO alone, and this combination is useful to predict asthma control statuses in asthmatic patients in Viet Nam.
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Sutiratanachai, Woralak, Watcharoot Kanchongkittiphon, Natchanun Klangkalya, Wanlapa Jotikasthira, Potjanee Kiewngam, and Wiparat Manuyakorn. "Airway Nitric Oxide in Children with HDM-Induced Allergic Rhinitis." American Journal of Rhinology & Allergy 36, no. 3 (December 8, 2021): 360–66. http://dx.doi.org/10.1177/19458924211064407.
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Background Rhinitis is a common problem in children. Airway nitric oxide (NO) was proposed to represent eosinophilic inflammation. Objectives To evaluate airway NO level in children with house dust mite (HDM)-induced allergic rhinitis Methods Children aged 5 to 18 years old with moderate–severe persistent rhinitis and positive result for the HDM nasal provocation test (NPT) was enrolled. The nasal symptoms evaluated by total nasal symptom score (TNSS) and visual analog scale (VAS) were recorded. Skin prick test (SPT) to common aeroallergens, fractional exhaled nitric oxide (FeNO), nasal nitric oxide (nNO), and blood test for specific IgE (sIgE) to HDM was measured. Rhinitis severity was categorized as severe if the VAS score > 7. Results Forty-eight children with HDM-induced allergic rhinitis with the mean age of 9.3 ± 2.4 years were enrolled. nNO levels and VAS score were significantly correlated (R = 0.398, P = .005). Children with severe rhinitis had significantly higher nNO levels than moderate rhinitis (1652.05 vs 941.30 parts per billion [ppb], P = .002), while there was no difference in FeNO level. ROC curve analysis demonstrated the cut-off value of nNO at 1350 ppb (AUC 0.764, 95% CI: 0.616-0.911, P = .002) for detecting severe HDM-induced allergic rhinitis with the sensitivity of 78% and the specificity of 71%. The level of FeNO in children who had HDM mean wheal diameter (MWD) > 8 mm was significantly higher than those with HDM MWD of 3 to 8 mm and those with a negative test (39.7 vs 14.3 vs 14.4 ppb; P = .006, respectively). Children who had sIgE to HDM < 0.35 KUA/L had significantly lower FeNO than those with sIgE to HDM 0.35 to 50 KUA/L and >50 KUA/L (9.5 vs 19.7 vs 40.4 ppb; P = .029, respectively). Conclusions Cut-off value for the diagnosis of severe HDM-induced chronic rhinitis was proposed. Rhinitis children who had a higher degree of HDM sensitization had a higher level of FeNO.
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Kellerer, Christina, Alexander Hapfelmeier, Rudolf A. Jörres, Konrad Schultz, Benjamin Brunn, and Antonius Schneider. "Evaluation of the diagnostic accuracy of fractional exhaled nitric oxide (FeNO) in patients with suspected asthma: study protocol for a prospective diagnostic study." BMJ Open 11, no. 2 (February 2021): e045420. http://dx.doi.org/10.1136/bmjopen-2020-045420.
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IntroductionThe measurement of fractional exhaled nitric oxide (FeNO) is promising for diagnosing asthma and might substitute for bronchial provocation (BP) tests. To evaluate the diagnostic accuracy of FeNO within a confirmatory study, the following hypotheses will be tested: (1) A FeNO cut-off >50 ppb (parts per billion) is suitable for diagnosing asthma (sensitivity 35%, specificity 95%); (2) If the clinical symptoms ‘allergic rhinitis’ and ‘wheezing’ are present, asthma can be diagnosed at FeNO >33 ppb with a positive predictive value (PPV) >70% and (3) A FeNO >33 ppb can predict responsiveness to inhaled corticosteroid (ICS) with a PPV >70%.Methods and analysisA prospective diagnostic study will be conducted in three practices of pneumologists in Germany. 300 patients suspected of suffering from asthma will be included. As an index test, patients perform FeNO measurement with the device NIOX VERO. As reference a test, patients are examined with whole bodyplethysmography and BP, if necessary. After 3 months, patients with an asthma diagnosis will be examined again to verify the diagnosis and evaluate ICS responsiveness. Patients who did not receive an asthma diagnosis at the initial examination will be phoned after 3 months and asked about persistent respiratory symptoms to exclude false negative findings. As a primary target, sensitivity and specificity of FeNO >50 ppb will be determined. As a secondary target the PPV for asthma at FeNO >33 ppb, when the symptoms ‘allergic rhinitis’ and ‘wheezing’ are present, will be calculated. Regarding ICS responsiveness, the PPV of FeNO >33 ppb will be determined.Ethics and disseminationThe study was approved by the Ethical Committee of the Technical University of Munich (Reference number 122/20 S). The major results will be published in peer-reviewed academic journals and disseminated through conferences.Trial registration numberDRKS00021125.
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Lehtimäki, Lauri, Tuomas Karvonen, and Marieann Högman. "Clinical Values of Nitric Oxide Parameters from the Respiratory System." Current Medicinal Chemistry 27, no. 42 (December 16, 2020): 7189–99. http://dx.doi.org/10.2174/0929867327666200603141847.
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Background: Fractional exhaled nitric oxide (FENO) concentration reliably reflects central airway inflammation, but it is not sensitive to changes in the NO dynamics in the lung periphery. By measuring FENO at several different flow rates one can estimate alveolar NO concentration (CANO), bronchial NO flux (JawNO), bronchial wall NO concentration (CawNO) and the bronchial diffusivity of NO (DawNO). Objective: We aimed to describe the current knowledge and clinical relevance of NO parameters in different pulmonary diseases. Methods: We conducted a systematic literature search to identify publications reporting NO parameters in subjects with pulmonary or systemic diseases affecting the respiratory tract. A narrative review was created for those with clinical relevance. Results: Estimation of pulmonary NO parameters allows for differentiation between central and peripheral inflammation and a more precise analysis of central airway NO output. CANO seems to be a promising marker of parenchymal inflammation in interstitial lung diseases and also a marker of tissue damage and altered gas diffusion in chronic obstructive pulmonary disease and systemic diseases affecting the lung. In asthma, CANO can detect small airway involvement left undetected by ordinary FENO measurement. Additionally, CawNO and DawNO can be used in asthma to assess if FENO is increased due to enhanced inflammatory activity (increased CawNO) or tissue changes related to bronchial remodelling (altered DawNO). Conclusion: : NO parameters may be useful for diagnosis, prediction of disease progression and prediction of treatment responses in different parenchymal lung and airway diseases. Formal trials to test the added clinical value of NO parameters are needed.
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Heaney, LG, and KJ Hetherington. "P145 Using Fractional Exhaled Nitric Oxide (FeNO) Suppression and Inhaled Compliance Assessment (INCA) to identify and manage non-adherence in Difficult Asthmatics." Thorax 70, Suppl 3 (November 12, 2015): A149.2—A150. http://dx.doi.org/10.1136/thoraxjnl-2015-207770.282.
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Asano, Takamitsu, Hiroyuki Ohbayashi, Mitsue Ariga, Osamu Furuta, Sahori Kudo, Junya Ono, and Kenji Izuhara. "Serum periostin reflects dynamic hyperinflation in patients with asthma." ERJ Open Research 6, no. 2 (April 2020): 00347–2019. http://dx.doi.org/10.1183/23120541.00347-2019.
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IntroductionDynamic hyperinflation (DH) is sometimes observed and is associated with impaired daily life activities of asthma. We assessed the relationship between DH and asthma biomarkers (blood eosinophil, fractional exhaled nitric oxide (FeNO) and serum periostin) in patients with asthma.MethodsFifty patients with stable asthma were prospectively recruited and underwent blood test, FeNO measurement, spirometry and metronome-paced tachypnoea (MPT) test to assess DH. In MPT tests, inspiratory capacity (IC) was measured at baseline and after 30 s of MPT with breathing frequencies of 20, 30 and 40 breaths·min−1. DH was assessed by the decline of IC from baseline, and maximal IC reduction ≥10% was considered as positive DH.ResultsThirty patients (60%) showed positive DH. Patients with positive DH showed higher serum periostin levels (107.0±30.7 ng·mL−1) than patients with negative DH (89.7±23.7) (p=0.04). Patients in Global Initiative for Asthma treatment steps 4–5 (n=19) showed higher serum periostin levels (p=0.01) and more severe IC reduction after MPT (p<0.0001) than patients in steps 1–3 (n=31). Maximal IC reduction after MPT was significantly correlated with asthma control test score (r=−0.28, p=0.05), forced expiratory volume in 1 s (r=−0.56, p<0.0001), and serum periostin levels (r=0.41, p=0.003).ConclusionSerum periostin may have the possibility to reflect DH in patients with stable asthma.
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Mohd Isa, Khairul Nizam, Zailina Hashim, Juliana Jalaludin, Leslie Thian Lung Than, and Jamal Hisham Hashim. "The Effects of Indoor Pollutants Exposure on Allergy and Lung Inflammation: An Activation State of Neutrophils and Eosinophils in Sputum." International Journal of Environmental Research and Public Health 17, no. 15 (July 28, 2020): 5413. http://dx.doi.org/10.3390/ijerph17155413.
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Background: To explore the inflammation phenotypes following indoor pollutants exposure based on marker expression on eosinophils and neutrophils with the application of chemometric analysis approaches. Methods: A cross-sectional study was undertaken among secondary school students in eight suburban and urban schools in the district of Hulu Langat, Selangor, Malaysia. The survey was completed by 96 students at the age of 14 by using the International Study of Asthma and Allergies in Children (ISAAC) and European Community Respiratory Health Survey (ECRHS) questionnaires. The fractional exhaled nitric oxide (FeNO) was measured, and an allergic skin prick test and sputum induction were performed for all students. Induced sputum samples were analysed for the expression of CD11b, CD35, CD63, and CD66b on eosinophils and neutrophils by flow cytometry. The particulate matter (PM2.5 and PM10), NO2, CO2, and formaldehyde were measured inside the classrooms. Results: Chemometric and regression results have clustered the expression of CD63 with PM2.5, CD11b with NO2, CD66b with FeNO levels, and CO2 with eosinophils, with the prediction accuracy of the models being 71.88%, 76.04%, and 76.04%, respectively. Meanwhile, for neutrophils, the CD63 and CD66b clustering with PM2.5 and CD11b with FeNO levels showed a model prediction accuracy of 72.92% and 71.88%, respectively. Conclusion: The findings indicated that the exposure to PM2.5 and NO2 was likely associated with the degranulation of eosinophils and neutrophils, following the activation mechanisms that led to the inflammatory reactions.
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Yalcin, Arzu D., and Rusen Uzun. "Anti-IgE Significantly Changes Circulating Interleukin-25, Vitamin-D and Interleukin-33 Levels in Patients with Allergic Asthma." Current Pharmaceutical Design 25, no. 35 (December 11, 2019): 3784–95. http://dx.doi.org/10.2174/1381612825666190930095725.
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Background: Multi-center, randomized-controlled trials and observational studies have demonstrated that, in severe asthmatic patients receiving omalizumab treatment, the frequency of exacerbations, the number of urgent adverse events, and the need for oral steroids tend to decrease. Material and Method: This study included a total of 32 patients. The patients were divided into two groups as Group IA (pre-omalizumab) and Group IB (post-omalizumab). Serum IL-25 and IL-33 levels were measured and the number of emergency admissions, length of hospitalization (day), Asthma Control Test (ACT) scores, eosinophil cationic protein (ECP), and fractional exhaled nitric oxide (FeNO) value were analyzed. Results: ACT and FeNO values increased after omalizumab treatment, while IL-33, IL-25 levels decreased after the completion of omalizumab treatment. Furthermore, there was a weak, positive, and significant relationship between the changes in the ECP levels and IL-33 levels (r=0.38, p=0.03). Conclusion: To the best of our knowledge, this is the first study to compare circulating IL-25 and IL-33 levels with specific IgE synthesis in the literature. Multivariate correlation analysis showed that the changes in serum IL-33 levels were significantly correlated with the changes in the mite sIgE levels and length of hospital stay (Fmodel=11.2, p=0.01, r2=0.45). On the other hand, there was no significant relationship between the other variables and changes in the IL-25 levels.
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Kirenga, Bruce, Jeremiah Chakaya, Getnet Yimer, George Nyale, Tewodros Haile, Winters Muttamba, Levicatus Mugenyi, et al. "Phenotypic characteristics and asthma severity in an East African cohort of adults and adolescents with asthma: findings from the African severe asthma project." BMJ Open Respiratory Research 7, no. 1 (February 2020): e000484. http://dx.doi.org/10.1136/bmjresp-2019-000484.
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RationaleThe relationship between clinical and biomarker characteristics of asthma and its severity in Africa is not well known.MethodsUsing the Expert Panel Report 3, we assessed for asthma severity and its relationship with key phenotypic characteristics in Uganda, Kenya and Ethiopia. The characteristics included adult onset asthma, family history of asthma, exposures (smoking and biomass), comorbidities (HIV, hypertension, obesity, tuberculosis (TB), rhinosinusitis, gastro-oesophageal disease (GERD) and biomarkers (fractional exhaled nitric oxide (FeNO), skin prick test (SPT) and blood eosinophils). We compared these characteristics on the basis of severity and fitted a multivariable logistic regression model to assess the independent association of these characteristics with asthma severity.ResultsA total of 1671 patients were enrolled, 70.7% women, with median age of 40 years. The prevalence of intermittent, mild persistent, moderate persistent and severe persistent asthma was 2.9%, 19.9%, 42.6% and 34.6%, respectively. Only 14% were on inhaled corticosteroids (ICS). Patients with severe persistent asthma had a higher rate of adult onset asthma, smoking, HIV, history of TB, FeNO and absolute eosinophil count but lower rates of GERD, rhinosinusitis and SPT positivity. In the multivariate model, Ethiopian site and a history of GERD remained associated with asthma severity.DiscussionThe majority of patients in this cohort presented with moderate to severe persistent asthma and the use of ICS was very low. Improving access to ICS and other inhaled therapies could greatly reduce asthma morbidity in Africa.
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Jia-ying, Luo, Ou Li-li, Ma Jing, Lin Xin-yuan, Fan Li-min, Liu Hai-cheng, and Sun Bao-qing. "Efficacy of air purifier therapy for patients with allergic asthma." Allergologia et Immunopathologia 49, no. 5 (September 1, 2021): 16–24. http://dx.doi.org/10.15586/aei.v49i5.146.
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Objectives: This study aimed to evaluate the efficacy of air purifier therapy for patients with allergic asthma. Methods: Thirty-eight subjects were categorized under two groups namely treatment group and control group. All subjects were under 18 years of age and they had been clinically diagnosed with allergic asthma. The treatment group used high efficiency particulate air (HEPA) purifiers for six consecutive months, and the control group did not use the air filters. Particulate matter (PM) data and dust samples (from bedding and a static point) were collected from the subjects’ bedrooms before they started using the air purifiers and each month thereafter. Simultaneously, the subjects were asked to complete a questionnaire for the Asthma Control Test (ACT) or Childhood Asthma Control Test (C-ACT). Fractional exhaled nitric oxide (FENO) tests were performed at the start and end of the study. The concentrations of Der p1 and Der f1 were measured in the dust samples. Results: (1) After utilizing the air purifier, the concentrations of house dust mite (HDM) allergens (Der p1+ Der f1) in the dust samples decreased. In addition, the PM indoor/outdoor values significantly decreased. (2) The ACT and C-ACT scores in the treatment group maintained a steady significant upward trend. (3) At the end of the study, the FENO levels in both groups were lower, although the differences were not significant. Conclusions: It is witnessed that HEPA air purifiers can decrease indoor HDM allergen and PM levels and improve the quality of life for allergic asthma patients.
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Kołodziejczyk, Krzysztof, and Andrzej Bozek. "Clinical Distinctness of Allergic Rhinitis in Patients with Allergy to Molds." BioMed Research International 2016 (2016): 1–6. http://dx.doi.org/10.1155/2016/3171594.
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Introduction. Molds are a very diverse group of allergens. Exposure and sensitization to fungal allergens can promote the development and worsening of allergic rhinitis (AR).Objective. The natural course of allergic rhinitis was compared between a group of patients with allergy to molds and patients with AR to other allergens as the control groups.Material and Methods. The study group consisted of 229 patients, with a mean age of27.4±6.5 yrs. The study group was compared to groups of AR patients with allergy to house dust mites or pollens or with multivalent allergy. Allergic sensitization was assessed using the skin prick test (SPT) with a panel of 15 allergens to molds and other common inhalant allergens. Specific IgEs against all tested allergens were measured. Nasal fractional exhaled nitric oxide (FeNO) level was assessed with a chemiluminescence analyzer (NIOX MINO) and compared between groups. Cluster analysis was performed for determine models of AR in whole population.Results. Patients with allergy to mold have had AR with a higher blockage of nose than in the patients with other allergies.Alternaria alternata(59% of examined),Cladosporium herbarum(40%), andAspergillus fumigatus(36%) were the predominant allergens in the study group. Patients with allergy to mold were more often present in two clusters: there were patients with more frequent accompanying asthma and high level of FeNO.Conclusion. Patients with allergy to molds have a significantly greater predisposition for bronchial asthma and high concentration of FeNO.
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Demange, Valérie, Denis Zmirou-Navier, Abraham Bohadana, and Pascal Wild. "O3A.3 Do airway inflammation and airway responsiveness markers at start of apprenticeship predict their evolution during initial training? A longitudinal study." Occupational and Environmental Medicine 76, Suppl 1 (April 2019): A22.2—A22. http://dx.doi.org/10.1136/oem-2019-epi.59.
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The natural history of airway inflammation and symptoms in occupations at risk of asthma is still not fully understood. We aimed to study the evolution during apprenticeship of inflammation markers, bronchial hyperresponsiveness (BHR) and symptoms in at-risk subgroups as defined from measurements of markers made shortly after the start of training.Respiratory symptoms, FEV1 and airway resistance post-bronchial challenge (MBC) test results, fractional exhaled nitric oxide (FeNO) measurements, and eosinophils in nasal lavage fluid were longitudinally investigated in apprentice bakers, pastry-makers and hairdressers. Four baseline risk groups were defined, based on, (i) a high level of FeNO (NO), (ii) eosinophils>1% (Eosino), (iii) a≥15% decrease in FEV1 during the MBC test (HR), and (iv) a≥50% increase in the resistance (Resist). The statistical analysis relied on mixed models.At baseline, the inflammation markers were related to the MBC markers. There was no evidence to suggest that the baseline risk groups predict a differential evolution of the airway inflammation and bronchial responsiveness markers, or the asthma-like symptoms considered. The baseline risk groups defined from MBC test predicted the levels of MBC markers. Similarly, the baseline risk groups based on eosinophilic inflammation predicted the levels of markers for eosinophilia. Twelve possible new asthma cases were identified, only the HR risk group predicted their occurrence.Among this young population, at-risk groups based on initial high levels of inflammation markers did not experience any worsening during the follow-up. Initial BHR predicted consistently high levels of all markers considered and occurrence of possible asthma. These results have been published in BMC Pulmonary Medicine (Demange et al. BMC Pulm Med. 2018 July 11;18(1):113).
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Malewska-Kaczmarek, Kamila, Katarzyna Bobeff, Tymoteusz Mańkowski, Daniela Podlecka, Joanna Jerzyńska, and Iwona Stelmach. "Adolescent Athletes at Risk of Exercise-Induced Bronchoconstriction: A Result of Training or Pre-Existing Asthma?" International Journal of Environmental Research and Public Health 19, no. 15 (July 26, 2022): 9119. http://dx.doi.org/10.3390/ijerph19159119.
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Exercise may trigger bronchoconstriction, especially in a group of athletes in whom bronchospasm during exercise is reported to occur more frequently than in nonathletes. The aim of this study was to determine the prevalence and environmental risk factors contributing to exercise-induced bronchoconstriction (EIB) in adolescent athletes. A prospective study was conducted among a group of 101 adolescent athletes who underwent spirometry, exercise challenge, fractional exhaled nitric oxide (FeNO) measurements, and allergy assessment. The study group was divided into three subgroups of athletes based on the most common sports environments: swimmers, “indoor” athletes, and “outdoor” athletes. The clinical evaluation demonstrated a high frequency of EIB in the study group. Moreover, a large proportion of the athletes in whom EIB was observed reported no pre-existing symptoms suggestive of bronchospasm or asthma. Among patients without a previous diagnosis of asthma, clinical evaluation confirmed 22% with positive exercise challenges, compared with 77% of adolescents with negative test results. Moreover, among the athletes with a history of asthma, 39% had positive exercise challenges. Both EIB and asthma are common conditions that affect adolescent athletes. Physicians should pay particular attention to this group, as the symptoms can lead to under- and overdiagnosis.
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Quaranta, Vitaliano, Silvano Dragonieri, Nunzio Crimi, Claudia Crimi, Pierachille Santus, Francesco Menzella, Corrado Pelaia, et al. "Can Leukotriene Receptor Antagonist Therapy Improve the Control of Patients with Severe Asthma on Biological Therapy and Coexisting Bronchiectasis? A Pilot Study." Journal of Clinical Medicine 11, no. 16 (August 11, 2022): 4702. http://dx.doi.org/10.3390/jcm11164702.
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Introduction: Asthma and bronchiectasis appear to be two related diseases and in their complex inflammatory interaction, the cysteinyl leukotriene/cysteinyl leukotriene receptor 1 (cysLT/cysLTR1) axis appears to play an important role given its involvement also in the neutrophilic pathway. To our knowledge, few studies have been conducted so far to evaluate the role of the leukotriene cysLT/cysLTr1 axis in the management of clinical and inflammatory outcomes within a population of patients with severe asthma and bronchiectasis. The aim of our study was to verify in this population the effect of leukotriene receptor antagonist (LTRA) therapy in clinical and inflammatory control before and after 6 months of introduction of biologic therapy. Methods: We retrospectively enrolled, from eight different severe asthma centers’ outpatients, 36 atopic patients with the simultaneous presence of non-cystic fibrosis (non-CF) and non-allergic bronchopulmonary aspergillosis (non-ABPA) bronchiectasis and severe asthma. The first biological injection was performed at baseline (T0 time). Patients who were already taking LTRA therapy at time T0 were recorded, and no new prescriptions were made. We observed our population over a 6-month period (T1 time). At the baseline we collected the following data: baseline characteristics, clinical history, high resolution computed tomography and bronchiectasis-related parameters and skin prick test. At both times T0 and T1 we collected the following data: asthma control test (ACT), asthma control questionnaire (ACQ), immunoglobulin E (IgE) level, blood count, fractional exhaled nitric oxide 50 (FeNO 50) and flow-volume spirometry. The study was retrospectively registered. Results: Our population had a mean age of 59.08 ± 11.09 and 50% were female. At T1, patients on LTRA therapy had a significantly lower FeNO value (33.03 ± 23.61 vs. 88.92 ± 77.96; p = 0.012). We assessed that the value of ΔFeNO (FeNO 50 T1 − FeNO 50 T0) and the number of unplanned specialist visits allowed a discrimination of 66.7% in the presence of LTRA therapy. We also verified how low FeNO values at time T1 were statistically significant predictors of LTRA therapy (ODD = 9.96 (0.94–0.99); p = 0.032). Conclusion: The presence of LTRA in therapy in a population of severe asthmatics with coexisting non-ASBPA bronchiectasis and non-cystic fibrosis, acting simultaneously on the T helper type 2 (TH2) pathway and probably on the neutrophilic component of bronchiectasis, would allow a further amplification of the beneficial effects of biological therapy, leading to a reduction in the number of unplanned visits to specialists.
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Cholakovska, Valentina Cvejoska, Emilija Vlashki, Mirjana Kochova, Vesna Velikj Stefanovska, and Aleksandar Petlichkovski. "Leptin, Obesity Parameters, and Atopy Among Children with Asthma." PRILOZI 42, no. 2 (October 1, 2021): 79–88. http://dx.doi.org/10.2478/prilozi-2021-0024.
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Abstract Leptin, as a major adipokine, positively correlates with the body’s fat, while atopy is an important feature in the development of childhood asthma. We aimed to evaluate the relationship between leptin, parameters of obesity, and atopy in children with asthma. The study included 112 children (73 boys, 39 girls, mean age 11.1±2.4). 41 were overweight, 38 had asthma and a normal body mass index (BMI), and 33 were overweight asthmatics. Serum leptin levels, BMI, waist circumference (WC), and waist to hips ratio (WHR) were measured. Skin prick test (SPT)/CAP, total serum IgE, fractional exhaled nitric oxide (FeNO), and pulmonary function tests were performed. In asthmatic children, serum leptin median level was 9.2±16.2 ng/ml, in overweight children was 30.6±21.6 ng/ml, and in overweight asthmatics was 31.1±20.3 ng/ml with a significant difference between the groups (p=0.0374), yet with a significantly lower median level in the group of children with asthma compared to the overweight children: with asthma (p=0.00001) and without asthma (p=0.00001). In the three groups of patients, BMI and WC displayed a significant positive correlation with leptin (for BMI r=0.652 vs. r=0.530 vs. r=0.563, respectively and for WC r=0.508 vs. r=0.426 vs. r=0.527, respectively). No significant correlations of leptin within atopy parameters (Eo, IgE, SPT/CAP, FeNO) in all three analyzed groups (p>0.05) was detected. Conclusion: Atopy was not confirmed as an underlying mechanism of the association between asthma and being overweight. Leptin had a significant linear correlation as a parameter of central obesity with BMI and WC in all three groups, but not with WHR.
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Ishiura, Yoshihisa, Masaki Fujimura, Yasutaka Shiba, Noriyuki Ohkura, Johsuke Hara, Miki Abo, and Kazuo Kasahara. "A Comparison of the Efficacy of Once-Daily Fluticasone Furoate/Vilanterole with Twice-Daily Fluticasone Propionate/Salmeterol in Elderly Asthmatics." Drug Research 68, no. 01 (September 19, 2017): 38–44. http://dx.doi.org/10.1055/s-0043-118536.
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Abstract Background Asthma in the elderly population has been focused because it affects quality of life and results in a higher hospitalization rate and mortality. Fluticasone furoate (FF)/vilanterole (VI) is a novel inhaled corticosteroids (ICS)/long-acting β2 agonist (LABA) combination being developed for once-daily administration for asthma with greater anti-inflammatory activity and longer duration of bronchidilation. The ElliptaTM dry powder inhaler (DPI) has also been available as a new device with high levels of satisfaction and preference. Methods A 12-week, randomized, open-label cross-over, pilot study was conducted in 18 elderly patients with bronchial asthma to compare the effectiveness of once-daily FF/VI 200/25 µg via the ElliptaTM DPI vs. twice-daily fluticasone propionate (FP)/salmeterol (SAL) 500/50 µg via the DiskusTM DPI. The study period included a 4-week run-in, the first 4-week treatment, and the second 4-week treatment. Respiratory functions, fractional exhaled nitric oxide (FeNO) and asthma control test (ACT) scores were measured 0, 4, and 8 weeks after randomization. Preferences for their device were also assessed using a self-completed questionnaire. Results Spirometric paramters, FeNO levels and ACT scores were not significantly different during the run-in period, the FP/SAL treatment period, and the FF/VI treatment period. FF/VI treatment via the ElliptaTM DPI was preferred to the FP/SAL treatment via the DiskusTM DPI (p<0.01). Conclusions These data indicate that FF/VI treatment via the ElliptaTM DPI is preferred in elderly patients with asthma based on its ease-of-use, suggesting the potential to improve patient adherence and, as a result, overall disease management.
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Dixon, Eleanor Grace, Charlotte King, Andrew Lilley, Ian P. Sinha, and Daniel B. Hawcutt. "Deprescribing montelukast in children with asthma: a systematic review." BMJ Open 12, no. 1 (January 2022): e053112. http://dx.doi.org/10.1136/bmjopen-2021-053112.
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BackgroundNational and international asthma guidelines recommend adjusting asthma treatment based on levels of control, yet no guidance is given regarding the stepping-down of montelukast in children and young people (CYP).ObjectiveTo systematically review evidence regarding deprescribing montelukast in CYP with established asthma.DesignSystematic review.Data sourcesEmbase, Medline, PubMed and CINAHL were searched up to October 2020.Study selectionEligible studies contained patients aged 0–18 years with a diagnosis of asthma, who had been administering montelukast before it was withdrawn. All reasons for withdrawal were included.ResultsThe search identified 197 papers. After deduplication, five papers were included (three randomised control studies and two cohort studies). Four studies observed the impact of montelukast withdrawal for 2 weeks, and one study for 8 weeks. The impact of withdrawal was measured in the studies using a combination of lung tests (eg, forced expiratory volume in 1 s (FEV1), fractional exhaled nitric oxide (FeNO)), asthma scoring methods and exercise challenges. Of the 17 domains in the Core Outcome Set for Clinical Trials in Childhood Asthma, eight outcomes were measured in at least one of the five studies, with all five studies measuring the outcome of ‘Lung Function’. No significant differences were found between the montelukast and placebo groups following montelukast withdrawal. Significant differences between the comparator points within the test group were found in nine outcomes across four studies; FEV1/forced vital capacity, FEV1, forced expiratory flows (25%–75%), asthma score (study specific), maximum % fall in FEV1 and time to recovery (post exercise) significantly decreased whereas FEV1/bronchodilator response, FeNO and eNO significantly increased.ConclusionOnly limited, contradictory and short-term effects of deprescribing montelukast in CYP with established asthma are presented in literature. Definitive studies determining clinical stability, and impact of deprescribing montelukast in CYP are imperative to improve the safety of asthma treatment in CYP.PROSPERO registration numberCRD42020213971.
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Dierick, Boudewijn H. J., Maria Achterbosch, Sandra Been-Buck, Titia Klemmeier, Susanne J. van de Hei, Paul Hagedoorn, Huib A. M. Kerstjens, Janwillem W. H. Kocks, and Job F. M. van Boven. "Can electronic monitoring with a digital smart spacer support personalised medication adherence and inhaler technique education in patients with asthma?: Protocol of the randomised controlled OUTERSPACE trial." BMJ Open 12, no. 6 (June 2022): e059929. http://dx.doi.org/10.1136/bmjopen-2021-059929.
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IntroductionMedication adherence and inhaler technique in patients with asthma remain suboptimal. A digital, smart spacer may support personalised adherence and inhaler technique education. The aim of this study is to assess the feasibility of undertaking a definitive randomised controlled trial of personalised, smart spacer data-driven education and explore clinical benefits.Methods and analysisWe present the design of the multicentre, randomised controlled OUtcomes following Tailored Education and Retraining: Studying Performance and AdherenCE feasibility trial of 2 months. Patients will be recruited from four Dutch general practices. At t=−1, patients with asthma ≥18 years using inhaled corticosteroids±long-acting beta-agonists±short-acting beta-agonists administered with a pressurised-metered-dose-inhaler and spacer (n=40) will use a smart spacer for 1 month. The rechargeable CE-marked smart spacer (Aerochamber Plus with Flow Vu) includes a sensor that monitors adherence and inhalation technique to prescribed dosing regimen of both maintenance and reliever inhalers. After 1 month (t=0), patients are 1:1 randomised into two groups: control group (usual care) versus intervention group (personalised education). At t=-1, t=0 and t=1 month, the Asthma Control Questionnaire (ACQ), Work Productivity and Activity Impairment (WPAI) questionnaire and Test of Adherence to Inhalers (TAI) are administered and fractional exhaled nitric oxide (FeNO) is assessed. At t=0 and t=1, spirometry is performed. At t=1, usability and satisfaction will be analysed using the System Usability Scale and interviews with patients and healthcare providers. Primary outcome is the overall feasibility of a definitive trial assessed by patient recruitment speed, participation and drop-out rate. Secondary outcomes are patient and healthcare provider satisfaction and exploratory clinical outcomes are adherence, inhaler technique, TAI score, FeNO, lung function, ACQ and WPAI.Ethics and disseminationEthical approval was obtained from the RTPO in Leeuwarden, Netherlands (number: NL78361.099.21). Patients will provide written informed consent. Study findings will be disseminated through conferences and peer-reviewed scientific and professional journals.Trial registration numberNL9637.
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Kotsiou, Ourania S., Ioannis Pantazopoulos, Georgios Mavrovounis, Konstantinos Marsitopoulos, Konstantinos Tourlakopoulos, Paraskevi Kirgou, Zoe Daniil, and Konstantinos I. Gourgoulianis. "Serum Levels of Urokinase Plasminogen Activator Receptor (suPAR) Discriminate Moderate Uncontrolled from Severe Asthma." Journal of Personalized Medicine 12, no. 11 (October 28, 2022): 1776. http://dx.doi.org/10.3390/jpm12111776.
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Introduction: The most clinically useful concept in asthma is based on the intensity of treatment required to achieve good asthma control. Biomarkers to guide therapy are needed. Aims: To investigate the role of circulating levels of soluble urokinase plasminogen activator receptor suPAR as a marker for asthma severity. Methods: We recruited patients evaluated at the Asthma Clinic, University of Thessaly, Greece. Asthma severity and control were defined according to the GINA strategy and Asthma Contro Test (ACT). Anthropometrics, spirometry, fractional exhaled nitric oxide (FeNO), suPAR, blood cell count, c-reactive protein (CRP), and analyses of kidney and liver function were obtained. Patients with a history of inflammatory, infectious, or malignant disease or other lung disease, more than 5 pack years of smoking history, or corticosteroid therapy were excluded. Results: We evaluated 74 asthma patients (69% female, mean age 57 ± 17 years, mean body mass index (BMI) 29 ± 6 kg/m2). In total, 24%, 13%, 6%, 5%, 29% and 23% of the participants had mild well-controlled, mild uncontrolled, moderate well-controlled, moderate uncontrolled, severe well-controlled, and severe uncontrolled asthma, respectively. Overall, 67% had T2-high asthma, 26% received biologics (15% and 85% received omalizumab and mepolizumab, respectively), and 34% had persistent airway obstruction. suPAR levels were significantly lower in asthmatics with moderate uncontrolled asthma than in patients with severe uncontrolled asthma without (2.1 ± 0.4 vs. 3.3 ± 0.7 ng/mL, p = 0.023) or with biologics (2.1 ± 0.4 vs. 3.6 ± 0.8 ng/mL, p = 0.029). No correlations were found between suPAR levels and age, BMI, T2 biomarkers, CRP, or spirometric parameters. Conclusions: suPAR levels were higher in asthmatics with severe disease than in those with moderate uncontrolled asthma.
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Zhao, Bo, Haiming Zheng, Tengfei Yang, and Rui Zheng. "Eosinophilic granulomatosis with polyangiitis in allergic asthma: Efforts to make early diagnosis possible." Allergy and Asthma Proceedings 44, no. 1 (January 1, 2023): 59–63. http://dx.doi.org/10.2500/aap.2023.44.220072.
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Background: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare autoimmune disease that can affect multiple organ systems in the body. A majority of patients with EGPA present with asthma-like symptoms and may be misdiagnosed with refractory asthma. It is necessary to distinguish EGPA from asthma and provide a theoretical basis for effective future prevention and treatment. Objective: This study aimed to compare the clinical features of EGPA and the clinical features of allergic asthma in an effort to make an early diagnosis possible. Methods: We reviewed the basic information, test results, pre-onset conditions, and prognosis of 44 adult patients with EGPA who were admitted to our hospital between January 2013 and June 2021, and conducted a 1:1 matched case-control study to compare patients with EGPA and patients with allergic asthma. Results: The 44 patients with EGPA were older than those with allergic asthma, but more than half of the patients with EGPA had been diagnosed with bronchial asthma, with a history of 10 months to 40 years, and had previously used inhalers or systemic steroids. The proportion of male-to-female cases was ∼1:1, with seven antineutrophil cytoplasmic antibodies (ANCA) positive cases (15.9%), 20 limited EGPA cases (45.45%), and 24 systemic EGPA cases (54.55%). Although the peripheral blood eosinophil count and percentage were lower in the male patients than in the female patients, male patients with higher five-factor scores might indicate worse prognosis. The fractional exhaled nitric oxide (FeNO) level, eosinophil percentage and count, and total immunoglobulin E (IgE) level were higher in the EGPA group than in the allergic asthma group. Unlike in allergic asthma, the FeNO level is not correlated with the blood eosinophil count or percentage in EGPA. Seven patients received cardiac emission computed tomography (ECT) tests, with abnormalities suggested in six patients. Results of an electrocardiogram, color-Doppler echocardiography, myocardial enzyme level, and troponin level suggested no obvious abnormality. Conclusion: The proportion of patients with EGPA who tested positive for ANCA is not high, and patients with high eosinophil counts should be alert to the possibility of having EGPA. For patients with infiltration of eosinophils into the airway, a diagnosis should not be based on peripheral blood eosinophil counts. It is recommended that the FeNO level and pulmonary function should also be monitored for patients who present with symptoms in other body systems. The sensitivity of cardiac ECT tests is higher than routine tests, so timely screening by cardiac ECT is recommended for all patients with EGPA.
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Morillo, Diana, Santiago Mena-Bucheli, Angélica Ochoa, Martha E. Chico, Claudia Rodas, Augusto Maldonado, Karen Arteaga, et al. "Prospective study of factors associated with asthma attack recurrence (ATTACK) in children from three Ecuadorian cities during COVID-19: a study protocol." BMJ Open 12, no. 6 (June 2022): e056295. http://dx.doi.org/10.1136/bmjopen-2021-056295.
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IntroductionAsthma is a growing health problem in children in marginalised urban settings in low-income and middle-income countries. Asthma attacks are an important cause of emergency care attendance and long-term morbidity. We designed a prospective study, the Asthma Attacks study, to identify factors associated with recurrence of asthma attacks (or exacerbations) among children and adolescents attending emergency care in three Ecuadorian cities.Methods and analysisProspective cohort study designed to identify risk factors associated with recurrence of asthma attacks in 450 children and adolescents aged 5–17 years attending emergency care in public hospitals in three Ecuadorian cities (Quito, Cuenca and Portoviejo). The primary outcome will be rate of asthma attack recurrence during up to 12 months of follow-up. Data are being collected at baseline and during follow-up by questionnaire: sociodemographic data, asthma history and management (baseline only); recurrence of asthma symptoms and attacks (monthly); economic costs of asthma to family; Asthma Control Test; Pediatric Asthma Quality of life Questionnaire; and Newcastle Asthma Knowledge Questionnaire (baseline only). In addition, the following are being measured at baseline and during follow-up: lung function and reversibility by spirometry before and after salbutamol; fractional exhaled nitric oxide (FeNO); and presence of IgG antibodies to SARS-CoV-2 in blood. Recruitment started in 2019 but because of severe disruption to emergency services caused by the COVID-19 pandemic, eligibility criteria were modified to include asthmatic children with uncontrolled symptoms and registered with collaborating hospitals. Data will be analysed using logistic regression and survival analyses.Ethics and disseminationEthical approval was obtained from the Hospital General Docente de Calderon (CEISH-HGDC 2019-001) and Ecuadorian Ministry of Public Health (MSP-CGDES-2021-0041-O N° 096-2021). The study results will be disseminated through presentations at conferences and to key stakeholder groups including policy-makers, postgraduate theses, peer-review publications and a study website. Participants gave informed consent to participate in the study before taking part.
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Liu, Ting, Dan Yang, and Chuntao Liu. "Extrafine HFA-beclomethasone-formoterol vs. nonextrafine combination of an inhaled corticosteroid and a long acting β2-agonist in patients with persistent asthma: A systematic review and meta-analysis." PLOS ONE 16, no. 9 (September 3, 2021): e0257075. http://dx.doi.org/10.1371/journal.pone.0257075.
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Objective Airway inflammation in asthma involves not only the central airways but extends to peripheral airways. Lung deposition may be key for an appropriate treatment of asthma. We compared the clinical effects of extrafine hydrofluoroalkane (HFA)-beclomethasone-formoterol (BDP-F) versus equipotent doses of nonextrafine combination of an inhaled corticosteroid and a long acting β2-agonist (ICS-LABA) in asthma. Methods We identified eligible studies by a comprehensive literature search of PubMed, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). Data analysis was performed with the Review Manager 5.3.5 software (Cochrane IMS, 2014). Results A total of 2326 patients with asthma from ten published randomized controlled trials (RCTs) were enrolled for analysis. Change from baseline in morning pre-dose peak expiratory flow (PEF), evening pre-dose PEF and forced expiratory volume in one second (FEV1) were detected no significant differences between extrafine HFA-BDP-F and nonextrafine ICS-LABAs (p = 0.23, p = 0.99 and p = 0.23, respectively). Extrafine HFA-BDP-F did not show any greater benefit in forced expiratory flow between 25% and 75% of forced vital capacity (FEF25-75%), the parameter concerning peripheral airways (MD 0.03L/s, p = 0.65; n = 877). There were no substantial differences between interventions in fractional exhaled nitric oxide (FeNO) levels or in its alveolar fraction. The overall analysis showed no significant benefit of extrafine HFA-BDP-F over nonextrafine ICS-LABA in improving Asthma Control Test (ACT) score (p = 0.30) or decreasing the number of puffs of rescue medication use (p = 0.16). Extrafine HFA-BDP-F did not lead to less exacerbations than nonextrafine ICS-LABA (RR 0.61, 95% CI: 0.31 to 1.20; I2 = 0; p = 0.15). Conclusion Enrolled RCTs of extrafine HFA-BDP-F have demonstrated no significant advantages over the equivalent combination of nonextrafine ICS-LABA in improving pulmonary function concerning central airways or peripheral airways, improving asthma symptom control or reducing exacerbation rate.
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Chen, Xi, Wei-jie Guan, Shi-xue Sun, Pei-yan Zheng, Li-hong Sun, De-hui Chen, Dan-dan Wang, Chang Chen, Bao-qing Sun, and Xiao-hua Douglas Zhang. "Effects of Intranasal Cellulose Powder on Asthma Control in Children With Mild-to-Moderate Perennial Allergic Rhinitis: A Randomized, Placebo-Controlled Trial." American Journal of Rhinology & Allergy 33, no. 2 (February 1, 2019): 184–93. http://dx.doi.org/10.1177/1945892419826509.
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Background Perennial allergic rhinitis (PAR) often coexists in asthmatic patients. Intranasal cellulose powder (ICP) was reportedly effective in ameliorating PAR. Objective We investigated whether ICP is equally effective compared with intranasal corticosteroids in improving asthma control as well as nasal symptoms among children with PAR and allergic asthma (AA). Methods Between July 2015 and September 2016, we did a single-center, randomized, placebo-controlled trial. Asthmatic children aged 6 to 11 years with mild-to-moderate PAR were randomly assigned to formoterol/budesonide inhalation (4·5 µg/80 µg, twice daily) plus intranasal budesonide 64 µg twice daily (group A), ICP 250 µg thrice daily (group B), or intranasal placebo 250 µg thrice daily (group C) for 8 weeks. The primary outcome was change in asthma control test for children (C-ACT) score from baseline to week 8 posttreatment. Changes in spirometry, peak expiratory flow (PEF), fractional exhaled nitric oxide (FeNO), and visual analog scale (VAS) for nasal and ocular symptoms were detected as secondary outcomes. Results We included 121 patients (38 in group A, 41 in group B, and 42 in group C) in full-analysis set. C-ACT score was markedly higher at week 8 compared with baseline (mean difference: 5.11, 6.05, and 4.85 points in groups A, B, and C, respectively; P < .05). There were interactions between baseline and treatment in C-ACT scores ( P < .05). Group B demonstrated greater improvement in C-ACT score than group C among children with baseline C-ACT score of 6 to 18. 95% confidence intervals of group A at baseline overlapped with those of groups B and C. The treatment achieved reduced VAS symptoms in groups A and B but not in group C. Incidence of adverse events was comparable. No serious adverse event was reported. Conclusions ICP could be recommended for children with PAR and AA who have poorer asthma control.
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Butler, C. A., A. J. McMichael, K. Honeyford, L. Wright, J. Logan, J. Holmes, J. Busby, et al. "Utility of fractional exhaled nitric oxide suppression as a prediction tool for progression to biologic therapy." ERJ Open Research, July 8, 2021, 00273–2021. http://dx.doi.org/10.1183/23120541.00273-2021.
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RationaleThe utility of fractional exhaled nitric oxide (FeNO) suppression (FeNOSuppT) to identify non-adherence with inhaled corticosteroid (ICS) treatment has previously been reported, but whether it can predict clinical outcome remains unclear.ObjectivesWe examined the utility of FeNOSuppT in prediction of progression to biologic agents or discharge from specialist care.MethodsFeNOSuppT was measured at home using remote monitoring technology of inhaler use alongside daily FeNO measurement over 7 days. Long-term clinical outcome in terms of progression to biologic agent or discharge from specialist care were compared for non-suppressors and suppressors.Measurements and Main ResultsOf the 162 subjects, 135 successfully completed the test with 81 (60%) positive FeNO suppression tests. Subjects with a negative FeNOSuppT were more likely to proceed to biologic therapy (39 of 54 patients, 72%) compared to those with a positive FeNOSuppT (35 of 81 patients, 43%, p=0.001). In subjects with a positive FeNOSuppT, predictors of progression to biologic included higher dose of maintenance steroid at initial assessment and prior intensive care unit admission. These subjects had a significant rise in FeNO between post suppression test and follow-up (median, 33 [IQR, 25–55] versus 71 [IQR, 24–114]; p=0.009) which was not explained by altered corticosteroid dose.ConclusionsA negative FeNOSuppT correlates with progression to biologic therapy. A positive FeNOSuppT, with subsequent maintenance of “optimised” FeNO, predicts a sub-group of patients in whom asthma control is preserved with adherence to high dose ICS/LABA and can be discharged from specialist care.
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Loewenthal, Lola, and Andrew Menzies-Gow. "FeNO in Asthma." Seminars in Respiratory and Critical Care Medicine, March 4, 2022. http://dx.doi.org/10.1055/s-0042-1743290.
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AbstractAsthma is a common disease affecting 350 million people worldwide, which is characterized by airways inflammation and hyperreactivity. Historically diagnosis and treatment have been mainly based on symptoms, which have the potential to result in misdiagnosis and inappropriate treatment. Nitric oxide (NO) is exhaled in human breath and is a marker of airways inflammation. Levels of NO are increased in the exhaled breath of patients with type 2 asthma and fractional exhaled nitric oxide (FeNO) provides an objective biomarker of airway inflammation. FeNO testing is an accessible, noninvasive, and easy-to-use test. Cut-off values have been established by the American Thoracic Society (ATS), the Global Initiative for Asthma (GINA), and the National Institute for Health and Care Excellence (NICE) but vary between guidance. FeNO levels have been shown to be predictive of blood and sputum eosinophil levels but should not be used in isolation and current guidance emphasizes the importance of incorporating clinical symptoms and testing when utilizing FeNO results. The inclusion of FeNO testing can increase diagnostic accuracy of asthma, while high levels in asthmatic patients can help predict response to inhaled corticosteroids (ICS) and suppression of levels with ICS to monitor adherence. FeNO levels are also a predictor of asthma risk with increased exacerbation rates and accelerated decline in lung function associated with high levels as well as having an emerging role in predicting response to some biologic therapies in severe asthma. FeNO testing is cost-effective and has been shown, when combined with clinical assessment, to improve asthma management.
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Hoggins, Rhiannon, Madhavi Velpula, Susan Woodward, and Mark Peter Tighe. "How to use the fractional exhaled nitric oxide test." Archives of disease in childhood - Education & practice edition, August 3, 2021, edpract-2019-318326. http://dx.doi.org/10.1136/archdischild-2019-318326.
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Measurement of fractional exhaled nitric oxide (FeNO) has become a mainstream, NICE-recommended, objective test of asthma severity. We explore the uses and practical issues with the FeNO test using clinically relevant questions for general paediatricians.
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Olonisakin, Tolani F., John A. Moore, Stephanie Barel, Bliss Uribe, Dana Parker, Eve M. R. Bowers, Seyed M. Nouraie, Sally E. Wenzel, and Stella E. Lee. "Fractional Exhaled Nitric Oxide as a Marker of Mucosal Inflammation in Chronic Rhinosinusitis." American Journal of Rhinology & Allergy, March 3, 2022, 194589242210802. http://dx.doi.org/10.1177/19458924221080260.
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Background Fractional exhaled nitric oxide (FeNO) is a cost-effective, noninvasive point-of-care test that has proven valuable in identifying patients with lower airway inflammation and predicting the likelihood of responsiveness to inhaled corticosteroid therapy in asthma. The utility of FeNO in upper airway disease, specifically in CRS, remains to be determined. Objective The goal of this study was to test whether FeNO could serve as a noninvasive marker of sinonasal mucosal inflammation in CRS patients. Methods FeNO was obtained using a nitric oxide analyzer (NIOX VERO) as well as nasal mucus, the 22-item Sinonasal Outcome Test (SNOT-22), University of Pennsylvania Smell Identification Test (UPSIT), and Lund-Kennedy endoscopic scores concurrently in 112 CRS patients. Nasal mucus was analyzed for cytokine expression using solid-phase sandwich ELISA. Linear regression with Spearman correlation coefficient was used to determine strength of relationship between variables. Results CRS patients showed elevated FeNO levels with asthma (47.12 ± 5.21 ppb) or without asthma (43.24 ± 9.810 ppb). Elevated FeNO levels correlated with sinonasal mucosal inflammation, as determined by increased levels of CCL26 and TNFα in nasal mucus obtained from CRS patients. Furthermore, elevated FeNO levels selectively correlated with worsened SNOT-22 nasal symptoms (P = 0.03) and Lund-Kennedy endoscopic scores (P = 0.007), but did not correlate with UPSIT scores. Conclusions FeNO levels correlated with increased sinonasal mucosal inflammation and symptom severity in CRS regardless of asthma status. FeNO measurements may serve as a quick and noninvasive marker in evaluating CRS patients.
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Oțelea, Marina Ruxandra, Anne Kristin M. Fell, Claudia Mariana Handra, Mathias Holm, Francesca Larese Filon, Dragan Mijakovski, Jordan Minov, et al. "The value of fractional exhaled nitric oxide in occupational diseases – a systematic review." Journal of Occupational Medicine and Toxicology 17, no. 1 (July 25, 2022). http://dx.doi.org/10.1186/s12995-022-00355-1.
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AbstractFractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of respiratory tract inflammation, originally designated to identify eosinophilic airway inflammation and to predict steroid response. The main field of application of this biomarker is asthma, but FeNO has also been used for other allergic and non-allergic pulmonary disorders such as chronic obstructive pulmonary disease, hypersensitivity pneumonitis and interstitial lung disease. A substantial part of respiratory diseases are related to work, and FeNO, a safe and easy measure to conduct, is a potential valid examination in an occupational setting.This systematic review assesses the value of measuring FeNO related to three types of airborne exposures: allergens, irritants, and respiratory particles inhaled during occupational activities. The review covers results from longitudinal and observational clinical studies, and highlights the added value of this biomarker in monitoring effects of exposure and in the diagnostic criteria of occupational diseases. This review also covers the possible significance of FeNO as an indicator of the efficacy of interventions to prevent work-related respiratory diseases.Initially, 246 articles were identified in PUBMED and SCOPUS. Duplicates and articles which covered results from the general population, symptoms (not disease) related to work, non-occupational diseases, and case reports were excluded. Finally, 39 articles contributed to this review, which led to the following conclusions:a) For occupational asthma there is no consensus on the significant value of FeNO for diagnosis, or on the magnitude of change needed after specific inhalation test or occupational exposure at the workplace. There is some consensus for the optimal time to measure FeNO after exposure, mainly after 24 h, and FeNO proved to be more sensitive than spirometry in measuring the result of an intervention. b) For other occupational obstructive respiratory diseases, current data suggests performing the measurement after the work shift. c) For interstitial lung disease, the evaluation of the alveolar component of NO is probably the most suitable.
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Jena, Kartick, and Andhare Ramesh. "A PROSPECTIVE COHORT RESEARCH COMPARED FRACTIONAL EXHALED NITRIC OXIDE, SPIROMETRY, AND THE ASTHMA CONTROL TEST IN PREDICTING ASTHMA EXACERBATIONS." International Journal of Medical Reviews and Case Reports, 2022, 1. http://dx.doi.org/10.5455/ijmrcr.172-1666983830.
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Background’: Fractional exhaled nitric oxide (FeNO) is a quick, accurate, noninvasive tool to detect the measurement of airway inflammation. FeNO is therefore vastly used in the diagnosis and treatment of asthma. Aim: The purpose of the study is to evaluate and compare the accuracy of spirometry, the asthma control test (ACT), and fractional exhaled nitric oxide in predicting future asthma attacks, as well as their association with each other. Materials and Methods: Patients with asthma between the ages of 21 to 60 were included. Patients with a smoking history of more than 8 packs per year, as well as, patients in whom spirometry was not recommended were excluded. Fractional exhaled nitric oxide (FeNO) and spirometry were performed on patients who gave their consent to conduct the study. The Asthma Control Test (ACT) questionnaire was used to analyze asthma control. Over the course of the three-month follow-up, several exacerbations were recorded. The effectiveness of FeNO, spirometry, and ACT in predicting exacerbations was compared using the Mann-Whitney test, and the correlation between them was determined using Spearman's correlation coefficient. Results: Exacerbations occurred in 27% of the 100 trial participants. Patients with and without exacerbations had similar levels of FeNO, according to our research. The median (interquartile range [IQR]) FEV1% in patients with and without exacerbations was 67 (54-78) and 74 (64-87), respectively (P = 0.012). In contrast to those without exacerbations, whose median (IQR) ACT scores were 14 (13-17), patients with exacerbations had a median (IQR) ACT score of 11 (9–15), which was considerably lower (P = 0.002). ACT and FeNO had a poor connection (correlation coefficient: -0.166, P = 0.037). The median (IQR) FeNO level (ppb) was lower in patients taking inhaled corticosteroids (ICS) than in the other group, with values of 21 (13-37) and 29 (16-57), respectively (P = 0.04). Conclusion: FeNO level and ACT score had an inverse relation. FEV1% and ACT scores were better than FeNO at predicting asthma attacks, as per the research conducted in the present study. The utilization of inhaled corticosteroids caused a drop in FeNO levels.
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Chaudhri, Moiuz, and Khushboo K Agarwal. "Fractional Exhaled Nitric Oxide Testing: Change in Clinical Management of Asthma, or Chronic Obstructive Pulmonary." Journal of Medicine and Healthcare, October 31, 2022, 1–4. http://dx.doi.org/10.47363/jmhc/2022(4)214.
Full textAbstract:
Asthma and chronic obstructive pulmonary disease (COPD) are common airway inflammatory conditions that can present in isolation or a combination known as asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS). Due to similarities in clinical presentation, differentiating these conditions can be challenging. Fractional exhaled nitric oxide (FeNO) is an endogenous molecule that can be elevated in patients with airway inflammation, particularly asthma. The purpose of this study was to determine if FeNO levels can be used to change pharmacologic management (addition, in patients presenting with asthma, COPD, and ACOS. A retrospective chart review of 250 patients underwent FeNO testing; 93 patients were included in the final analysis with their FeNO levels and medications. Out of 76 patients, 34 were prescribed medications of interest (inhaled corticosteroids (ICS), Inhaled corticosteroids - long-acting beta-agonists (ICS-LABA), anticholinergics (AC) monotherapy or combination therapy). After the FeNO testing, the number of patients on ICS therapy doubled (8 to 16), and the number of patients on ICS -LABA increased by 69.2%. Lastly, the number of patients not on medication of interest, 57.1%, ended up on one after FeNO testing. Our results support the utility of FeNO as a viable test to manage patients with obstructive lung disease.
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Santillo, Marta, Ben Ainsworth, Michelle Helena Van Velthoven, Lucy Yardley, Mike Thomas, Kay Wang, and Sarah Tonkin-Crine. "Qualitative study on perceptions of use of Fractional Exhaled Nitric Oxide (FeNO) in asthma reviews." npj Primary Care Respiratory Medicine 32, no. 1 (March 21, 2022). http://dx.doi.org/10.1038/s41533-022-00272-0.
Full textAbstract:
AbstractCurrent methods to assess asthma and guide inhaled corticosteroid (ICS) dose titration mainly centre on patient-reported symptoms and lung function assessments. However, these methods correlate only weakly with airway inflammation making them unreliable predictors of future exacerbations and ICS requirement. Fractional Exhaled Nitric Oxide (FeNO) is a simple non-invasive objective measure of airways inflammation used predominantly in specialist clinics. Previous qualitative studies have mainly focused on the acceptability of FeNO in secondary care and there is limited insight to support clinicians and patients using FeNO in primary care asthma reviews. This study aimed to explore adult patient with asthma and primary care health care professional (HCP) views on introducing FeNO as part of routine asthma reviews. Twenty-three health care professionals and 22 patients were interviewed over the phone or online. Both groups reported that current asthma reviews are often seen as tick-box exercises and that introducing the FeNO test would make reviews more tailored to the individual patient, rather than relying on subjective patient reports of asthma control. Adults with asthma also highlighted support more open communication and their understanding of asthma, as they desired to feel more engaged in decisions and conversations about their asthma. HCPs reported valuing patient education and empowerment over a paternalistic approach, when time and resources allow. They also recognised FeNO to provide an objective measure of inflammation that could support them in the education and empowerment of patients. FeNO was seen by both groups as a potentially valuable addition to current asthma reviews mainly led by nurses, both for increasing their understanding of current risk of exacerbation and also to provide more tailored and personalised asthma management to patients. Our findings highlighted the need for open and clear communication about how to interpret FeNO results.