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Pesantes E, Hernando R, Lores C, Cámara J, Arévalo E, Lores L. Utility of exhaled nitric oxide to guide mild asthma treatment in atopic patients and its correlation with asthma control test score: a randomized controlled trial. BMC Pulm Med 2024; 24:421. [PMID: 39210358 PMCID: PMC11360837 DOI: 10.1186/s12890-024-03227-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Fractional exhaled nitric oxide (FeNO) is used for the diagnosis and monitoring of asthma, although its utility to guide treatment and its correlation with other tools is still under discussion. We study the possibility to withdraw inhaled corticosteroid treatment in atopic patients with mild asthma based on the FeNO level, as well as to study its correlation with other clinical control tools. METHODS Prospective and randomized study including atopic patients aged 18 to 65 with mild asthma, stable, on low-dose inhaled corticosteroid (ICS) treatment, who had their treatment withdrawn based on a FeNO level of 40 ppb. Patients were randomized into two groups: control group (treatment with ICS was withdrawn regardless of FeNO level) and experimental group (according to the FeNO levels, patients were assigned to one of two groups: FeNO > 40 ppb on treatment with budesonide 200 mcg every 12 h and SABA on demand; FeNO ≤ 40 ppb only with SABA on demand). Follow-up was conducted for one year, during which medical assessment was performed with FeNO measurements, asthma control test (ACT), lung function tests (FEV1, FEV1/FVC, PEF, and RV/TLC), and recording of the number of exacerbations. RESULTS Ninety-two patients were included, with a mean age of 39.92 years (SD 13.99); 46 patients were assigned to the control group, and 46 patients to the experimental group. The number of exacerbations was similar between the groups (p = 0.301), while the time to the first exacerbation was significantly shorter in the control group (30.86 vs. 99.00 days), p < 0.001, 95% CI (43.332-92.954). Lung function tests (FEV1, FEV1/FVC, PEF, and RV/TLC) showed no differences between the groups (p > 0.05). Both FeNO and ACT showed significant changes in the groups in which ICS was withdrawn (p < 0.05 for both parameters). A significant negative correlation was observed between FeNO and ACT (r = -0.139, p = 0.008). CONCLUSIONS In atopic patients with mild asthma, withdrawal of ICS based on an FeNO of 40 ppb led to worsened symptoms but without changes in lung function tests or an increase in exacerbations. There was a negative correlation between FeNO values and symptomatic control measured by the ACT. TRIAL REGISTRATION Clinical Trial Number: 2012-000372-42. Start Date: 2012-07-23. Trial registered prospectively ( https://www.clinicaltrialsregister.eu/ctr-search/search?query=2012-000372-42 ). This study adheres to CONSORT guidelines of randomised control trials.
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Affiliation(s)
- Edwin Pesantes
- Parc Sanitari Sant Joan de Dèu, Camí Vell de la colonia, 25, Sant Boi de Llobregat, Barcelona, 08830, Spain.
| | - Rosana Hernando
- Parc Sanitari Sant Joan de Dèu, Camí Vell de la colonia, 25, Sant Boi de Llobregat, Barcelona, 08830, Spain
| | - Carmen Lores
- Bellvitge University Hospital,, Barcelona, Spain
| | - Jonathan Cámara
- Parc Sanitari Sant Joan de Dèu, Camí Vell de la colonia, 25, Sant Boi de Llobregat, Barcelona, 08830, Spain
| | - Elías Arévalo
- San Francisco Xavier de Chuquisaca University, Sucre, Bolivia
| | - Luis Lores
- Parc Sanitari Sant Joan de Dèu, Camí Vell de la colonia, 25, Sant Boi de Llobregat, Barcelona, 08830, Spain
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Lelieveld S, Lelieveld J, Mishra A, Daiber A, Pozzer A, Pöschl U, Berkemeier T. Endogenous Nitric Oxide Can Enhance Oxidative Stress Caused by Air Pollutants and Explain Higher Susceptibility of Individuals with Inflammatory Disorders. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:1823-1831. [PMID: 38235527 PMCID: PMC10832043 DOI: 10.1021/acs.est.3c07010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/22/2023] [Accepted: 01/07/2024] [Indexed: 01/19/2024]
Abstract
Air pollution causes morbidity and excess mortality. In the epithelial lining fluid of the respiratory tract, air pollutants trigger a chemical reaction sequence that causes the formation of noxious hydroxyl radicals that drive oxidative stress. For hitherto unknown reasons, individuals with pre-existing inflammatory disorders are particularly susceptible to air pollution. Through detailed multiphase chemical kinetic analysis, we show that the commonly elevated concentrations of endogenous nitric oxide in diseased individuals can increase the production of hydroxyl radicals via peroxynitrite formation. Our findings offer a molecular rationale of how adverse health effects and oxidative stress caused by air pollutants may be exacerbated by inflammatory disorders.
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Affiliation(s)
- Steven Lelieveld
- Multiphase
Chemistry Department, Max Planck Institute
for Chemistry, Mainz 55128, Germany
| | - Jos Lelieveld
- Atmospheric
Chemistry Department, Max Planck Institute
for Chemistry, Mainz 55128, Germany
- Climate and Atmosphere
Research Center, the Cyprus Institute, Nicosia 2121, Cyprus
| | - Ashmi Mishra
- Multiphase
Chemistry Department, Max Planck Institute
for Chemistry, Mainz 55128, Germany
| | - Andreas Daiber
- Department
of Cardiology, University Medical Center
of the Johannes Gutenberg University, Mainz 55131, Germany
- German
Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz 55131, Germany
| | - Andrea Pozzer
- Atmospheric
Chemistry Department, Max Planck Institute
for Chemistry, Mainz 55128, Germany
- Climate and Atmosphere
Research Center, the Cyprus Institute, Nicosia 2121, Cyprus
| | - Ulrich Pöschl
- Multiphase
Chemistry Department, Max Planck Institute
for Chemistry, Mainz 55128, Germany
| | - Thomas Berkemeier
- Multiphase
Chemistry Department, Max Planck Institute
for Chemistry, Mainz 55128, Germany
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Michils A, Akset M, Haccuria A, Perez-Bogerd S, Malinovschi A, Van Muylem A. The Impact of Airway Obstruction on Feno Values in Asthma Patients. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:111-117. [PMID: 37634805 DOI: 10.1016/j.jaip.2023.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 07/20/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Exhaled nitric oxide (Feno) is used as a marker of type-2 airway inflammation in asthma management. Studies with airway challenges demonstrated that a reduction in airway caliber decreases Feno levels. OBJECTIVE To evaluate the impact of airway caliber reduction occurring spontaneously in patients with asthma on Feno values in daily clinical practice. METHODS In this post hoc analysis, Feno, FEV1, and asthma control questionnaire scores were recorded on each visit for 120 (1073 visits) adult patients with asthma. Blood eosinophils were measured intermittently. The intraindividual relationship between Feno and FEV1 was evaluated via a linear mixed model. The determinants of the individual mean Feno were measured by a stepwise multivariate linear model including individual mean FEV1, inhaled corticosteroid dose, asthma control questionnaire score, and blood eosinophils. RESULTS Variations in the negative Feno-FEV1 relationship within individuals at different times were significantly determined by the individual's mean FEV1. This relationship did not hold for individuals above the 75th and below the 25th quartiles. The best explanatory variables for individual mean Feno were FEV1 (+4.3 parts per billion/10%pred) and blood eosinophil count (+1 part per billion per 100 cells/mm3). DISCUSSION In the presence of variable degrees of heterogeneous patterns of airway inflammation, airway caliber is shown to be an independent and significant determinant of Feno when measured in patients with asthma. We would propose a +4-parts-per-billion correction factor to the measured Feno value for each 10% reduction below 100% predicted FEV1. Doing this should improve the rigor of interpretation of Feno as an indicator of type-2 inflammation in patients with low FEV1.
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Affiliation(s)
- Alain Michils
- Chest Department, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Maud Akset
- Chest Department, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Amaryllis Haccuria
- Chest Department, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Silvia Perez-Bogerd
- Chest Department, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Andreï Malinovschi
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Alain Van Muylem
- Chest Department, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium.
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Maniscalco M, Fuschillo S, Mormile I, Detoraki A, Sarnelli G, de Paulis A, Spadaro G, Cantone E. Exhaled Nitric Oxide as Biomarker of Type 2 Diseases. Cells 2023; 12:2518. [PMID: 37947596 PMCID: PMC10649630 DOI: 10.3390/cells12212518] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023] Open
Abstract
Nitric oxide (NO) is a short-lived gas molecule which has been studied for its role as a signaling molecule in the vasculature and later, in a broader view, as a cellular messenger in many other biological processes such as immunity and inflammation, cell survival, apoptosis, and aging. Fractional exhaled nitric oxide (FeNO) is a convenient, easy-to-obtain, and non-invasive method for assessing active, mainly Th2-driven, airway inflammation, which is sensitive to treatment with standard anti-inflammatory therapy. Consequently, FeNO serves as a valued tool to aid the diagnosis and monitoring of several asthma phenotypes. More recently, FeNO has been evaluated in several other respiratory and/or immunological conditions, including allergic rhinitis, chronic rhinosinusitis with/without nasal polyps, atopic dermatitis, eosinophilic esophagitis, and food allergy. In this review, we aim to provide an extensive overview of the current state of knowledge about FeNO as a biomarker in type 2 inflammation, outlining past and recent data on the application of its measurement in patients affected by a broad variety of atopic/allergic disorders.
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Affiliation(s)
- Mauro Maniscalco
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy;
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy;
| | - Salvatore Fuschillo
- Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, 82037 Telese Terme, Italy;
| | - Ilaria Mormile
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy; (I.M.); (A.D.); (A.d.P.); (G.S.)
| | - Aikaterini Detoraki
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy; (I.M.); (A.D.); (A.d.P.); (G.S.)
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy;
| | - Amato de Paulis
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy; (I.M.); (A.D.); (A.d.P.); (G.S.)
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy; (I.M.); (A.D.); (A.d.P.); (G.S.)
| | - Elena Cantone
- Department of Neuroscience, Reproductive and Odontostomatological Sciences-ENT Section, University of Naples Federico II, 80131 Naples, Italy;
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Kiss H, Örlős Z, Gellért Á, Megyesfalvi Z, Mikáczó A, Sárközi A, Vaskó A, Miklós Z, Horváth I. Exhaled Biomarkers for Point-of-Care Diagnosis: Recent Advances and New Challenges in Breathomics. MICROMACHINES 2023; 14:391. [PMID: 36838091 PMCID: PMC9964519 DOI: 10.3390/mi14020391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/29/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
Cancers, chronic diseases and respiratory infections are major causes of mortality and present diagnostic and therapeutic challenges for health care. There is an unmet medical need for non-invasive, easy-to-use biomarkers for the early diagnosis, phenotyping, predicting and monitoring of the therapeutic responses of these disorders. Exhaled breath sampling is an attractive choice that has gained attention in recent years. Exhaled nitric oxide measurement used as a predictive biomarker of the response to anti-eosinophil therapy in severe asthma has paved the way for other exhaled breath biomarkers. Advances in laser and nanosensor technologies and spectrometry together with widespread use of algorithms and artificial intelligence have facilitated research on volatile organic compounds and artificial olfaction systems to develop new exhaled biomarkers. We aim to provide an overview of the recent advances in and challenges of exhaled biomarker measurements with an emphasis on the applicability of their measurement as a non-invasive, point-of-care diagnostic and monitoring tool.
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Affiliation(s)
- Helga Kiss
- National Koranyi Institute for Pulmonology, Koranyi F Street 1, 1121 Budapest, Hungary
| | - Zoltán Örlős
- National Koranyi Institute for Pulmonology, Koranyi F Street 1, 1121 Budapest, Hungary
| | - Áron Gellért
- National Koranyi Institute for Pulmonology, Koranyi F Street 1, 1121 Budapest, Hungary
| | - Zsolt Megyesfalvi
- National Koranyi Institute for Pulmonology, Koranyi F Street 1, 1121 Budapest, Hungary
| | - Angéla Mikáczó
- Department of Pulmonology, University of Debrecen, Nagyerdei krt 98, 4032 Debrecen, Hungary
| | - Anna Sárközi
- Department of Pulmonology, University of Debrecen, Nagyerdei krt 98, 4032 Debrecen, Hungary
| | - Attila Vaskó
- Department of Pulmonology, University of Debrecen, Nagyerdei krt 98, 4032 Debrecen, Hungary
| | - Zsuzsanna Miklós
- National Koranyi Institute for Pulmonology, Koranyi F Street 1, 1121 Budapest, Hungary
| | - Ildikó Horváth
- National Koranyi Institute for Pulmonology, Koranyi F Street 1, 1121 Budapest, Hungary
- Department of Pulmonology, University of Debrecen, Nagyerdei krt 98, 4032 Debrecen, Hungary
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Crespo-Lessmann A, Curto E, Mateus Medina EF, Palones E, Belda Soler A, Sánchez Maza S, Soto-Retes L, Plaza V. Characteristics of Induced-Sputum Inflammatory Phenotypes in Adults with Asthma: Predictors of Bronchial Eosinophilia. J Asthma Allergy 2023; 16:95-103. [PMID: 36699564 PMCID: PMC9869783 DOI: 10.2147/jaa.s389402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/19/2022] [Indexed: 01/19/2023] Open
Abstract
Purpose The objectives of this study were, for patients attending a specialist asthma clinic at a tertiary care hospital, to determine, from sputum induction (SI), proportions of bronchial inflammatory phenotypes, demographic, clinical and functional characteristics of each phenotype, and the most accessible non-invasive inflammatory marker that best discriminates between phenotypes. Patients and Methods Included were 96 patients with asthma, attending a specialist asthma clinic at a tertiary care hospital, who underwent testing as follows: SI, spirometry, fractional exhaled nitric oxide (FeNO), blood eosinophilia, total immunoglobulin E (IgE), and a skin prick test. Results SI phenotypes were 46.9% eosinophilic, 33.3% paucigranulocytic, 15.6% neutrophilic, and 4.2% mixed. No significantly different clinical or functional characteristics were observed between the phenotypes. A positive correlation was observed between SI eosinophilia and both emergency visits in the last 12 months (p = 0.041; r = 0.214) and FeNO values (p = 0.000; r = 0.368). Blood eosinophilia correlated with SI eosinophilia (p = 0.001; r = 0.362) and was the best predictor of bronchial eosinophilia, followed by FeNO, and total blood IgE (area under the receiver operating characteristic curve (AUC-ROC) 72%, 65%, and 53%, respectively), although precision was only fair. Conclusion In consultations for severe asthma, the most frequent phenotype was eosinophilic. Peripheral blood eosinophilia is a reliable marker for discriminating between different bronchial inflammatory phenotypes, is useful in enabling doctors to select a suitable biologic treatment and so prevent asthma exacerbation, and is a better predictor of bronchial eosinophilia than FeNO and IgE values.
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Affiliation(s)
- Astrid Crespo-Lessmann
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d’Investigació Biomédica Sant Pau, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Curto
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d’Investigació Biomédica Sant Pau, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eder Freddy Mateus Medina
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d’Investigació Biomédica Sant Pau, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Esther Palones
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d’Investigació Biomédica Sant Pau, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alicia Belda Soler
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d’Investigació Biomédica Sant Pau, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Soraya Sánchez Maza
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d’Investigació Biomédica Sant Pau, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lorena Soto-Retes
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d’Investigació Biomédica Sant Pau, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vicente Plaza
- Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d’Investigació Biomédica Sant Pau, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Gvalani A, Athavale A, Gupta D. Biomarkers in severe asthma: Identifying the treatable trait. Lung India 2023; 40:59-67. [PMID: 36695260 PMCID: PMC9894287 DOI: 10.4103/lungindia.lungindia_271_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/24/2022] [Accepted: 08/08/2022] [Indexed: 01/01/2023] Open
Abstract
Asthma is a chronic condition of bronchial hyper-reactivity associated with inflammation ranges from mild to severe form. It affects 1 - 18% of the population globally and it is estimated that > 300million people in the world have asthma. Of this 5 - 10% have severe asthma. while the proportion of patients suffering from severe are smaller, the morbidity and mortality are higher in this group. With the advances in our understanding of the pathophysiology of asthma there is a need to understand the role of various biomarkers. We live in an era of precision medicine and today there is a clear unmet need to understand targeted therapies. This review aims to raise awareness to the available biomarkers used in clinical practice in India and their role in predicting response to targeted therapies.
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Affiliation(s)
- Aanchal Gvalani
- Medical Affairs, GlaxoSmithKline, Mumbai, Maharashtra, India
| | - Amita Athavale
- Department of Pulmonary Medicine and EPRC, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Disha Gupta
- Medical Affairs, GlaxoSmithKline, Mumbai, Maharashtra, India
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Menigoz C, Dirou S, Chambellan A, Hassoun D, Moui A, Magnan A, Blanc F. Use of FeNO to predict anti-IL-5 and IL-5R biologics efficacy in a real-world cohort of adults with severe eosinophilic asthma. J Asthma 2022; 60:1162-1170. [PMID: 36301080 DOI: 10.1080/02770903.2022.2136526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Severe eosinophilic asthma (SEA) is associated with multiple exacerbations. Fractional exhaled nitric oxide (FeNO), a biomarker of airway T2 inflammation, is known to be correlated with the risk of exacerbations. While the use of FeNO is well established to predict the therapeutic response to dupilumab (anti-IL-4/IL-13), it remains uncertain for biologics targeting the IL-5 pathway. METHODS We conducted an observational, retrospective, monocentric analysis of adults with SEA who started mepolizumab (anti-IL-5) or benralizumab (anti-IL-5R) between January 1, 2016 and December 31, 2020. RESULTS Data were collected for 109 patients. All participants reported uncontrolled asthma with a median of 3 annual exacerbations and a median Asthma Control Test score of 12. They all had an initial blood eosinophilia >300/mm3, with a median at 610/mm3 (IQR 420-856). Patients with a baseline FeNO ≥50 ppb reported more exacerbations in the previous year than those with a FeNO <50 ppb (p = 0.02). After initiation of treatment, change in FeNO was not associated with therapeutic response. However, decrease in the annual number of exacerbations was significantly greater in patients with a baseline FeNO ≥50 ppb than in those with a baseline FeNO <50 ppb (-3.3 ± 2.7 vs -0.9 ± 2.4, respectively; p = 0.01). There was no association between baseline FeNO values and subsequent lung function, asthma control or reduction of oral corticosteroids use. CONCLUSION In this real-world cohort, adults with SEA who had a baseline FeNO ≥50 ppb experienced a greater decrease in exacerbations after 12 months of anti-IL-5 or IL-5R biologics than those with a FeNO <50 ppb.
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Affiliation(s)
- C. Menigoz
- Nantes Université, CHU Nantes, Service de Pneumologie, L’institut du thorax, Nantes, France.
| | - S. Dirou
- Nantes Université, CHU Nantes, Service de Pneumologie, L’institut du thorax, Nantes, France.
| | - A. Chambellan
- Nantes Université, CHU Nantes, Service d’Explorations Fonctionnelles, L’institut du thorax, Nantes, France.
| | - D. Hassoun
- Nantes Université, CHU Nantes, CNRS, INSERM, L’institut du Thorax, Nantes, France.
| | - A. Moui
- Nantes Université, CHU Nantes, Service de Pneumologie, L’institut du thorax, Nantes, France.
| | - A. Magnan
- Université de Versailles Saint-Quentin Paris-Saclay, Hôpital Foch, INRAe UMR 0892, Suresnes, France
| | - F.X. Blanc
- Nantes Université, CHU Nantes, Service de Pneumologie, L’institut du thorax, Nantes, France.
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Guida G, Bagnasco D, Carriero V, Bertolini F, Ricciardolo FLM, Nicola S, Brussino L, Nappi E, Paoletti G, Canonica GW, Heffler E. Critical evaluation of asthma biomarkers in clinical practice. Front Med (Lausanne) 2022; 9:969243. [PMID: 36300189 PMCID: PMC9588982 DOI: 10.3389/fmed.2022.969243] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
The advent of personalized medicine has revolutionized the whole approach to the management of asthma, representing the essential basis for future developments. The cornerstones of personalized medicine are the highest precision in diagnosis, individualized prediction of disease evolution, and patient-tailored treatment. To this aim, enormous efforts have been established to discover biomarkers able to predict patients' phenotypes according to clinical, functional, and bio-humoral traits. Biomarkers are objectively measured characteristics used as indicators of biological or pathogenic processes or clinical responses to specific therapeutic interventions. The diagnosis of type-2 asthma, prediction of response to type-2 targeted treatments, and evaluation of the risk of exacerbation and lung function impairment have been associated with biomarkers detectable either in peripheral blood or in airway samples. The surrogate nature of serum biomarkers, set up to be less invasive than sputum analysis or bronchial biopsies, has shown several limits concerning their clinical applicability. Routinely used biomarkers, like peripheral eosinophilia, total IgE, or exhaled nitric oxide, result, even when combined, to be not completely satisfactory in segregating different type-2 asthma phenotypes, particularly in the context of severe asthma where the choice among different biologics is compelling. Moreover, the type-2 low fraction of patients is not only an orphan of biological treatments but is at risk of being misdiagnosed due to the low negative predictive value of type-2 high biomarkers. Sputum inflammatory cell analysis, considered the highest specific biomarker in discriminating eosinophilic inflammation in asthma, and therefore elected as the gold standard in clinical trials and research models, demonstrated many limits in clinical applicability. Many factors may influence the measure of these biomarkers, such as corticosteroid intake, comorbidities, and environmental exposures or habits. Not least, biomarkers variability over time is a confounding factor leading to wrong clinical choices. In this narrative review, we try to explore many aspects concerning the role of routinely used biomarkers in asthma, applying a critical view over the "state of the art" and contemporarily offering an overview of the most recent evidence in this field.
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Affiliation(s)
- Giuseppe Guida
- Severe Asthma and Rare Lung Disease Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Torino, Turin, Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, Department of Internal Medicine (DIMI), University of Genoa, Genoa, Italy
| | - Vitina Carriero
- Severe Asthma and Rare Lung Disease Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Torino, Turin, Italy
| | - Francesca Bertolini
- Severe Asthma and Rare Lung Disease Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Torino, Turin, Italy
| | - Fabio Luigi Massimo Ricciardolo
- Severe Asthma and Rare Lung Disease Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Torino, Turin, Italy
| | - Stefania Nicola
- Allergy and Immunology, AO Mauriziano Hospital, University of Turin, Turin, Italy
| | - Luisa Brussino
- Allergy and Immunology, AO Mauriziano Hospital, University of Turin, Turin, Italy
| | - Emanuele Nappi
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giovanni Paoletti
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giorgio Walter Canonica
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Enrico Heffler
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Hassoun D, Rose L, Blanc FX, Magnan A, Loirand G, Sauzeau V. Bronchial smooth muscle cell in asthma: where does it fit? BMJ Open Respir Res 2022; 9:9/1/e001351. [PMID: 36109087 PMCID: PMC9478857 DOI: 10.1136/bmjresp-2022-001351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/04/2022] [Indexed: 11/04/2022] Open
Abstract
Asthma is a frequent respiratory condition whose pathophysiology relies on altered interactions between bronchial epithelium, smooth muscle cells (SMC) and immune responses. Those leads to classical hallmarks of asthma: airway hyper-responsiveness, bronchial remodelling and chronic inflammation. Airway smooth muscle biology and pathophysiological implication in asthma are now better understood. Precise deciphering of intracellular signalling pathways regulating smooth muscle contraction highlighted the critical roles played by small GTPases of Rho superfamily. Beyond contractile considerations, active involvement of airway smooth muscle in bronchial remodelling mechanisms is now established. Not only cytokines and growth factors, such as fibroblats growth factor or transforming growth factor-β, but also extracellular matrix composition have been demonstrated as potent phenotype modifiers for airway SMC. Although basic science knowledge has grown significantly, little of it has translated into improvement in asthma clinical practice. Evaluation of airway smooth muscle function is still limited to its contractile activity. Moreover, it relies on tools, such as spirometry, that give only an overall assessment and not a specific one. Interesting technics such as forced oscillometry or specific imagery (CT and MRI) give new perspectives to evaluate other aspects of airway muscle such as bronchial remodelling. Finally, except for the refinement of conventional bronchodilators, no new drug therapy directly targeting airway smooth muscle proved its efficacy. Bronchial thermoplasty is an innovative and efficient therapeutic strategy but is only restricted to a small proportion of severe asthmatic patients. New diagnostic and therapeutic strategies specifically oriented toward airway smooth muscle are needed to improve global asthma care.
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Affiliation(s)
- Dorian Hassoun
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France
| | - Lindsay Rose
- Nantes Université, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, Pays de la Loire, France
| | - François-Xavier Blanc
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France
| | - Antoine Magnan
- INRAe, UMR 0892, Hôpital Foch, Suresnes, France.,Université Versailles-Saint-Quentin-en-Yvelines Paris-Saclay, Versailles, France
| | - Gervaise Loirand
- Nantes Université, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, Pays de la Loire, France
| | - Vincent Sauzeau
- Nantes Université, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, Pays de la Loire, France
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Li M, Wen Ma Z, Jun Deng S, Oliver BG, Wang T, Ping Zhang H, Wang L, McDonald VM, Wang J, Liu D, Gibson PG, Ming Luo F, Min Li W, Jing Wan H, Wang G. Development and validation of a noninvasive prediction model for identifying eosinophilic asthma. Respir Med 2022; 201:106935. [DOI: 10.1016/j.rmed.2022.106935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 10/17/2022]
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Su KC, Ko HK, Hsiao YH, Chou KT, Chen YW, Yu WK, Pan SW, Feng JY, Perng DW. Fractional Exhaled Nitric Oxide Guided-Therapy in Chronic Obstructive Pulmonary Disease: A Stratified, Randomized, Controlled Trial. Arch Bronconeumol 2022; 58:601-610. [PMID: 35312525 DOI: 10.1016/j.arbres.2021.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/21/2021] [Accepted: 11/15/2021] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) with eosinophilic airway inflammation represents a distinct phenotype that might respond to treatment with inhaled corticosteroids. Fractional exhaled nitric oxide (FENO) might predict eosinophilic inflammation and guide treatment option. We hypothesized that COPD patients with different baseline levels of FENO might have differentiated response to treatment with salmeterol/fluticasone (SFC) or tiotropium (TIO). METHODS This open-label, randomized-controlled trial enrolled treatment-naïve COPD patients who were stratified into high- (≥23.5ppb) and low-FENO group, followed by 12-week treatment with SFC or TIO. A linear mixed model with repeated measures was applied to analyze the changes in FENO (primary outcome), COPD assessment test (CAT) score, FEV1, and parameters in induced sputum and blood after treatment. RESULTS 134 patients were divided into 4 subgroups: low-FENO/SFC (n=30), low-FENO/TIO (n=29), high-FENO/SFC (n=37), and high-FENO/TIO (n=38). At baseline, FENO 23.5ppb clearly differentiated between eosinophilic and non-eosinophilic inflammation groups based on the eosinophils in induced sputum and blood. FENO significantly correlated with sputum and blood eosinophils at baseline. High-FENO/SFC (vs. high-FENO/TIO) subgroup had significant reduction in FENO and sputum inflammation profiles (including eosinophils, macrophages, matrix metalloproteinase-9, and interlukin-8) after treatment. These differences were not replicated between low-FENO/SFC and low-FENO/TIO subgroups. The improvement in CAT and FEV1 after treatment was indiscriminate between SFC and TIO in the low- and high-FENO groups. CONCLUSION High baseline FENO can serve as an indicator of eosinophilic airway inflammation in COPD patients who may respond favorably to treatment with inhaled corticosteroids/long-acting β2-agonists. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT02546349.
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Affiliation(s)
- Kang-Cheng Su
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City 11217, Taiwan, ROC; Center of Sleep Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City 11217, Taiwan, ROC; School of Medicine, Yangming Campus, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Beitou District, Taipei City, Taiwan, ROC
| | - Hsin-Kuo Ko
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City 11217, Taiwan, ROC; School of Medicine, Yangming Campus, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Beitou District, Taipei City, Taiwan, ROC
| | - Yi-Han Hsiao
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City 11217, Taiwan, ROC; Center of Sleep Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City 11217, Taiwan, ROC; School of Medicine, Yangming Campus, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Beitou District, Taipei City, Taiwan, ROC
| | - Kun-Ta Chou
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City 11217, Taiwan, ROC; Center of Sleep Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City 11217, Taiwan, ROC; School of Medicine, Yangming Campus, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Beitou District, Taipei City, Taiwan, ROC
| | - Yen-Wen Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City 11217, Taiwan, ROC; School of Medicine, Yangming Campus, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Beitou District, Taipei City, Taiwan, ROC
| | - Wen-Kuang Yu
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City 11217, Taiwan, ROC; School of Medicine, Yangming Campus, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Beitou District, Taipei City, Taiwan, ROC
| | - Sheng-Wei Pan
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City 11217, Taiwan, ROC; School of Medicine, Yangming Campus, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Beitou District, Taipei City, Taiwan, ROC
| | - Jia-Yih Feng
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City 11217, Taiwan, ROC; School of Medicine, Yangming Campus, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Beitou District, Taipei City, Taiwan, ROC
| | - Diahn-Warng Perng
- Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City 11217, Taiwan, ROC; School of Medicine, Yangming Campus, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Beitou District, Taipei City, Taiwan, ROC.
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Summary for Clinicians: Clinical Practice Guideline for the Use of Fractional Exhaled Nitric Oxide to Guide the Treatment of Asthma. Ann Am Thorac Soc 2022; 19:1627-1630. [PMID: 35507440 DOI: 10.1513/annalsats.202204-289cme] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Rouadi PW, Idriss SA, Bousquet J, Laidlaw TM, Azar CR, Al-Ahmad MS, Yañez A, Al-Nesf MAY, Nsouli TM, Bahna SL, Abou-Jaoude E, Zaitoun FH, Hadi UM, Hellings PW, Scadding GK, Smith PK, Morais-Almeida M, Maximiliano Gómez R, Gonzalez Diaz SN, Klimek L, Juvelekian GS, Riachy MA, Canonica GW, Peden D, Wong GW, Sublett J, Bernstein JA, Wang L, Tanno LK, Chikhladze M, Levin M, Chang YS, Martin BL, Caraballo L, Custovic A, Ortego-Martell JA, Lesslar OJ, Jensen-Jarolim E, Ebisawa M, Fiocchi A, Ansotegui IJ. WAO-ARIA consensus on chronic cough - Part III: Management strategies in primary and cough-specialty care. Updates in COVID-19. World Allergy Organ J 2022; 15:100649. [PMID: 35600836 PMCID: PMC9117692 DOI: 10.1016/j.waojou.2022.100649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background Chronic cough management necessitates a clear integrated care pathway approach. Primary care physicians initially encounter the majority of chronic cough patients, yet their role in proper management can prove challenging due to limited access to advanced diagnostic testing. A multidisciplinary approach involving otolaryngologists and chest physicians, allergists, and gastroenterologists, among others, is central to the optimal diagnosis and treatment of conditions which underly or worsen cough. These include infectious and inflammatory, upper and lower airway pathologies, or gastro-esophageal reflux. Despite the wide armamentarium of ancillary testing conducted in cough multidisciplinary care, such management can improve cough but seldom resolves it completely. This can be due partly to the limited data on the role of tests (eg, spirometry, exhaled nitric oxide), as well as classical pharmacotherapy conducted in multidisciplinary specialties for chronic cough. Other important factors include presence of multiple concomitant cough trigger mechanisms and the central neuronal complexity of chronic cough. Subsequent management conducted by cough specialists aims at control of cough refractory to prior interventions and includes cough-specific behavioral counseling and pharmacotherapy with neuromodulators, among others. Preliminary data on the role of neuromodulators in a proof-of-concept manner are encouraging but lack strong evidence on efficacy and safety. Objectives The World Allergy Organization (WAO)/Allergic Rhinitis and its Impact on Asthma (ARIA) Joint Committee on Chronic Cough reviewed the recent literature on management of chronic cough in primary, multidisciplinary, and cough-specialty care. Knowledge gaps in diagnostic testing, classical and neuromodulator pharmacotherapy, in addition to behavioral therapy of chronic cough were also analyzed. Outcomes This third part of the WAO/ARIA consensus on chronic cough suggests a management algorithm of chronic cough in an integrated care pathway approach. Insights into the inherent limitations of multidisciplinary cough diagnostic testing, efficacy and safety of currently available antitussive pharmacotherapy, or the recently recognized behavioral therapy, can significantly improve the standards of care in patients with chronic cough.
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Affiliation(s)
- Philip W. Rouadi
- Department of Otolaryngology – Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
- Ear, Nose and Throat Department, Dar Al Shifa Hospital, Hawally, Kuwait
| | - Samar A. Idriss
- Department of Otolaryngology – Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
- Department of Audiology and Otoneurological Evaluation, Edouard Herriot Hospital, Lyon, France
| | - Jean Bousquet
- Hospital Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Berlin Institute of Health, Berlin, Germany
- Macvia France, Montpellier France
- Université Montpellier, Montpellier, France
| | - Tanya M. Laidlaw
- Department of Medicine, Harvard Medical School, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital Boston, Massachusetts, USA
| | - Cecilio R. Azar
- Department of Gastroenterology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
- Department of Gastroenterology, Middle East Institute of Health (MEIH), Beirut, Lebanon
- Department of Gastroenterology, Clemenceau Medical Center (CMC), Beirut, Lebanon
| | - Mona S. Al-Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| | - Anahi Yañez
- INAER - Investigaciones en Alergia y Enfermedades Respiratorias, Buenos Aires, Argentina
| | - Maryam Ali Y. Al-Nesf
- Allergy and Immunology Section, Department of Medicine, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | | | - Sami L. Bahna
- Allergy & Immunology Section, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | | | - Fares H. Zaitoun
- Department of Allergy Otolaryngology, LAU-RIZK Medical Center, Beirut, Lebanon
| | - Usamah M. Hadi
- Clinical Professor Department of Otolaryngology Head and Neck Surgery, American University of Beirut, Lebanon
| | - Peter W. Hellings
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology, Leuven, Belgium
- University Hospitals Leuven, Department of Otorhinolaryngology, Leuven, Belgium
- University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium
- Academic Medical Center, University of Amsterdam, Department of Otorhinolaryngology, Amsterdam, the Netherlands
| | | | - Peter K. Smith
- Clinical Medicine Griffith University, Southport Qld, 4215, Australia
| | | | | | - Sandra N. Gonzalez Diaz
- Universidad Autónoma de Nuevo León, Hospital Universitario and Facultad de Medicina, Monterrey, Nuevo León, Mexico
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Georges S. Juvelekian
- Department of Pulmonary, Critical Care and Sleep Medicine at Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Moussa A. Riachy
- Department of Pulmonary and Critical Care, Hôtel-Dieu de France university Hospital, Beirut, Lebanon
| | - Giorgio Walter Canonica
- Humanitas University & Personalized Medicine Asthma & Allergy Clinic-Humanitas Research Hospital-IRCCS-Milano Italy
| | - David Peden
- UNC Center for Environmental Medicine, Asthma, and Lung Biology, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics UNC School of Medicine, USA
| | - Gary W.K. Wong
- Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China
| | - James Sublett
- Department of Pediatrics, Section of Allergy and Immunology, University of Louisville School of Medicine, 9800 Shelbyville Rd, Louisville, KY, USA
| | - Jonathan A. Bernstein
- University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, Cincinnati, OH, USA
| | - Lianglu Wang
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, 100730, China
| | - Luciana K. Tanno
- Université Montpellier, Montpellier, France
- Desbrest Institute of Epidemiology and Public Health, UMR UA-11, INSERM University of Montpellier, Montpellier, France
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| | - Manana Chikhladze
- Medical Faculty at Akaki Tsereteli State University, National Institute of Allergy, Asthma & Clinical Immunology, KuTaisi, Tskaltubo, Georgia
| | - Michael Levin
- Division of Paediatric Allergology, Department of Paediatrics, University of Cape Town, South Africa
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Bryan L. Martin
- Department of Otolaryngology, Division of Allergy & Immunology, The Ohio State University, Columbus, OH, USA
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena. Cartagena de Indias, Colombia
| | - Adnan Custovic
- National Heart and Lund Institute, Imperial College London, UK
| | | | | | - Erika Jensen-Jarolim
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Austria
- The interuniversity Messerli Research Institute, Medical University Vienna and University of Veterinary Medicine, Vienna, Austria
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Alessandro Fiocchi
- Translational Pediatric Research Area, Allergic Diseases Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Holy See
| | - Ignacio J. Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
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Czubaj-Kowal M, Nowicki GJ, Kurzawa R, Polak M, Ślusarska B. Factors Influencing the Concentration of Exhaled Nitric Oxide (FeNO) in School Children Aged 8–9-Years-Old in Krakow, with High FeNO Values ≥ 20 ppb. Medicina (B Aires) 2022; 58:medicina58020146. [PMID: 35208470 PMCID: PMC8877257 DOI: 10.3390/medicina58020146] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 11/21/2022] Open
Abstract
Background and Objectives: Measurement of fractional exhaled nitric oxide (FeNO) concentration is currently used as a non-invasive biomarker to assess airway inflammation. Many factors can influence the FeNO level. However, there have been no reports concerning factors attributed to FeNO levels in different age groups of children, especially those with high FeNO values. Therefore, this study aimed to assess the influence of selected factors on nitric oxide concentration in exhaled air in children aged 8–9 attending class 3 of public primary schools in Krakow with high FeNO values ≥ 20 ppb. Materials and Methods: The population-based study covered all third-grade pupils attending primary schools in the city of Krakow. Five thousand, four hundred and sixty children participated in the first screening stage, conducted from October 2017 to January 2018. Then, 792 participants with an FeNO level ≥ 20 ppb were selected. Finally, those selected pupils were invited to participate in the second stage, diagnostic, in April 2018. Four hundred and fifty-four children completed the diagnostic stage of the study, and their data was included in the presented analysis. Results and Conclusions: Significantly higher FeNO levels were observed in children diagnosed with the following diseases: asthma, allergic rhinitis, atopic dermatitis, and allergy (p < 0.05). In addition, it was observed that a higher FeNO concentration characterised children taking antihistamines compared to children not taking those medications (p = 0.008). In multivariate models, we observed that regardless of sex, age, BMI value, home smoking, and whether they were taking medications, children who had allergic rhinitis, or atopic dermatitis, or allergies had significantly higher FeNO levels. The strongest relationship was noted with allergic diseases. The results of our study may be of importance to clinicians when interpreting FeNO results, for example, when making a therapeutic decision.
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Affiliation(s)
- Marta Czubaj-Kowal
- Department of Paediatrics, Stefan Zeromski Specialist Hospital in Krakow, Na Skarpie 66 Str., 31-913 Krakow, Poland
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzińskiego 1 Str., 30-705 Krakow, Poland
- Correspondence: ; Tel.: +48-604-433-42
| | - Grzegorz Józef Nowicki
- Department of Family and Geriatric Nursing, Medical University of Lublin, Staszica 6 Str., 20-081 Lublin, Poland; (G.J.N.); (B.Ś.)
| | - Ryszard Kurzawa
- Department of Alergology and Pneumonology, Institute of Tuberculosis and Lung Disorders, Prof. Jana Rudnika 3B Str., 34-700 Rabka-Zdrój, Poland;
| | - Maciej Polak
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Grzegórzecka 20 Str., 31-531 Krakow, Poland;
| | - Barbara Ślusarska
- Department of Family and Geriatric Nursing, Medical University of Lublin, Staszica 6 Str., 20-081 Lublin, Poland; (G.J.N.); (B.Ś.)
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Khatri SB, Iaccarino JM, Barochia A, Soghier I, Akuthota P, Brady A, Covar RA, Debley JS, Diamant Z, Fitzpatrick AM, Kaminsky DA, Kenyon NJ, Khurana S, Lipworth BJ, McCarthy K, Peters M, Que LG, Ross KR, Schneider-Futschik EK, Sorkness CA, Hallstrand TS. Use of Fractional Exhaled Nitric Oxide to Guide the Treatment of Asthma: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2021; 204:e97-e109. [PMID: 34779751 PMCID: PMC8759314 DOI: 10.1164/rccm.202109-2093st] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: The fractional exhaled nitric oxide (FENO) test is a point-of-care test that is used in the assessment of asthma. Objective: To provide evidence-based clinical guidance on whether FENO testing is indicated to optimize asthma treatment in patients with asthma in whom treatment is being considered. Methods: An international, multidisciplinary panel of experts was convened to form a consensus document regarding a single question relevant to the use of FENO. The question was selected from three potential questions based on the greatest perceived impact on clinical practice and the unmet need for evidence-based answers related to this question. The panel performed systematic reviews of published randomized controlled trials between 2004 and 2019 and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) evidence-to-decision framework to develop recommendations. All panel members evaluated and approved the recommendations. Main Results: After considering the overall low quality of the evidence, the panel made a conditional recommendation for FENO-based care. In patients with asthma in whom treatment is being considered, we suggest that FENO is beneficial and should be used in addition to usual care. This judgment is based on a balance of effects that probably favors the intervention; the moderate costs and availability of resources, which probably favors the intervention; and the perceived acceptability and feasibility of the intervention in daily practice. Conclusions: Clinicians should consider this recommendation to measure FENO in patients with asthma in whom treatment is being considered based on current best available evidence.
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Using FeNO Measurement in Clinical Asthma Management. Chest 2021; 161:906-917. [PMID: 34673021 DOI: 10.1016/j.chest.2021.10.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 09/30/2021] [Accepted: 10/10/2021] [Indexed: 11/24/2022] Open
Abstract
Asthma is a common and heterogeneous disease, characterised by lower airway inflammation and airflow limitation. Critical factors in asthma management include establishing an accurate diagnosis and ensuring appropriate selection and dosage of anti-inflammatory therapies. The majority of asthma patients exhibit type 2 (T2) inflammation, with increased interleukin (IL)-4, IL-5, and IL-13 signalling, often with associated eosinophilia. Identifying lower airway eosinophilia with sputum induction improves asthma outcomes, but is time consuming and costly. Increased T2-inflammation leads to upregulation of nitric oxide (NO) release into the airway, with increasing fractional exhaled NO (FeNO) reflecting greater T2-inflammation. FeNO can be easily and quickly measured in the clinic, offering a point of care surrogate measure of the degree of lower airway inflammation. FeNO testing can be used to help confirm an asthma diagnosis, to guide inhaled corticosteroid therapy, to assess adherence to treatment, and to aid selection of appropriate biologic therapy. However, FeNO levels may also be influenced by a variety of intrinsic and extrinsic factors other than asthma, including nasal polyposis and cigarette smoking, and must be interpreted in the broader clinical context rather than viewed in isolation. This review discusses the clinical application of FeNO measurement in asthma care, from diagnosis to treatment selection, and describes its place in current international expert guidelines.
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Hassoun D, Malard O, Barbarot S, Magnan A, Colas L. Type 2 immunity-driven diseases: Towards a multidisciplinary approach. Clin Exp Allergy 2021; 51:1538-1552. [PMID: 34617355 PMCID: PMC9292742 DOI: 10.1111/cea.14029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/23/2021] [Accepted: 09/08/2021] [Indexed: 12/31/2022]
Abstract
Asthma, atopic dermatitis and chronic rhinoconjunctivitis are highly heterogeneous. However, epidemiologic associations exist between phenotypic groups of patients. Atopic march is one such association but is not the only common point. Indeed, beyond such phenotypes, hallmarks of type 2 immunity have been found in these diseases involving immune dysregulation as well as environmental triggers and epithelial dysfunction. From the canonical Th2 cytokines (IL-4, IL-5, IL-13), new cellular and molecular actors arise, from the epithelium's alarmins to new innate immune cells. Their interactions are now better understood across the different environmental barriers, and slight differences appeared. In parallel, the development of type 2-targeting biotherapies not only raised hope to treat those diseases but also raised new questions regarding their true pathophysiological involvement. Here, we review the place of type 2 immunity in the different phenotypes of asthma, chronic rhinitis, chronic rhinosinusitis and atopic dermatitis, highlighting nuances between them. New hypotheses rising from the use of biotherapies will be discussed along with the uncertainties and unmet needs of this field.
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Affiliation(s)
- Dorian Hassoun
- CHU Nantes, CNRS, INSERM, l'institut du Thorax, Université de Nantes, Nantes, France
| | - Olivier Malard
- Department of Otorhinolaryngology and Head and Neck Surgery, Nantes University Hospital, Nantes, France
| | - Sébastien Barbarot
- Department of Dermatology, CHU Nantes, UMR 1280 PhAN, INRA, Nantes Université, Nantes, France
| | - Antoine Magnan
- INRAe UMR_S 0892, Hôpital Foch, Université de Versailles Saint-Quentin, Paris Saclay, France
| | - Luc Colas
- Plateforme Transversale d'Allergologie et d'Immunologie Clinique, Institut du Thorax, CHU de Nantes, Nantes, France.,INSERM, CHU Nantes, Centre de Recherche en Transplantation et Immunologie UMR1064, Nantes Université, ITUN, Nantes, France
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Cheng L, Yang T, Ma X, Han Y, Wang Y. Effectiveness and Safety Studies of Omalizumab in Children and Adolescents With Moderate-To-Severe Asthma. J Pharm Pract 2021; 36:370-382. [PMID: 34384308 DOI: 10.1177/08971900211038251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Omalizumab is currently approved for the treatment of moderate-to-severe allergic asthma in patients 6 years and older. OBJECTIVE To assess the effectiveness and safety of subcutaneous omalizumab as an add-on therapy option for moderate-severe allergic asthma in patients aged 6-20 years old. METHODS The studies published from July, 1970 to May, 2021 were searched from the electronic databases which followed keywords: ("anti-IgE" OR "anti-immunoglobulin E" OR "anti-IgE antibody" OR "omalizumab" OR "rhuMAb-E25" OR "Xolair") AND "asthma" AND ("child" OR "children" OR "adolescents" OR "youth" OR "teenager" OR "kids" OR "pediatric"). Thirteen studies were pooled to determine the effectiveness and safety of omalizumab. Efficacy endpoints were evaluated using a fixed-effects model or a random-effects model depending on heterogeneity. Safety endpoints were evaluated by odds ratio. RESULTS Thirteen studies were included. In this meta-analysis, our results showed that fractional exhaled nitric oxide and asthma control test scores were significantly improved with omalizumab treatment. Serum immunoglobulin E was also decreased in children with moderate-to-severe asthma after treatment with omalizumab. The analysis found that there was no significant difference between pre-and post-treatment in forced expiratory volume in one second/ forced vital capacity ratio, forced expiratory flow between 25 and 75% of vital capacity, or FEV1. Overall, more adverse events occurred with omalizumab compared to placebo. However, the degree was mild to moderate. CONCLUSION This meta-analysis indicates that omalizumab is safe and effective to treat children and adolescents with moderate-to-severe asthma.
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Affiliation(s)
- Lu Cheng
- Department of Respiratory Medicine, Jinan Children's Hospital, Jinan, China
| | - Tianrui Yang
- Ben and Maytee Fisch College of Pharmacy, 23534University of Texas at Tyler, Tyler, TX, USA
| | - Xiang Ma
- Department of Respiratory Medicine, Jinan Children's Hospital, Jinan, China
| | - Yuling Han
- Department of Respiratory Medicine, Jinan Children's Hospital, Jinan, China
| | - Yongtai Wang
- College of Nursing and Health Sciences, 12347University of Texas at Tyler, Tyler, TX, USA
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20
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Abstract
Biomarkers may be diagnostic of asthma, they may predict or reflect response to therapy or they may identify patients at risk of asthma exacerbation. A biomarker is most often measured in biologic fluids that are sampled using relatively non-invasive sampling techniques such as blood, sputum, urine or exhaled breath. Biomarkers should be stable, readily quantifiable and their measurement should be reproducible and not confounded by other host factors, or the presence of comorbidities. However, asthma comprises multiple molecular endotypes and single, sensitive, specific, biomarkers reflecting these endotypes may not exist. Combining biomarkers may improve their predictive capability in asthma. The most well-established endotypes are those described as Type2 and non-Type2 asthma. Clinical trials established the fraction of exhaled nitric oxide (FeNO) and blood eosinophil counts as key biomarkers of response to corticosteroid or targeted anti-inflammatory therapy in Type2 asthma. However, these biomarkers may have limited value in the management of asthma in real-life settings or routine clinical practise. Biomarkers for Type2 asthma are not well described or validated and more research is needed. Breathomics has provided evidence to propose a number of exhaled volatile organic compounds (VOCs) as surrogate biomarkers for airway inflammatory phenotypes, disease activity and adherence to therapy. Analysis of urinary eicosanoids has identified eicosanoids related to Type2 and non-Type2 inflammation. Future clinical trials will be important in determining how exhaled VOCs or urinary eicosanoid profiles can be used to direct precision treatments. Their future clinical use will also depend on developing simplified instrumentation for biomarker analysis at the point-of-care.
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Affiliation(s)
- Janis Shute
- School of Pharmacy and Biomedical Sciences, Institute of Biomedical and Biomolecular Sciences, University of Portsmouth, Portsmouth, UK -
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21
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Bao W, Zhang X, Yin J, Han L, Huang Z, Bao L, Lv C, Hao H, Xue Y, Zhou X, Zhang M. Small-Airway Function Variables in Spirometry, Fractional Exhaled Nitric Oxide, and Circulating Eosinophils Predicted Airway Hyperresponsiveness in Patients with Mild Asthma. J Asthma Allergy 2021; 14:415-426. [PMID: 33907426 PMCID: PMC8071078 DOI: 10.2147/jaa.s295345] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/09/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose Patients with variable symptoms suggestive of asthma but with normal forced expiratory volume in 1 second (FEV1) often fail to be diagnosed without a bronchial provocation test, but the test is expensive, time-consuming, risky, and not readily available in all clinical settings. Patients and Methods A cross-sectional study was performed in 692 patients with FEV1≥80% predicted; normal neutrophils and chest high-resolution computed tomography; and recurrent dyspnea, cough, wheeze, and chest tightness. Results Compared with subjects negative for AHR (n=522), subjects positive for AHR (n=170) showed increased FENO values, peripheral eosinophils (EOS), and R5-R20; decreased FEV1, FEV1/Forced vital capacity (FVC), and forced expiratory flow (FEFs) (P≤.001 for all). Small-airway dysfunction was identified in 104 AHR+ patients (61.17%), and 132 AHR− patients (25.29%) (P<0.001). The areas under the curve (AUCs) of variables used singly for an AHR diagnosis were lower than 0.77. Using joint models of FEF50%, FEF75%, or FEF25%-75% with FENO increased the AUCs to 0.845, 0.824, and 0.844, respectively, significantly higher than univariate AUCs (P <0.001 for all). Patients who reported chest tightness (n=75) had lower FEFs than patients who did not (P<0.001 for all). In subjects with chest tightness, the combination of FEF50% or FEF25%-75% with EOS also increased the AUCs substantially, to 0.815 and 0.816, respectively (P <0.001 for all versus the univariate AUCs). Conclusion FENO combined with FEF50% and FEF25%-75% predict AHR in patients with normal FEV1. FEF25%-75%, FEF50%, or FEF25%-75% together with EOS also can potentially suggest asthma in patients with chest tightness.
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Affiliation(s)
- Wuping Bao
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xue Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Junfeng Yin
- School of Mathematical Sciences, Tongji University, Shanghai, People's Republic of China
| | - Lei Han
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Zhixuan Huang
- School of Mathematical Sciences, Tongji University, Shanghai, People's Republic of China
| | - Luhong Bao
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Chengjian Lv
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Huijuan Hao
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yishu Xue
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xin Zhou
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Min Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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22
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Malerba M, Ragnoli B, Azzolina D, Montuschi P, Radaeli A. Predictive Markers of Bronchial Hyperreactivity in a Large Cohort of Young Adults With Cough Variant Asthma. Front Pharmacol 2021; 12:630334. [PMID: 33953671 PMCID: PMC8089476 DOI: 10.3389/fphar.2021.630334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/25/2021] [Indexed: 12/01/2022] Open
Abstract
Cough variant asthma (CVA), a common asthma phenotype characterized by nonproductive cough and bronchial hyperreactivity (BHR), is usually detected by bronchial provocation tests (BPTs) which are time-consuming, expensive, and unsafe. The primary study objective was to provide proof of concept for the use of fractional exhaled nitric oxide (FENO), eosinophil count percentage in induced sputum (sEOS%), forced expiratory flow between 25 and 75% of forced vital capacity (FEF25–75%) % predicted value, and FEF25–75% z-scores as surrogate markers predicting BHR in young adults with suspected CVA; the secondary objective was to compare the diagnostic performance of the various techniques. Three hundred and ten subjects (median age 24 years) were included in a cross-sectional study. Subjects were characterized as BHR positive (POS) (n = 147) or BHR negative (NEG) (n = 163) according to methacholine BPT. Classification accuracies were expressed as areas under the receiver operator characteristic curves (AUC). Compared with BHR NEG, FEF25–75% % predicted value and FEF25–75% z-scores were lower in the BHR POS group (p < 0.001), whereas FENO (p < 0.001) and sEOS% were higher (p < 0.001). AUC values for detecting BHR were as follows: FENO, 0.98 (SD = 0.02); sEOS%, 0.98 (SD = 0.02); FEF25–75% % pred, 0.93 (SD = 0.05); FEF25–75% z scores, 0.92 (SD = 0.05). Optimal cutoff values (OCV) for BHR prediction were as follows: FENO, 32.7 ppb (sensitivity = 0.93, specificity = 0.96), sEOS%, 3.80% (sensitivity = 0.94, specificity = 0.94), FEF25–75% % predicted value, 80.0% (sensitivity = 0.90, specificity = 0.87), and FEF25–75% z-score, −0.87 (sensitivity = 0.89, specificity = 0.87). Non-invasive/semi-invasive airway inflammatory or small airway functional measures might be used as surrogate markers predicting BHR in young adults with suspected CVA.
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Affiliation(s)
- Mario Malerba
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.,Respiratory Unit, S. Andrea Hospital, Vercelli, Italy
| | - Beatrice Ragnoli
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.,Respiratory Unit, S. Andrea Hospital, Vercelli, Italy
| | - Danila Azzolina
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Paolo Montuschi
- Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Roma, Italy
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23
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Hou L, Hao H, Huang G, Liu J, Yu L, Zhu L, Shen H, Zhang M. The value of small airway function parameters and fractional exhaled nitric oxide for predicting positive methacholine challenge test in asthmatics of different ages with FEV 1 ≥ 80% predicted. Clin Transl Allergy 2021; 11:e12007. [PMID: 33900045 PMCID: PMC8099229 DOI: 10.1002/clt2.12007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/04/2021] [Indexed: 02/01/2023] Open
Abstract
Background Small airway function parameters (SAFPs) combined with fractional exhaled nitric oxide (FeNO) can predict a positive methacholine challenge test (MCT) for asthma diagnosis. However, their predictive utility in patients with forced expiratory volume in one second (FEV1) ≥80% predicted within different age ranges remains unclear. This study aimed to assess the utility of SAFPs, alone or combined with FeNO, to predict a positive MCT in patients in two age groups (<55 and ≥55 years) with asthma‐suggestive symptoms and FEV1 ≥80% predicted. Methods We enrolled 846 Chinese patients with suspected asthma and standard spirometry, FeNO, and MCT findings. Using the area under the curves (AUCs), the utility of SAFPs, alone or combined with FeNO, for predicting a positive MCT was analyzed in a discovery (n = 534) and validation cohort (n = 312) in both age groups with FEV1 ≥80% predicted. Results In the discovery cohort, the optimal cut‐off values for predicting a positive MCT in patients aged <55 years (74.2% and 74.9% for forced expiratory flow (FEF)50% and FEF25%–75%, respectively) were higher than those in patients aged ≥55 years (65.0% and 62.9% for FEF50%, FEF25%–75%, respectively). However, the optimal FeNO value in patients aged <55 years (43 ppb) was lower than that in patients aged ≥55 years (48 ppb). FeNO combined with SAFPs (FEF50%, FEF25%–75%) significantly increased the AUCs in both groups (≥55 years [0.851 for FEF50% and 0.844 for FEF25%–75%]; <55 years [0.865 for FEF50% and 0.883 for FEF25%–75%]) compared with a single parameter (p < 0.05). These findings were confirmed in the validation cohort. Compared with patients ≥55 years, those aged <55 years had higher and lower optimal cut‐off values for SAFPs and FeNO, respectively. The AUCs of FeNO combined with SAFPs for predicting a positive MCT for asthma diagnosis were significantly higher than those of the individual parameters (p < 0.05) in both age groups. Conclusions There were age‐group differences in the utility of SAFPs combined with FeNO for predicting a positive MCT. Patients with an asthma‐suggestive history and a normal FEV1 should be stratified by age when using SAFPs combined with FeNO to predict a positive MCT.
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Affiliation(s)
- Lili Hou
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huijuan Hao
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gang Huang
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jinkai Liu
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Li Yu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Zhu
- Department of Respiratory and Critical Care Medicine, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Huahao Shen
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Min Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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24
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Braithwaite IE, Cai F, Tom JA, Galanter JM, Owen RP, Zhu R, Williams M, McGregor AG, Eliahu A, Durk MR, Dengler HS, Zak M, Kenny JR, Wilson ME, Beasley R, Chen H. Inhaled JAK inhibitor GDC-0214 reduces exhaled nitric oxide in patients with mild asthma: A randomized, controlled, proof-of-activity trial. J Allergy Clin Immunol 2021; 148:783-789. [PMID: 33744327 DOI: 10.1016/j.jaci.2021.02.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/01/2021] [Accepted: 02/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Janus kinase (JAK) pathway mediates the activity of many asthma-relevant cytokines, including IL-4 and IL-13. GDC-0214 is a potent, inhaled, small-molecule JAK inhibitor being developed for the treatment of asthma. OBJECTIVE We sought to determine whether GDC-0214 reduces fractional exhaled nitric oxide (Feno), a JAK1-dependent biomarker of airway inflammation, in patients with mild asthma. METHODS We conducted a double-blind, randomized, placebo-controlled, phase 1 proof-of-activity study in adults with mild asthma and Feno higher than 40 parts per billion (ppb). Subjects were randomized 2:1 (GDC-0214:placebo) into 4 sequential ascending-dose cohorts (1 mg once daily [QD], 4 mg QD, 15 mg QD, or 15 mg twice daily). All subjects received 4 days of blinded placebo, then 10 days of either active drug or placebo. The primary outcome was placebo-corrected percent reduction in Feno from baseline to day 14. Baseline was defined as the average Feno during the blinded placebo period. Pharmacokinetics, safety, and tolerability were also assessed. RESULTS Thirty-six subjects (mean age, 28 years; 54% females) were enrolled. Mean Feno at baseline across all subjects was 93 ± 43 ppb. At day 14, placebo-corrected difference in Feno was -23% (95% CI, -37.3 to -9) for 15 mg QD and -42% (95% CI, -57 to -27.4) for 15 mg twice daily. Higher plasma exposure was associated with greater Feno reduction. No dose-limiting adverse events, serious adverse events, or treatment discontinuations occurred. There were no major imbalances in adverse events or laboratory findings, or evidence of systemic JAK inhibition. CONCLUSIONS GDC-0214, an inhaled JAK inhibitor, caused dose-dependent reductions in Feno in mild asthma and was well tolerated without evidence of systemic toxicity.
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Affiliation(s)
| | - Fang Cai
- Genentech, Inc, South San Francisco, Calif
| | | | | | | | - Rui Zhu
- Genentech, Inc, South San Francisco, Calif
| | - Mathew Williams
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Avi Eliahu
- Genentech, Inc, South San Francisco, Calif
| | | | | | - Mark Zak
- Genentech, Inc, South San Francisco, Calif
| | | | | | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
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25
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Rolla G, Heffler E, Pizzimenti S, Michils A, Malinovschi A. An Emerging Role for Exhaled Nitric Oxide in Guiding Biological Treatment in Severe Asthma. Curr Med Chem 2021; 27:7159-7167. [PMID: 32660394 DOI: 10.2174/0929867327666200713184659] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 11/22/2022]
Abstract
Asthma is a heterogeneous disease with regard to the inflammatory pathways activated. In recent years, biologic drugs (monoclonal antibodies) directed towards specific components of type 2 inflammation have been approved for the treatment of severe asthma. Phenotyping of patients with severe asthma and evaluation of biomarkers have been recommended to help identify patients who are candidates for treatment with biologics and to monitor treatment responses. Fractional exhaled Nitric Oxide (FeNO) is a biomarker of type 2 inflammation in asthma, signaling activation of Interleukin (IL)-4/IL-13 pathway. FeNO could be useful to assess treatment response or identify candidates for a specific drug that acts on type 2 inflammation mechanisms linked to Nitric Oxide (NO) production, such as the IL-4/IL-13 pathway or upstream processes. The value of FeNO as a biomarker predictive of responses to the biologics available for treating severe asthma is discussed based on the published studies at the moment of the review.
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Affiliation(s)
- Giovanni Rolla
- Department of Medical Sciences, Allergy and Clinical Immunology AO Mauriziano, University of Torino,
Torino, Italy
| | - Enrico Heffler
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy,Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano,
Italy
| | - Stefano Pizzimenti
- Respiratory Medicine Unit, National Health System, ASL Città di Torino, Torino, Italy
| | - Alain Michils
- Chest Department, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
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26
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Borhani Fard M, Samet M, Salmani Nodoushan M, Mehrparvar AH, Bahrami-Ahmadi A. Determination of a Cut-off Point for Exhaled Nitric Oxide in the Diagnosis of Asthma in an Iranian Population. TANAFFOS 2021; 20:150-155. [PMID: 34976086 PMCID: PMC8710218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 09/19/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Asthma is a major source of global social and economic burden; thus, its early detection is important. Measurement of fractional exhaled nitric oxide (FENO) has been used recently considered a good indicator of asthma and also a sensitive and non-invasive method for monitoring airway inflammation. This study was conducted to determine the cut-off point of FENO for the diagnosis of asthma in the studied population. MATERIALS AND METHODS The subjects of this cross-sectional diagnostic study were assessed by the FENO test, spirometry, and methacholine challenge test. The best cut-off point of the FENO for the diagnosis of asthma was determined. The data were analyzed by SPSS 20 using student t-test, and Chi-square test and the ROC curves were also drawn. RESULTS The mean FENO in asthmatic and non-asthmatic subjects was 43.5±33.41 and 17.5±21.48 ppb, respectively (P <0.001). The best cut-off point of the FENO based on the overall sensitivity and specificity was 39.5 ppb. CONCLUSION According to the results of this study, symptomatic patients with FENO higher than 39.5 ppb could be considered as asthmatic.
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Affiliation(s)
- Mohammad Borhani Fard
- Department of Occupational Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Samet
- Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mojahede Salmani Nodoushan
- Occupational Medicine Research Center, Iran University of Medical sciences, Tehran, Iran,, Department of Occupational Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Correspondence to: Salmani Nodoushan M, Address: Occupational Medicine Research Center, Iran University of Medical sciences, Tehran, Iran Email address:
| | | | - Amir Bahrami-Ahmadi
- Occupational Medicine Research Center, Iran University of Medical sciences, Tehran, Iran
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27
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Antosova M, Bencova A, Mokra D, Plevkova J, Pepucha L, Buday T. Exhaled and Nasal Nitric Oxide - Impact for Allergic Rhinitis. Physiol Res 2021; 69:S123-S130. [PMID: 32228017 DOI: 10.33549/physiolres.934393] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
FeNO measurement is a validated non-invasive technique, which is used for diagnosis and monitoring of asthma. It would be desirable to find a reliable method to monitor allergic rhinitis (AR) via measurement of FeNO, and/or nasal nitric oxide (nNO). The aim of our study was the assessment of the efficacy of FeNO and nNO as markers in AR treatment. FeNO and nNO were measured with the portable NO analyser (NIOX MINO®) in healthy participants and in patients with AR. The patients were examined during the pollen season and out of it. The effect of local corticosteroids and antihistamine therapy was observed in patients with AR during pollen season after three weeks of therapy. There are significant differences between FeNO and nNO in patients with AR compared to healthy controls at all set points of measurements. While FeNO responded well to the treatment with both antihistamines and combined therapy, nNO decreased only after combined therapy with antihistamines and nasal corticosteroids. nNO monitoring alone is not a suitable method to monitor inflammation of the upper airways in AR and its suppression by anti-allergic treatment and should be correlated with other markers as FeNO or symptom scores.
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Affiliation(s)
- M Antosova
- BioMed Martin, Division of Respirology, Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Slovak
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28
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Pignatti P, Visca D, Loukides S, Märtson AG, Alffenaar JWC, Migliori GB, Spanevello A. A snapshot of exhaled nitric oxide and asthma characteristics: experience from high to low income countries. Pulmonology 2020; 28:44-58. [PMID: 33358001 DOI: 10.1016/j.pulmoe.2020.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 12/30/2022] Open
Abstract
Nitric oxide is a gas produced in the airways of asthmatic subjects and related to T2 inflammation. It can be measured as fractional nitric oxide (FeNO) in the exhaled air and used as a non-invasive, easy to evaluate, rapid marker. It is now widely used in many settings to determine airway inflammation. The aim of this narrative review is to report relationship between FeNO and the physiopathologic characteristics of asthmatic patients. Factors affecting FeNO levels have also been analysed as well as the impact of corticosteroid, target therapies and rehabilitation programs. Considering the availability of the test, spreading this methodology to low income countries has also been considered as a possibility for evaluating airway inflammation and monitoring adherence to inhaled corticosteroid therapy. PubMed data search has been performed restricted to English language papers. Research was limited to studies in adults unless studies in children were the only ones reported for a particular issue. This revision could be useful to summarize the role of FeNO in relation to asthma characteristics and help in the use of FeNO in different clinical settings particularly in low income countries.
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Affiliation(s)
- Patrizia Pignatti
- Allergy and Immunology Unit, Istituti Clinici Scientifici Maugeri IRCCS Pavia, Italy.
| | - Dina Visca
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy and Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
| | - Stelios Loukides
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Anne-Grete Märtson
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Jan-Willem C Alffenaar
- Sydney Pharmacy School, University of Sydney, Sydney, New South Wales, Australia; Westmead Hospital, Sydney, Australia; Marie Bashir Institute of Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - Giovanni Battista Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - Antonio Spanevello
- Division of Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS, Tradate, Italy and Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
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29
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Exhaled nitric oxide and its predictive power related to lung function and bronchial inflammation. Biochem Pharmacol 2020; 179:114101. [DOI: 10.1016/j.bcp.2020.114101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 11/22/2022]
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30
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Comberiati P, Peroni D, Malka-Rais J, Morganti R, Spahn JD. Fractional exhaled nitric oxide response to oral corticosteroids in children with mild-to-moderate asthma: Influence of race. Ann Allergy Asthma Immunol 2020; 125:440-446.e1. [PMID: 32621994 DOI: 10.1016/j.anai.2020.06.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/11/2020] [Accepted: 06/24/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fractional exhaled nitric oxide (FeNO) is a noninvasive biomarker of type 2 asthma that can predict response to inhaled corticosteroid therapy. Little is known regarding the magnitude of FeNO reduction after an oral corticosteroid (OCS) course, and less is known whether there are differential responses based on race in children with mild-to-moderate asthma. OBJECTIVE To assess the effect of a short course of OCS on FeNO in children with asthma and to determine whether the effect is influenced by race. METHODS Children presenting with an acute asthma exacerbation, who had a FeNO measurement within the past 6 months when clinically stable, were enrolled. Spirometry and FeNO were obtained at the time of exacerbation and after a short course of prednisone. RESULTS A total of 92 children were identified (aged 11 ± 3.3 years; white, n = 46 [50%], Hispanics, n = 30 [33%], African Americans [AAs], n = 16 [7%]). At baseline, AAs were more atopic and had higher mean FeNO values than both white (48.9 vs 25.6 ppb; P < .05) and Hispanic children (22.5 ppb; P < .05), despite being prescribed similar inhaled corticosteroid doses. During the exacerbation, AAs had the highest FeNO values, whereas there was no difference in lung function between AAs and non-AAs. After prednisone therapy, there was a 56.6% reduction in FeNO, and although AAs maintained the highest FeNO levels, the relative reduction was similar between AAs and non-AAs (53.9% vs 57.8%, respectively). CONCLUSION FeNO levels reduced by more than 50% after an OCS course. African American children had a greater degree of type 2-driven airway inflammation at baseline, during an exacerbation and after a short course of OCS, compared with non-AAs, although the relative reduction in FeNO was similar between the groups.
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Affiliation(s)
- Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy; Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
| | - Diego Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Jonathan Malka-Rais
- Pediatric Associates, Division of Allergy and Immunology, Plantation, Florida
| | | | - Joseph D Spahn
- Allergy and Immunology Center, Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, Division of Allergy and Immunology, National Jewish Health, Denver, Colorado
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The Pattern of Sensitization Influences Exhaled and Nasal Nitric Oxide Levels in Young Adults. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020. [PMID: 32193864 DOI: 10.1007/5584_2020_509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Nitric oxide (NO) from upper (nasal NO, nNO) or lower airways (fractional exhaled NO, FeNO) is considered a surrogate marker for Th2-type inflammation, which is influenced by atopy. The aim of this study was to analyze nNO and FeNO in regard to qualitative and quantitative aspects of sensitization. We evaluated 244 non-smoking young adults. All of them were first-year students recruited for a longitudinal study. An inhalation allergy screening tool was used for atopy definition (specific immunoglobulin E (sIgE) to sx1 ≥ 0.35 kU/L), and also sIgE response to three inhalant perennial allergens, house dust mite (HDM, d1), cat (e1), and dog (e5), was determined in the non-pollen season. With respect to sx1, 100 subjects could be classified as atopic. Sensitization to one, two, or three perennial allergens could be demonstrated in 46, 10, and 16 students, respectively. The subjects with positive IgE response to sx1, but not sensitized to HDM, cat, and/or dog, had FeNO levels comparable to those of non-atopic subjects (13.5 vs. 13.0 ppb, respectively; p = 0.485). These levels were significantly lower compared to atopic subjects being sensitized to any perennial allergen (19.0 ppb; p = 0.0003). After grouping the atopic subjects for perennial sensitization patterns, significantly higher FeNO could be detected in subjects with poly-sensitization (n = 26; 26.0 ppb) compared to the mono-sensitized ones (n = 46; 18.0 ppb; p = 0.023). Regarding nNO, no differences could be observed. Applying a two-way ANOVA, we could reveal a significant correlation of specific HDM-IgE CAP-class with FeNO (p < 0.0001) and nNO levels (p = 0.007). Finally, a significant relationship was found between nNO and FeNO for the whole cohort (p < 0.0001). In summary, our findings support the argument that atopy and perennial sensitization should be considered for the interpretation of NO.
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Ramadan AA, Gaffin JM, Israel E, Phipatanakul W. Asthma and Corticosteroid Responses in Childhood and Adult Asthma. Clin Chest Med 2020; 40:163-177. [PMID: 30691710 DOI: 10.1016/j.ccm.2018.10.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Corticosteroids are the most effective treatment for asthma; inhaled corticosteroids (ICSs) are the first-line treatment for children and adults with persistent symptoms. ICSs are associated with significant improvements in lung function. The anti-inflammatory effects of corticosteroids are mediated by both genomic and nongenomic factors. Variation in the response to corticosteroids has been observed. Patient characteristics, biomarkers, and genetic features may be used to predict response to ICSs. The existence of multiple mechanisms underlying glucocorticoid insensitivity raises the possibility that this might indeed reflect different diseases with a common phenotype.
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Affiliation(s)
- Amira Ali Ramadan
- Division of Allergy and Immunology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Beth Israel Deaconess Center, Cardiovascular institute, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Jonathan M Gaffin
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA, USA
| | - Elliot Israel
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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Virgin Coconut Oil Supplementation Prevents Airway Hyperreactivity of Guinea Pigs with Chronic Allergic Lung Inflammation by Antioxidant Mechanism. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:5148503. [PMID: 32089769 PMCID: PMC7008286 DOI: 10.1155/2020/5148503] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 12/16/2019] [Indexed: 02/06/2023]
Abstract
Asthma is a chronic inflammatory disease of the airways characterized by immune cell infiltrates, bronchial hyperresponsiveness, and declining lung function. Thus, the possible effects of virgin coconut oil on a chronic allergic lung inflammation model were evaluated. Morphology of lung and airway tissue exhibited peribronchial inflammatory infiltrate, epithelial hyperplasia, and smooth muscle thickening in guinea pigs submitted to ovalbumin sensitization, which were prevented by virgin coconut oil supplementation. Additionally, in animals with lung inflammation, trachea contracted in response to ovalbumin administration, showed a greater contractile response to carbachol (CCh) and histamine, and these responses were prevented by the virgin coconut oil supplementation. Apocynin, a NADPH oxidase inhibitor, did not reduce the potency of CCh, whereas tempol, a superoxide dismutase mimetic, reduced potency only in nonsensitized animals. Catalase reduced the CCh potency in nonsensitized animals and animals sensitized and treated with coconut oil, indicating the participation of superoxide anion and hydrogen peroxide in the hypercontractility, which was prevented by virgin coconut oil. In the presence of L-NAME, a nitric oxide synthase (NOS) inhibitor, the CCh curve remained unchanged in nonsensitized animals but had increased efficacy and potency in sensitized animals, indicating an inhibition of endothelial NOS but ineffective in inhibiting inducible NOS. In animals sensitized and treated with coconut oil, the CCh curve was not altered, indicating a reduction in the release of NO by inducible NOS. These data were confirmed by peribronchiolar expression analysis of iNOS. The antioxidant capacity was reduced in the lungs of animals with chronic allergic lung inflammation, which was reversed by the coconut oil, and confirmed by analysis of peribronchiolar 8-iso-PGF2α content. Therefore, the virgin coconut oil supplementation reverses peribronchial inflammatory infiltrate, epithelial hyperplasia, smooth muscle thickening, and hypercontractility through oxidative stress and its interactions with the NO pathway.
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Jo YS, Choe J, Shin SH, Koo HK, Lee WY, Kim YI, Ra SW, Yoo KH, Jung KS, Park HY, Park YB. Exhaled Nitric Oxide in Patients with Stable Chronic Obstructive Pulmonary Disease: Clinical Implications of the Use of Inhaled Corticosteroids. Tuberc Respir Dis (Seoul) 2020; 83:42-50. [PMID: 31905431 PMCID: PMC6953499 DOI: 10.4046/trd.2019.0050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/06/2019] [Accepted: 10/18/2019] [Indexed: 12/17/2022] Open
Abstract
Background Fractional exhaled nitric oxide (FeNO) is regarded as a potential biomarker for
identifying eosinophilic inflammation. We aimed to evaluate the clinical implication of
FeNO and its influence on inhaled corticosteroids (ICS) prescription rate in Korean
chronic obstructive pulmonary disease (COPD) patients. Methods FeNO level and its association with clinical features were analyzed. Changes in the
prescription rate of ICS before and after FeNO measurement were identified. Results A total of 160 COPD patients were divided into increased (≥25 parts per billion
[ppb], n=74) and normal (<25 ppb, n=86) FeNO groups according to the
recommendations from the American Thoracic Society. Compared with the normal FeNO group,
the adjusted odds ratio for having history of asthma without wheezing and with wheezing
in the increased FeNO group were 2.96 (95% confidence interval [CI], 1.40–6.29)
and 4.24 (95% CI, 1.37–13.08), respectively. Only 21 out of 74 patients (28.4%)
with increased FeNO prescribed ICS-containing inhaler and 18 of 86 patients (20.9%) with
normal FeNO were given ICS-containing inhaler. Previous exacerbation, asthma, and
wheezing were the major factors to maintain ICS at normal FeNO level and not to initiate
ICS at increased FeNO level. Conclusion Increased FeNO was associated with the history of asthma irrespective of wheezing.
However, FeNO seemed to play a subsidiary role in the use of ICS-containing inhalers in
real-world clinics, which was determined with prior exacerbation and clinical features
suggesting Th2 inflammation.
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Affiliation(s)
- Yong Suk Jo
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Junsu Choe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon Kyoung Koo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Won Yeon Lee
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Yonsei University Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yu Il Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Seung Won Ra
- Department of Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kwang Ha Yoo
- Division of Pulmonary and Allergy Medicine, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Ki Suck Jung
- Divsion of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Yong Bum Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea.
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35
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Duong-Quy S. Clinical Utility Of The Exhaled Nitric Oxide (NO) Measurement With Portable Devices In The Management Of Allergic Airway Inflammation And Asthma. J Asthma Allergy 2019; 12:331-341. [PMID: 31632093 PMCID: PMC6789173 DOI: 10.2147/jaa.s190489] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 09/12/2019] [Indexed: 01/11/2023] Open
Abstract
Nitric oxide (NO) is a potential bioactive gas produced continuously and constantly in the airways of healthy subjects. In allergic airway inflammation, the level of exhaled NO is usually increased and mediated by inducible nitric oxide synthase (iNOS) enzyme presenting in the epithelium and different inflammatory cells. The measurement of NO concentration in the airway is possible with portable devices which use an electroluminescence technique. In subjects with upper airway with allergic inflammation such as in allergic rhinitis, the measurement of nasal NO (nNO) may help to diagnose and manage the disease. In the lower airway, increased fractional exhaled NO (FENO) reflects directly the inflammatory process that occurs in the airways that are typically seen in asthma. It has been shown that there is a strong correlation between FENO levels and increased activity of airway inflammation mediated by immuno-allergic cells and mediators. Thus, FENO has higher specificity and sensitivity than other methods in diagnosing the severity of inflammation in asthmatic patients. Moreover, the correlation between increased FENO levels and a high risk of bronchial hyperresponsiveness has also been demonstrated. FENO is also a relevant biomarker to evaluate asthma status due to the change of its values occurring earlier than clinical manifestations and spirometry parameters. In addition, the measurement of FENO with portable devices helps to support the diagnosis of asthma, to follow-up the control of asthma and to personalize asthmatic patients for target treatment with biologic therapy. Therefore, measuring FENO with portable devices in the diagnosis and treatment of allergic airway inflammation, especially in asthma, is one of the most essential applications of NO biomarkers in exhaled breath.
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Affiliation(s)
- Sy Duong-Quy
- Department of Respiratory Diseases, Medical and Biological Research Centre, Lam Dong Medical College, Dalat City, Lam Dong Province, Vietnam
- Department of Immuno-Allergology, Penn State Medical College, Hershey, PA, USA
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Högman M, Thornadtsson A, Bröms K, Janson C, Lisspers K, Ställberg B, Hedenström H, Malinovschi A. Different Relationships between F ENO and COPD Characteristics in Smokers and Ex-Smokers. COPD 2019; 16:227-233. [PMID: 31357875 DOI: 10.1080/15412555.2019.1638355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Exhaled nitric oxide (FENO) is a marker of type-2 inflammation in asthma and is used in its management. However, smokers and ex-smokers have lower FENO values, and the clinical use of FENO values in COPD patients is unclear. Therefore, we investigated if FENO had a relationship to different COPD characteristics in smoking and ex-smoking subjects. Patients with COPD (n = 533, 58% females) were investigated while in stable condition. Measurements of FENO50, blood cell counts, IgE sensitisation and lung function were performed. Medication reconciliation was used to establish medication usage. Smokers (n = 150) had lower FENO50 9 (8, 10) ppb (geometric mean, 95% confidence interval) than ex-smokers did (n = 383) 15 (14, 16) ppb, p < 0.001. FENO50 was not associated with blood eosinophil or neutrophil levels in smokers, but in ex-smokers significant associations were found (r = 0.23, p < 0.001) and (r = -0.18, p = 0.001), respectively. Lower FENO values were associated with lower FEV1% predicted in both smokers (r = 0.17, p = 0.040) and ex-smokers (r = 0.20, p < 0.001). Neither the smokers nor ex-smokers with reported asthma or IgE sensitisation were linked to an increase in FENO50. Ex-smokers treated with inhaled corticosteroids (ICS) had lower FENO50 14 (13, 15) ppb than non-treated ex-smokers 17 (15, 19) ppb, p = 0.024. This was not found in smokers (p = 0.325). FENO is associated with eosinophil inflammation and the use of ICS in ex-smoking COPD subjects, but not in smoking subjects suggesting that the value of FENO as an inflammatory marker is more limited in smoking subjects. The association found between low FENO values and low lung function requires further investigation.
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Affiliation(s)
- M Högman
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University , Uppsala , Sweden
| | - A Thornadtsson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University , Uppsala , Sweden.,Center for Research & Development, Uppsala University/Region Gävleborg , Gävle , Sweden
| | - K Bröms
- Center for Research & Development, Uppsala University/Region Gävleborg , Gävle , Sweden.,Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University , Uppsala , Sweden
| | - C Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University , Uppsala , Sweden
| | - K Lisspers
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University , Uppsala , Sweden.,Center for Clinical Research, Uppsala University, County Council Dalarna , Falun , Sweden
| | - B Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University , Uppsala , Sweden.,Center for Clinical Research, Uppsala University, County Council Dalarna , Falun , Sweden
| | - H Hedenström
- Department of Medical Sciences, Clinical Physiology, Uppsala University , Uppsala , Sweden
| | - A Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University , Uppsala , Sweden
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37
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Liu J, Xu R, Zhan C, Luo W, Lai K, Zhong N, Chen W, Chen R. Clinical utility of ultrahigh fractional exhaled nitric oxide in predicting bronchial hyperresponsiveness in patients with suspected asthma. Postgrad Med J 2019; 95:541-546. [PMID: 31296792 DOI: 10.1136/postgradmedj-2018-136333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/18/2019] [Accepted: 06/23/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Fractional 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. METHODS A 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. RESULTS A 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. CONCLUSIONS Ultrahigh 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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Affiliation(s)
- Jiaxing Liu
- Department of Respirology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rong Xu
- Department of Respirology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chen Zhan
- Department of Respirology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Luo
- Department of Respirology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kefang Lai
- Department of Respirology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nanshan Zhong
- Department of Respirology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Chen
- Department of Biostatistics, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ruchong Chen
- Department of Respirology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Korn S, Wilk M, Voigt S, Weber S, Keller T, Buhl R. Measurement of Fractional Exhaled Nitric Oxide: Comparison of Three Different Analysers. Respiration 2019; 99:1-8. [PMID: 31288246 DOI: 10.1159/000500727] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/30/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Fractional exhaled nitric oxide (FeNO) is a surrogate marker for airway inflammation, supporting the diagnostic pathway and treatment decisions for asthma patients. OBJECTIVES Aim of this study was to compare the new analyser Vivatmo pro (Bosch, BV) with NIOX VERO (Circassia, CN) and CLD (Ecomedics, EC). METHODS In 100 asthmatics (median 53 years [range 20-87], 62% female, 86% on inhaled corticosteroids [mean 1,300 μg beclomethasone dipropionate or equivalent], 35% treated with biologics) 2 FeNO measurements per device were performed. Additionally, the success rate to achieve a valid NO value was evaluated. RESULTS Sixty-eight percent of the patients had FeNO values below 50 ppb. Median NO concentrations were 31 ppb (range 6-194) for BV, 33 ppb (9-164) for CN and 31ppb (7-353) for EC. Bland-Altman plots suggested an agreement within the predefined limits of ±5 ppb for all analysers within the therapeutically relevant range (0-70 ppb). The highest agreement in FeNO levels were between BV and EC with mean differences of -0.26 (95% CI -1.48 to 0.95) vs. 1.52 (95% CI 0.4-2.6) ppb for CN and EC. The results indicate an equivalence of the methods (two-one sided t test-equivalence test: p < 0.0001, ±5 ppb margins). Acceptance of the measurements was high for all devices (97%). The highest success rate to obtain 2 valid NO values without failed attempts was achieved with the BV analyser (73 vs. 62% for the CN analyser and 46% for the EC analyser). CONCLUSIONS For the range between 0 and 70 ppb, FeNO concentrations measured with all 3 devices were statistically equivalent within predefined acceptance criteria and did not differ in a clinically relevant way.
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Affiliation(s)
- Stephanie Korn
- Department of Pulmonary, Mainz University Hospital, Mainz, Germany,
| | - Maike Wilk
- Department of Pulmonary, Mainz University Hospital, Mainz, Germany
| | - Stefanie Voigt
- Department of Pulmonary, Mainz University Hospital, Mainz, Germany
| | | | | | - Roland Buhl
- Department of Pulmonary, Mainz University Hospital, Mainz, Germany
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39
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Kuo CR, Spears M, Haughney J, Smith A, Miller J, Bradshaw T, Murray L, Williamson P, Lipworth B. Scottish consensus statement on the role of FeNO in adult asthma. Respir Med 2019; 155:54-57. [PMID: 31299469 DOI: 10.1016/j.rmed.2019.07.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 06/14/2019] [Accepted: 07/05/2019] [Indexed: 01/15/2023]
Abstract
Fractional exhaled nitric oxide (FeNO) is the only available point of care test to assess type-2 inflammation in asthma. In making a diagnosis of asthma, FeNO should be used together with blood eosinophils and spirometry, alongside a history. Raised FeNO in conjunction with blood eosinophilia are treatable traits of type 2 inflammation in asthma, which in turn may guide personalised management. A FeNO suppression test can be used to assess adherence and device use with ICS therapy. Furthermore FeNO may be used to provide feedback to patients in response to ICS, especially when spirometry is normal. FeNO may facilitate appropriate referral to secondary care for more definitive specialist investigations. In summary, FeNO is cost effective in the diagnosis and management of asthma and should be incorporated into primary and secondary care as part of routine clinical practice.
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Affiliation(s)
- Chris RuiWen Kuo
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, DD1 9SY, UK
| | - Mark Spears
- Respiratory Medicine, Forth Valley Royal Hospital, Larbert, FK5 4WR, UK
| | - John Haughney
- Clinical R&D, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK
| | - Andrew Smith
- Department of Respiratory Medicine, University Hospital Wishaw, ML2 0DP, UK
| | - Joy Miller
- Respiratory Medicine Unit, Aberdeen Royal Infirmary, University of Aberdeen, AB25 2ZN, UK
| | - Tracey Bradshaw
- Respiratory Medicine Unit, Royal Infirmary of Edinburgh, EH16 4SA, UK
| | - Lorna Murray
- Department of Respiratory Medicine, Raigmore Hospital, Inverness, IV2 4AG, UK
| | | | - Brian Lipworth
- Scottish Centre for Respiratory Research, Ninewells Hospital and Medical School, University of Dundee, DD1 9SY, UK.
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40
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Kotsiou OS, Peletidou S, Vavougios G, Karetsi E, Stavrou V, Zakynthinos G, Gourgoulianis KI, Daniil Z. Exhaled nitric oxide as a marker of chlorine exposure in young asthmatic swimmers. Ann Allergy Asthma Immunol 2019; 123:249-255. [PMID: 31247303 DOI: 10.1016/j.anai.2019.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/25/2019] [Accepted: 06/17/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Swimming is recommended for people with asthma. However, the inevitable exposure to chlorine and its disinfectant byproducts in indoor swimming pools could be responsible for bronchial inflammation and asthma development. Fractional exhaled nitric oxide (FeNO) is a noninvasive marker of airway inflammation that predicts asthma exacerbations. OBJECTIVES To evaluate pretraining and posttraining FeNO levels in young swimmers with asthma attending an indoor chlorinated pool compared with a set of healthy swimmers and to examine the potential risk of exposure to chlorine as a factor associated with bronchial inflammation. METHODS A total of 146 children (8-18 years old) constantly attending an indoor chlorinated swimming pool were enrolled. Spirometry and FeNO measurements were performed 30 minutes after their arrival at the pool and immediately after exercise. Pre-exercise and postexercise spirometric and FeNO levels were assessed in a random subgroup of 14 swimmers (10 with asthma and 4 without) who performed cardiopulmonary exercise testing. RESULTS Asthma was detected in 23 swimmers. In swimmers with asthma, preswimming FeNO values were significantly elevated compared with swimmers without asthma and their FeNO values measured before cardiopulmonary exercise testing. Postexercise FeNO values were significantly decreased by approximately one-third in healthy children and children with asthma in all sporting backgrounds. However, postswimming FeNO values remained significantly higher in swimmers with asthma compared with those without asthma. Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio values showed no significant difference before and after 2 types of activity. CONCLUSION Elevated FeNO levels before and after swimming were recorded in swimmers with asthma not observed in a different exercise field. The presence of chlorine in the indoor swimming pool seems to explain this finding.
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Affiliation(s)
- Ourania S Kotsiou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece.
| | - Sotiria Peletidou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - George Vavougios
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Eleni Karetsi
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Vasileios Stavrou
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - George Zakynthinos
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | | | - Zoe Daniil
- Department of Respiratory Medicine, Faculty of Medicine, University of Thessaly, Larissa, Greece
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Ahovuo-Saloranta A, Csonka P, Lehtimäki L. Basic characteristics and clinical value of FeNO in smoking asthmatics-a systematic review. J Breath Res 2019; 13:034003. [PMID: 30861509 DOI: 10.1088/1752-7163/ab0ece] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fractional exhaled nitric oxide (FeNO) reflects eosinophilic airway inflammation and it can be used to diagnose and phenotype asthma and predict treatment responses. However, smoking decreases FeNO and it is not clear if FeNO has clinical value in smoking subjects with asthma. We conducted a systematic review focusing on four basic characteristics and five clinical questions on using FeNO in smokers with asthma. At least two authors independently screened search results, extracted data and assessed the quality of the included studies. Data were synthesised mainly by qualitative methods. Twenty-two studies were included. FeNO is lower in smoking than in non-smoking asthmatics, but importantly FeNO is higher in untreated smoking asthmatics than in healthy smokers. Information was incomplete but there is some indication that FeNO might be useful in detecting eosinophilic airway inflammation and in diagnosing asthma in smoking subjects. There was no data available to four of the five clinical questions. In conclusion, at the moment there is insufficient data to give specific guidelines on using FeNO in smoking subjects, but although smoking decreases FeNO it does not seem to make FeNO measurement redundant. FeNO is also associated with asthma in smokers and current results encourage conducting clinical trials on FeNO in smokers with asthma.
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Exhaled nitric oxide in chronic cough: A good tool in a multi-step approach. Respir Med Res 2019; 76:4-9. [PMID: 31254946 DOI: 10.1016/j.resmer.2019.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/02/2019] [Accepted: 04/12/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The impact of fractional exhaled nitric oxide (FENO) on the management of chronic cough (CC) is still inconclusive. The aim of the present study was to assess whether FENO is a good tool to predict the response to inhaled corticosteroids (ICS) in patients with CC. METHODS Patients, referred for investigation of CC, had a FENO measurement determined as part of their first-line assessment. A methacholine test was performed as part of a second-line assessement. Patients were assigned to two groups according to their FENO values: a high FENO level group (Ⱕ25 ppb) and a normal FENO level group (<25 ppb). RESULTS One hundred patients were included in the study. High FENO levels were found in 25 patients (25%). The proportion of patients who responded to ICS was significantly greater in the high FENO group compared to the normal FENO level group (86.4% vs 46.3%, P<0.05). FENO is a good tool to predict ICS response in patients with high FENO levels but a response to ICS cannot be ruled out in patients with normal FENO levels. In patients with normal FENO values, a methacholine test could be an interesting tool for a second-line assessment. Among the 13 patients with a positive methacholine test result, 11 responded to ICS whilst 2 did not. Of the patients with a negative methacholine test result, 3 responded to ICS whilst 13 did not. CONCLUSION FENO may be a more reliable predictor of ICS response when used as part of a multi-step assessment procedure.
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43
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Comberiati P, Katial RK, Covar RA. Bronchoprovocation Testing in Asthma: An Update. Immunol Allergy Clin North Am 2019; 38:545-571. [PMID: 30342579 DOI: 10.1016/j.iac.2018.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Bronchial hyperresponsiveness (BHR) is defined as a heightened bronchoconstrictive response to airway stimuli. It complements the cardinal features in asthma, such as variable or reversible airflow limitation and airway inflammation. Although BHR is considered a pathophysiologic hallmark of asthma, it should be acknowledged that this property of the airway is dynamic, because its severity and even presence can vary over time with disease activity, triggers or specific exposure, and with treatment. In addition, it is important to recognize that there is a component that is not reflective of a specific disease entity.
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Affiliation(s)
- Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Paediatrics, University of Pisa, 56126 Pisa, Italy; Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Rohit K Katial
- National Jewish Health, 1400 Jackson Street (J321), Denver, CO 80206, USA
| | - Ronina A Covar
- National Jewish Health, 1400 Jackson Street (J321), Denver, CO 80206, USA.
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Carpagnano GE, Scioscia G, Lacedonia D, Curradi G, Foschino Barbaro MP. Severe uncontrolled asthma with bronchiectasis: a pilot study of an emerging phenotype that responds to mepolizumab. J Asthma Allergy 2019; 12:83-90. [PMID: 30881051 PMCID: PMC6407514 DOI: 10.2147/jaa.s196200] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Asthma and bronchiectasis are different conditions that frequently coexist. The prevalence of bronchiectasis rises considerably in subjects with severe asthma (25%–51%). Objective We evaluated the clinical and biological efficacy of mepolizumab on our pilot population of severe uncontrolled asthmatics with bronchiectasis not related to other pathologies. Patients and methods Four patients with severe uncontrolled asthma and diagnosed as bronchiectasis were recruited and started biological treatment with mepolizumab. Standard investigations were performed in all four patients at baseline (T0), after 3 months (T1) and after 1 year (T2) of treatment. Results After 1 year (T2) of therapy with mepolizumab, patients showed a significant increment of asthma control test value (12±1.1 vs 24.5±0.3, P<0.01), a reduction of the number of exacerbations/year (5±0.7 vs 0.75±0.75, P<0.01), an increase of pre-bronchodilator FEV1 (1,680±500 vs 1,860±550 mL, P<0.01) and a reduction of eosinophils in blood (0.75±0.14 vs 0.12±0.02 cells/µL, P<0.01), in the sputum (9.6%±2.1% vs 5.6%±2.7%, P<0.05) and in nasal cytology (++ vs +). Conclusion The efficacy of mepolizumab in terms of reduction of inflammation and increase of control that we observed in our patients might suggest that targeting the IL-5 in severe eosinophilic asthma with bronchiectasis may be a good therapeutic strategy.
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Affiliation(s)
- Giovanna E Carpagnano
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy,
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy,
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy,
| | - Giacomo Curradi
- Medical and Scientific Department, GlaxoSmithKline, Verona, Italy
| | - Maria Pia Foschino Barbaro
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Foggia, Italy,
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45
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Li LX, Li YJ, He JX. Long noncoding RNA PAGBC contributes to nitric oxide (NO) production by sponging miR-511 in airway hyperresponsiveness upon intubation. J Cell Biochem 2019; 120:2058-2069. [PMID: 30246300 DOI: 10.1002/jcb.27513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/26/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES In this study, we aimed to study the molecular mechanisms underlying the symptoms of hyperresponsiveness during intubation. METHOD The value of circulating long noncoding RNA (lncRNA)-prognosis-associated gallbladder cancer (PAGBC) in the prediction of hyperresponsiveness upon intubation during general anesthesia was evaluated via the receiver operating characteristic analyses of serum miR-511, serum PAGBC, and serum nitric oxide (NO). In addition, the possible association between lncRNA-PAGBC/NOS1 messenger RNA (mRNA) and miR-511 was further validated via real-time quantitative polymerase chain reaction, immunohistochemistry assay, computational analysis, and luciferase assay. Enzyme-linked immunosorbent assay and Western blot analysis were also conducted to establish the regulatory relationship among PAGBC, miR-511, and NO synthase 1 (NOS1). RESULTS Compared with circulating miR-511 and serum NO, circulating PAGBC was associated with a higher predictive value. In addition, a negative correlation was found between serum miR-511 and serum PAGBC (multicorrelation coefficient: -0.5) as well as between serum miR-511 and serum NO (multicorrelation coefficient: -0.6). In addition, both lncRNA-PAGBC and NO were decreased in patients with hyperresponsiveness, whereas the levels of miR-511 and NOS1 in these patients were similar to those in normal patients. Furthermore, our computational analyses and luciferase assays validated the direct binding between miR-511 and lncRNA-PAGBC, whereas NOS1 mRNA was identified as a virtual target gene of miR-511. Moreover, in the presence of lncRNA-PAGBC, we also observed an evident increase in the levels of NOS1 and NO accompanied by an obvious decrease of miR-511 expression. CONCLUSION LncRNA-PAGBC downregulated the expression of miR-511, which in turn upregulated the expression of NOS1 mRNA and led to the increase in NOS1 expression, thus leading to the inhibited responsiveness (normal-responsiveness rather than hyperresponsiveness) to intubation in patients.
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Affiliation(s)
- Ling-Xia Li
- Anesthesia Department, Yanan University Affiliated Hospital, Yanan, Shaanxi, China
| | - Yuan-Jun Li
- Anesthesia Department, Yanan University Affiliated Hospital, Yanan, Shaanxi, China
| | - Jia-Xuan He
- Respiratory Medicine Department, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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46
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Maniscalco M, Fuschillo S, Gaudiosi C, De Felice A, Martucci M, Motta A. Exhaled and nasal nitric oxide measurement in the evaluation of chronic cough. Nitric Oxide 2018; 83:19-23. [PMID: 30557619 DOI: 10.1016/j.niox.2018.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/22/2018] [Accepted: 12/13/2018] [Indexed: 12/12/2022]
Abstract
Chronic cough is one of the most common and troublesome nonspecific respiratory symptom for which patients seek a general practitioner and specialist advice. It is conventionally defined as a cough lasting for more than 8 weeks. Exhaled nitric oxide has proven to be a specific biomarker capable to discriminate between differential diagnoses of chronic cough and simultaneously provide information about the response to specific treatment. In this review, we will discuss the potential use of exhaled and nasal nitric oxide in the diagnosis of chronic chough.
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Affiliation(s)
- Mauro Maniscalco
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA SB, Institute of Telese Terme, Benevento, Italy.
| | - Salvatore Fuschillo
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA SB, Institute of Telese Terme, Benevento, Italy
| | - Carlo Gaudiosi
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA SB, Institute of Telese Terme, Benevento, Italy
| | - Alberto De Felice
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA SB, Institute of Telese Terme, Benevento, Italy
| | - Michele Martucci
- Pulmonary Rehabilitation Unit, ICS Maugeri SpA SB, Institute of Telese Terme, Benevento, Italy
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, 80078, Pozzuoli, Naples, Italy
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47
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Levy J, Neukirch C, Larfi I, Demoly P, Thabut G. Tolerance to exposure to essential oils exposure in patients with allergic asthma. J Asthma 2018; 56:853-860. [PMID: 29985684 DOI: 10.1080/02770903.2018.1493601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Essential oils are volatile compounds of plant origin increasingly used by allergic and/or asthmatic subjects to purify indoor air. The active compounds of essential oils belong to terpenes, the most widespread biogenic volatile organic compounds (VOC). Although there is substantial literature showing associations between exposure to chemical VOCs and asthmatic symptoms and impaired respiratory function, the impact of essential oils in patients with asthma has never been studied. Objectives: To evaluate the safety of a purifying air spray containing 41 essential oils (PPAS) in patients with mild or moderate allergic asthma. Methods: This was a prospective open study in which 25 mild (19) and moderate (6) asthmatics were exposed to PPAS, one spray twice a day at 8 am and 8 pm in two different corners of a given subjects bedroom for 4 weeks. Before and after 4 weeks of exposure, fractional exhaled nitric oxide (FeNO), lung function and methacholine challenge (PD20) were performed and asthma control was assessed by the 5 questions of the Asthma Control Test (ACT). The spray was weighed after the 4-week exposure to assess compliance. Results: FeNO was the primary endpoint and was thus analyzed in all (N = 25) subjects irrespective of the level of airflow obstruction. The results apply to all (N = 25) subjects in which FeNO could be measured at D1 and D30 (17 subjects). Mean (SD) FeNO amounted to 37.4 (16.6) and to 33.1 (18.7) ppm before and after PPAS exposure, respectively (p = 0.09). No significant change in lung function and methacholine responsiveness was noted after PPAS exposure, the mean PD20 amounting to 1179 (1124.42) μg (range 100-3200) before and to 1226 (1189.8) μg (p = 0.06) after. The mean ACT before and after PPAS exposure amounted to 20.9 (4.2) and 21 (5.15), respectively (p = 0.80). The mean weight of the PPAS bottles was 211.4 g (DS:0) before the first use and 171.41 g (DS: 29.8) at the end of the study. The average amount of PPAS used was 40.0 g (29.8). In the subgroup of subjects who used the highest quantities of essential oils (>40 g), as assessed by the mean weight of the bottle at the end of the study, FeNO after 30 days of exposure decreased more than in the entire group: 7.9 ppm vs 4.2 ppm (p = 0.07). Conclusion: No difference was noted on airway inflammation, lung function or asthma control in mild and moderate allergic asthmatics after exposure twice a day for one month, to a spray containing a mixture of 41 essential oils.
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Affiliation(s)
- Jean Levy
- a Department of Pneumology A, Bichat-Claude Bernard University Hospital , Paris , France.,b Department of Pneumology B, Bichat-Claude Bernard University Hospital , Paris , France
| | - Catherine Neukirch
- a Department of Pneumology A, Bichat-Claude Bernard University Hospital , Paris , France.,b Department of Pneumology B, Bichat-Claude Bernard University Hospital , Paris , France
| | - Isabelle Larfi
- a Department of Pneumology A, Bichat-Claude Bernard University Hospital , Paris , France.,b Department of Pneumology B, Bichat-Claude Bernard University Hospital , Paris , France
| | - Pascal Demoly
- c Department of Pneumology and Allergology, Arnaud de Villeneuve Hospital, University Montpellier, and Sorbonne University, INSERM, IPLESP , Paris , France
| | - Gabriel Thabut
- a Department of Pneumology A, Bichat-Claude Bernard University Hospital , Paris , France.,b Department of Pneumology B, Bichat-Claude Bernard University Hospital , Paris , France.,d Faculty of Medicine, Bichat Campus, Paris Diderot University , Paris , France
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48
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Hoyte FCL, Gross LM, Katial RK. Exhaled Nitric Oxide: An Update. Immunol Allergy Clin North Am 2018; 38:573-585. [PMID: 30342580 DOI: 10.1016/j.iac.2018.06.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Fractional concentration of exhaled nitric oxide (FENO) is a biomarker used to identify allergic airway inflammation. Because it is noninvasive and easy to obtain, its utility has been studied in the diagnosis and management of several respiratory diseases. Much of the research has been done in asthma, and many studies support the use of FENO in aiding diagnosing asthma, predicting steroid responsiveness, and preventing exacerbations by guiding medication dosage and assessing adherence.
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Affiliation(s)
- Flavia C L Hoyte
- Division of Allergy and Immunology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA.
| | - Lara M Gross
- Division of Allergy and Immunology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA; Division of Allergy and Clinical Immunology, Department of Medicine, University of Colorado, 13001 E 17th Place, Aurora, CO 80045, USA
| | - Rohit K Katial
- Division of Allergy and Immunology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
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49
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Choi Y, Le Pham D, Lee DH, Lee SH, Kim SH, Park HS. Biological function of eosinophil extracellular traps in patients with severe eosinophilic asthma. Exp Mol Med 2018; 50:1-8. [PMID: 30115903 PMCID: PMC6095846 DOI: 10.1038/s12276-018-0136-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/18/2018] [Accepted: 05/28/2018] [Indexed: 11/09/2022] Open
Abstract
Eosinophil extracellular traps (EETs), a complex of DNA fibers and cytotoxic granule proteins, are implicated in the development of asthma; however, the pathophysiological function of EETs in immune responses has not been fully determined. The present study investigated the characteristics of EETs from patients with non-severe asthma (NSA, n = 20) and severe eosinophilic asthma (SEA, n = 20) and evaluated EET function. The percentage of EET-forming peripheral blood eosinophils stimulated with IL-5 and LPS was significantly higher in patients with SEA than in those with NSA (P = 0.009). This percentage negatively correlated with baseline FEV1 (r = -0.350, P = 0.027) and positively correlated with serum eosinophil-derived neurotoxin levels in asthmatic subjects (r = 0.437, P = 0.018). In addition, EET formation was markedly associated with reactive oxygen species production (r = 0.750, P < 0.001). These EETs exhibited an autocrine function to induce eosinophil degranulation, which led to granule protein production. Airway epithelial cells stimulated with EETs exhibited increased epithelial detachment and permeability and pro-inflammatory cytokine release. However, EETs were not significantly associated with mast cell activation. The present study suggests that peripheral blood eosinophils from patients with SEA may be more activated to produce EETs than those from patients with NSA, which further induces inflammation in asthmatic airways. Therefore, regulation of EET formation and function may be a novel therapeutic approach for asthma management.
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Affiliation(s)
- Youngwoo Choi
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - Duy Le Pham
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea.,Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh, Vietnam
| | - Dong-Hyun Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - So-Hee Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - Seung-Hyun Kim
- Clinical Trial Center, Ajou University Medical Center, Suwon, South Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea. .,Clinical Trial Center, Ajou University Medical Center, Suwon, South Korea.
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50
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Rath N, Raje N, Rosenwasser L. Immunoglobulin E as a Biomarker in Asthma. Immunol Allergy Clin North Am 2018; 38:587-597. [PMID: 30342581 DOI: 10.1016/j.iac.2018.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Asthma is a chronic disease that affects children and adults with significant morbidity and mortality. It is multifactorial, with genetic and environmental factors affecting the overall course of the disease. Both specific and total immunoglobulin (Ig)E can be used in specific phenotypes such as allergic asthma. Using IgE as a biomarker for asthma provides a target for management and treatment. Biotherapeutics continue to emerge as important advances in asthma treatment, and their effect on IgE and its biomarker role continue to be studied.
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Affiliation(s)
- Niharika Rath
- Allergy/Immunology, Children's Mercy Hospital, University of Missouri Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Nikita Raje
- Allergy/Immunology, Children's Mercy Hospital, University of Missouri Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Lanny Rosenwasser
- Allergy/Immunology, University of Missouri Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, USA.
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