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Karimi L, Vijverberg SJH, Farzan N, Ghanbari M, Verhamme KMC, Maitland-van der Zee AH. FCER2 T2206C variant associated with FENO levels in asthmatic children using inhaled corticosteroids: The PACMAN study. Clin Exp Allergy 2019; 49:1429-1436. [PMID: 31309641 PMCID: PMC6899548 DOI: 10.1111/cea.13460] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The FCER2 gene, via encoding of the CD23 receptor, plays an important role in the regulation of IgE responses. A genetic variant of the FCER2 gene (T2206C) was previously shown to be associated with IgE levels in asthmatic children. IgE sensitization has also been linked to increased levels of fractional exhaled nitric oxide (FENO). OBJECTIVE To investigate whether the FCER2 T2206C variant influences FENO levels in asthmatic children with a reported use of inhaled corticosteroids (ICS). METHODS This cross-sectional study involved 593 asthmatic children with a reported use of ICS, availability of FENO measurements and genotyping data on the FCER2 T2206C variant (rs28364072). An additive genetic model was assumed, and the association between the FCER2 T2206C variant and the log-transformed (ln) FENO levels was evaluated using linear regression analysis, adjusted for age, sex, adapted British Thoracic Society (BTS) treatment steps and atopy. RESULTS The mean age of the population was 9.1 ± 2.2 years, and the median of FENO levels was 13.0 ppb with an interquartile range (IQR) of (8.0-27.5 ppb). The minor allele (G) frequency of rs28364072 was 29.6%, and each extra copy of the G allele was significantly associated with a lower level of the geometric mean of FENO (log scale, β = -0.12, 95% CI: -0.23, -0.02). CONCLUSION AND CLINICAL RELEVANCE Our results showed that the FCER2 T2206C variant was significantly associated with lower FENO levels in carriers of the G allele. Nevertheless, this SNP contributed little to the variability in FENO levels in this patient population. Our findings contribute to the present knowledge on FENO in asthmatic children; however, future replication studies are required to establish the role of this gene in relation to FENO.
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Affiliation(s)
- Leila Karimi
- Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Susanne J H Vijverberg
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands.,Department of Pediatric Respiratory Medicine, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Niloufar Farzan
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Mohsen Ghanbari
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Genetics, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Katia M C Verhamme
- Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Bioanalysis, Ghent University, Ghent, Belgium
| | - Anke H Maitland-van der Zee
- Department of Respiratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, The Netherlands.,Department of Pediatric Respiratory Medicine, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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Koumpagioti D, Boutopoulou B, Priftis KN, Douros K. Effectiveness of an educational program for children and their families on asthma control treatment adherence. J Asthma 2019; 57:567-573. [PMID: 30905211 DOI: 10.1080/02770903.2019.1585873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: Τo investigate the effect of an asthma care educational program for children and adolescents with asthma, on adherence to asthma control treatment and on clinical indices.Methods: Individuals newly diagnosed with asthma, aged 4-16 years, randomized to the intervention and control group. The participants were monitored for 6 weeks. At baseline, before the initiation of inhaled corticosteroids/long-acting beta2-agonist (ICS/LABA), the intervention group attended the educational program; the control group received the usual care. Both groups were equipped with electronic monitoring devices for measuring adherence. Spirometry, exhaled nitric oxide fraction (FeNO), and asthma control test (ACT) score were measured in both groups in the pre and post-ICS/LABA initiation visit.Results: Seventy-eight participants were enrolled in this study (n = 39 to each group). Median percentage of adherence was 73% for the total sample, and 80% and 68% in intervention and control group, respectively (p < 0.001). In multivariate analysis, the program was positively associated with improved adherence (p < 0.001). ICS/LABA had a positive effect on spirometric indices, FeNO, and ACT score, whilst the educational program did not improved significantly the above variables.Conclusions: Establishing and increasing adherence is challenging. An asthma care educational program is associated with greater short-term adherence during a period of active monitoring.
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Affiliation(s)
| | - Barbara Boutopoulou
- Respiratory and Allergy Unit, 3rd Pediatric Department of National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens, Greece
| | - Kostas N Priftis
- Respiratory and Allergy Unit, 3rd Pediatric Department of National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens, Greece
| | - Konstantinos Douros
- Respiratory and Allergy Unit, 3rd Pediatric Department of National and Kapodistrian University of Athens, University General Hospital "Attikon", Athens, Greece
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Rickard K, Jain N, MacDonald-Berko M. Measurement of FeNO with a portable, electrochemical analyzer using a 6-second exhalation time in 7-10-year-old children with asthma: comparison to a 10-second exhalation. J Asthma 2018; 56:1282-1287. [PMID: 30451052 DOI: 10.1080/02770903.2018.1541350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Fractional exhaled nitric oxide (FeNO) is a valuable tool for assessing Th2 inflammation in children with asthma. Exhalation times of 6 and 10 s meet the current recommendations for assessing FeNO. The 6-s exhalation provides an alternative for 7-10 year olds not able to complete the 10-s exhalation. Methods: We performed a sub-analysis on data from 7-10-year-old children who participated in a previous study which evaluated the agreement of the 6 and 10-s exhalation times in 6-10 year olds with asthma. Agreement between observed FeNO results obtained by both modes was assessed by weighted Deming regression analysis and Bland-Altman plots. Repeatability was also assessed. Results: Repeatability and agreement of the 6 and 10-s exhalations was demonstrated in 7-10 year olds with two measurements in each mode. Mean observed FeNO measurements were 33.59 ppb (SD = 25.804) for 6 s and 32.46 ppb (SD = 25.302) for 10-s exhalation. Paired differences were centered close to 0 ppb (median = 0.50). Conclusions: Children aged 7-10 years can successfully perform FeNO measurements using a portable, electrochemical FeNO analyzer. Measurements from the 6 and 10-s exhalations were repeatable and consistent with a high degree of agreement between one another. Thus, in young children successful FeNO measurements can be obtained in either the 6-s or 10-s mode, providing physicians valuable information on airway inflammation to aid in the diagnosis and treatment of asthma.
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Affiliation(s)
| | - Neal Jain
- Arizona Allergy & Immunology Research , Gilbert , AZ , USA
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Crater G, Rickard K, Jain N. Successful Fractional Exhaled Nitric Oxide Measurements with NIOX VERO using 6- and 10-s Exhalation Modes in Children with Asthma Aged 4–10 Years: A Randomized Study. Pulm Ther 2017. [DOI: 10.1007/s41030-017-0028-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Hanson JR, De Lurgio SA, Williams DD, Dinakar C. Office-based exhaled nitric oxide measurement in children 4 years of age and older. Ann Allergy Asthma Immunol 2013; 111:358-63. [PMID: 24125141 DOI: 10.1016/j.anai.2013.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 06/27/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Fractional exhaled nitric oxide (FENO) is increasingly being used in the office-based management of asthma, but data in children are limited. OBJECTIVES To report FENO values in 4- to 7-year-old children with suspected asthma and characterize their relation to clinical variables and describe the relation among FENO levels, age, and sex in 4- to 18-year-old children with suspected asthma. METHODS Retrospective data in 4- to 18-year-old children (n = 825) who underwent FENO testing using the NIOX MINO device were collected and analyzed. Chart reviews were performed for the 4- to 7-year-old children (n = 75). RESULTS FENO values ranged from less than or equal to 5 to 89 ppb in 75 4- to 7-year-old children and less than or equal to 5 to 300 ppb in 750 > 7 to 18-year-old children. Approximately one tenth of 4- to 7-year-old children and one third of > 7 to 18-year-old children had FENO values indicative of eosinophilic/allergic inflammation (>35 ppb). In regression analysis of the 4- to 7-year-old children, increasing age (P = .03) and asthma severity (P = .01) were associated with higher FENO levels. Atopic dermatitis was significantly associated (P = .03), whereas allergic rhinitis was marginally associated (P = .06), with higher FENO levels. Inhaled corticosteroid use was associated with lower FENO levels (P = .02). CONCLUSION This study characterizes the largest cohort of 4- to 7-year-old children to undergo FENO testing in ambulatory asthma management. Correlations between FENO levels and clinical variables were consistent with established findings in older children. This preliminary real-world study suggests that FENO assessment may be feasible and useful in the office-based asthma management of children as young as 4 years.
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Affiliation(s)
- Jill R Hanson
- Pediatric Residency Program, Children's Mercy Hospital, Kansas City, Missouri.
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Vijverberg SJH, Koster ES, Koenderman L, Arets HGM, van der Ent CK, Postma DS, Koppelman GH, Raaijmakers JAM, Maitland-van der Zee AH. Exhaled NO is a poor marker of asthma control in children with a reported use of asthma medication: a pharmacy-based study. Pediatr Allergy Immunol 2012; 23:529-36. [PMID: 22624949 DOI: 10.1111/j.1399-3038.2012.01279.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND A high fraction of nitric oxide in exhaled breath (FeNO) has been suggested to be a marker of ongoing airway inflammation and poorly controlled disease in asthma. The usefulness of FeNO to monitor asthma control is still debated today. AIM To assess the validity of FeNO as a marker of asthma control in children with reported use of asthma medication. METHODS Fraction of nitric oxide in exhaled breath was measured in 601 children (aged 4-12 yr) with reported use of asthma medication in the past 6 months and in 63 healthy non-asthmatic children (aged 5-12). Asthma control was assessed by the Asthma Control Questionnaire (ACQ). A receiver-operator characteristics (ROC) curve was generated to assess the accuracy of FeNO as a marker for asthma control. Logistic regression analysis was used to study whether clinical, healthcare, medication, and environmental factors are associated with high FeNO levels (>25 ppb). RESULTS Fraction of nitric oxide in exhaled breath had a poor accuracy to discriminate well-controlled from not well-controlled asthma [area under the ROC curve: 0.56 (95% CI: 0.52-0.61, p = 0.008)]. In addition, high FeNO (>25 ppb) was associated with lower medication adherence rates (OR: 0.4; 95% CI 0.3-0.6), fewer antibiotic courses in the past year (OR: 0.6; 95% CI: 0.4-0.9), fewer leukotriene antagonists use in the past year (OR: 0.4; 95% CI: 0.2-0.9), and fewer visits to a (pulmonary) pediatrician (OR: 0.6; 95% CI: 0.4-0.9). Children living in a non-urban environment had more often high FeNO levels (OR: 1.7; 95% CI: 1.1-2.6). CONCLUSION High FeNO is a poor marker of asthma control in children with reported use of asthma medication. Various other factors, including medication adherence and medication use, are associated with increased FeNO levels.
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Affiliation(s)
- Susanne J H Vijverberg
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
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Piacentini GL, Cattazzo E, Tezza G, Peroni DG. Exhaled nitric oxide in pediatrics: what is new for practice purposes and clinical research in children? J Breath Res 2012; 6:027103. [PMID: 22523000 DOI: 10.1088/1752-7155/6/2/027103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fractional exhaled NO (FeNO) is universally considered an indirect marker of eosinophilic airways inflammation, playing an important role in the physiopathology of childhood asthma. Advances in technology and standardization have allowed a wider use of FeNO in clinical practice in children from the age of four years. FeNO measurements add a new dimension to the traditional clinical tools (symptoms scores, lung function tests) in the assessment of asthma. To date a number of studies have suggested a possible use of FeNO in early identification of exacerbation risk and in inhaled corticosteroids titration. The aim of this paper is to address practical issues of interest to paediatric clinicians who are attempting to use FeNO measurements as an adjunctive tool in the diagnosis and management of childhood airway diseases.
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Affiliation(s)
- G L Piacentini
- Faculty of Medicine, Department of Pediatrics, University of Verona, Policlinico GB Rossi, Piazzale L. Scuro 10, Verona, Italy.
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Arnold DH, Gebretsadik T, Abramo TJ, Hartert TV. Noninvasive testing of lung function and inflammation in pediatric patients with acute asthma exacerbations. J Asthma 2011; 49:29-35. [PMID: 22133263 DOI: 10.3109/02770903.2011.637599] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE There is limited information on performance rates for tests of lung function and inflammation in pediatric patients with acute asthma exacerbations. We sought to examine how frequently pediatric patients with acute asthma exacerbations could perform noninvasive lung function and exhaled nitric oxide (FE(NO)) testing and participant characteristics associated with successful performance. METHODS We studied a prospective convenience sample aged 5-17 years with acute asthma exacerbations in a pediatric emergency department. Participants attempted spirometry for percent predicted forced expiratory volume in 1 second (%FEV(1)), airway resistance (Rint), and FE(NO) testing before treatment. We examined overall performance rates and the associations of age, gender, race, and baseline acute asthma severity score with successful test performance. RESULTS Among 573 participants, age was (median [interquartile range]) 8.8 [6.8, 11.5] years, 60% were male, 57% were African-American, and 58% had Medicaid insurance. Tests were performed successfully by the following [n (%)]: full American Thoracic Society-European Respiratory Society criteria spirometry, 331 (58%); Rint, 561 (98%); and FE(NO), 354 (70% of 505 attempted test). Sixty percent with mild-moderate exacerbations performed spirometry compared to 17% with severe exacerbations (p = .0001). Participants aged 8-12 years (67%) were more likely to perform spirometry than those aged 5-7 years (48%) (OR = 2.23, 95% CI: 1.45-3.11) or 13-17 years (58%) (OR = 1.61, 95% CI: 1.00-2.59). CONCLUSIONS There is clinically important variability in performance of these tests during acute asthma exacerbations. The proportion of patients with severe exacerbations able to perform spirometry (17%) limits its utility. Almost all children with acute asthma can perform Rint testing, and further development and validation of this technology is warranted.
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Affiliation(s)
- Donald H Arnold
- Department of Pediatrics, Division of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
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Arnold DH, Gebretsadik T, Abramo TJ, Sheller JR, Resha DJ, Hartert TV. The Acute Asthma Severity Assessment Protocol (AASAP) study: objectives and methods of a study to develop an acute asthma clinical prediction rule. Emerg Med J 2011; 29:444-50. [PMID: 21586757 DOI: 10.1136/emj.2010.110957] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Acute asthma exacerbations are one of the most common reasons for paediatric emergency department visits and hospitalisations, and a relapse frequently necessitates repeat urgent care. While care plans exist, there are no acute asthma prediction rules (APRs) to assess severity and predict outcome. The primary objective of the Acute Asthma Severity Assessment Protocol study is to develop a multivariable APR for acute asthma exacerbations in paediatric patients. A prospective, convenience sample of paediatric patients aged 5-17 years with acute asthma exacerbations who present to an urban, academic, tertiary paediatric emergency department was enrolled. The study protocol and data analysis plan conform to accepted biostatistical and clinical standards for clinical prediction rule development. Modelling of the APR will be performed once the entire sample size of 1500 has accrued. It is anticipated that the APR will improve resource utilisation in the emergency department, aid in standardisation of disease assessment and allow physician and non-physician providers to participate in earlier objective decision making. The objective of this report is to describe the study objectives and detailed methodology of the Acute Asthma Severity Assessment Protocol study.
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Affiliation(s)
- Donald H Arnold
- Department of Pediatrics and Emergency Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
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Lanz MJ, Bautista AP, Peyrou NM, Prendes S. Exhaled nitric oxide in young, symptomatic patients with atopic asthma receiving nebulized budesonide therapy. Ann Allergy Asthma Immunol 2011; 105:400-1. [PMID: 21055669 DOI: 10.1016/j.anai.2010.08.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 07/23/2010] [Accepted: 08/30/2010] [Indexed: 10/18/2022]
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Ito Y, Adachi Y, Itazawa T, Okabe Y, Adachi YS, Katsumuma T, Miyawaki T. Comparison of exhalation time methods (6 sec vs. 10 sec) of a hand-held exhaled nitric oxide analyzer. Pediatr Pulmonol 2010; 45:1005-8. [PMID: 20648669 DOI: 10.1002/ppul.21286] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Standard exhalation time for measuring fractional exhaled nitric oxide (FeNO) is 10 sec, but this is not easy for younger children. We aimed to investigate the agreement between FeNO values during 10-sec (FeNO-10) and 6-sec (FeNO-6) exhalation and the feasibility of measuring FeNO-6, using a hand-held analyzer, NIOX-MINO®. FeNO values measured during 10- and 6-sec (random order) were compared. Success rates of the two different time modes were also evaluated. In 119 asthmatic children (median age 8 years [range 4-15]) who had been already accustomed to NIOX-MINO®, median FeNO-10 (29 ppb [IQR 15.2-42.0]) and FeNO-6 (27 ppb [IQR 16.0-43.5]) did not differ significantly (P = 0.90), and there was a good correlation between both values (r = 0.984, P < 0.001). Mean difference (FeNO-10-FeNO-6) was -0.151 ppb (95% CI: -0.95 to 0.65, limits of agreement: -8.8 to 8.5). In 46 asthmatic children (median age 7 years [range 4-15]) who had never used any FeNO analyzers, all the children aged 8 years and more (n = 21) succeeded in measuring FeNO on both time modes, whereas for children aged younger than 8 years (n = 25) success rates of the 10- and 6-sec mode were 60.0% and 92.0%, respectively. In conclusion, we showed good agreement between FeNO-10 and FeNO-6, and the 6-sec mode of NIOX-MINO® is more feasible than 10-sec mode for measuring FeNO in younger children.
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Affiliation(s)
- Yasunori Ito
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan
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