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Csoma BALÁ, Sydó N, SZŰcs G, Seres É, Erdélyi T, Horváth G, Csulak E, Merkely B, Müller V. Exhaled and Systemic Biomarkers to Aid the Diagnosis of Bronchial Asthma in Elite Water Sports Athletes. Med Sci Sports Exerc 2024; 56:1256-1264. [PMID: 38650115 DOI: 10.1249/mss.0000000000003419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE Our aim was to evaluate the accuracy of a combined airway inflammatory biomarker assessment in diagnosing asthma in elite water sports athletes. METHODS Members of the Hungarian Olympic and Junior Swim Team and elite athletes from other aquatic disciplines were assessed for asthma by objective lung function measurements, and blood eosinophil count (BEC), serum total immunoglobulin E (IgE), fractional exhaled nitric oxide (F ENO ) measurements, and skin prick testing were performed. A scoring system from BEC, F ENO , serum IgE, and skin test positivity was constructed by dichotomizing the variables and assigning a score of 1 if the variable is elevated. These scores were summed to produce a final composite score ranging from 0 to 4. RESULTS A total of 48 participants were enrolled (age 21 ± 4 yr, 42% male), of which 22 were diagnosed with asthma. Serum total IgE and F ENO levels were higher in asthmatic individuals (68 [27-176] vs 24 [1-43], P = 0.01; 20 [17-26] vs 15 [11-22], P = 0.02), and positive prick test was also more frequent (55% vs 8%, P < 0.01). Asthmatic participants had higher composite variable scores (2 [1-3] vs 1 [0-1], P = 0.02). Receiver operating characteristic analysis showed that total IgE, F ENO , and composite variable were suitablefor identifying asthmatic participants (area under the curve = 0.72, P = 0.01; 0.70, P = 0.02, and 0.69, P = 0.03). A composite score of >2 reached a specificity of 96.2%, a sensitivity of 36.4%, and a likelihood ratio of 9.5. Logistic regression model revealed a strong association between the composite variable and the asthma diagnosis (OR = 2.71, 95% confidence interval = 1.17-6.23, P = 0.02). CONCLUSIONS Our data highlight the diagnostic value of combined assessment of Th2-type inflammation in elite water sports athletes. The proposed scoring system may be helpful in ruling in asthma in this population upon clinical suspicion.
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Affiliation(s)
- BALÁzs Csoma
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
| | - Nóra Sydó
- Heart and Vascular Centre, Semmelweis University, Budapest, HUNGARY
| | - Gergő SZŰcs
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
| | - Éva Seres
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
| | - Tamás Erdélyi
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
| | - Gábor Horváth
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
| | - Emese Csulak
- Heart and Vascular Centre, Semmelweis University, Budapest, HUNGARY
| | - Béla Merkely
- Heart and Vascular Centre, Semmelweis University, Budapest, HUNGARY
| | - Veronika Müller
- Department of Pulmonology, Semmelweis University, Budapest, HUNGARY
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Werthmann DW, Rabito FA, Adamkiewicz G, Reponen T, Calafat AM, Ospina M, Chew GL. Pesticide exposure and asthma morbidity in children residing in urban, multi-family housing. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2024; 34:241-250. [PMID: 36765101 PMCID: PMC10412724 DOI: 10.1038/s41370-023-00524-2] [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: 07/07/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Children are potentially more susceptible to the adverse effects of pesticides due to more sensitive organ systems and lower capacity to metabolize and eliminate chemicals compared to adults. The health risks are particularly concerning children with asthma, living in low-income neighborhoods in multi-family housing because of their impaired respiratory health, and factors associated with low-income, multi-family environments. OBJECTIVE To assess the association between pesticide exposure and asthma morbidity among children 7-12 years residing in low-income, multi-family housing. METHODS The concentrations of seven urinary pesticide biomarkers: 3,5,6-trichloro-2-pyridinol (TCPy), 2-isopropyl-4-methyl-6-hydroxypyrimidine, para-nitrophenol (PNP), 3-phenoxybenzoic acid (3-PBA), 4-fluoro-3-phenoxybenzoic acid, trans-3-(2,2-dichlorovinyl)-2,2-dimethyl-cyclopropane-1-carboxylic acid, and 2,4-dichlorophenoxyacetic acid (2,4-D) were measured. Children (n = 162) were followed for one year with three measures of pesticides biomarkers. Associations between individual biomarkers and asthma attack, asthma related health care utilization, and fraction of exhaled nitric oxide (FeNO), adjusting for demographic and household factors were examined with Generalized Estimating Equations (GEE). Weighted Quantile Sum (WQS) regression was used to examine the effect of pesticide mixture on asthma attacks and asthma-related health care utilization (HCU). RESULTS In adjusted GEE models, positive non-significant associations were found between PNP and HCU (adjusted Odds Ratio(aOR):2.05 95% CI:0.76-5.52) and null associations for 3-PBA and HCU (aOR:1.07 95% CI: 0.88-1.29). Higher concentrations of PNP and 2,4-D were associated with significantly lower FeNO levels (PNP: -17.4%; 2,4-D:-19.74%). The mixture was positively associated with HCU in unadjusted (OR: 1.56 97.5% CI: 1.08-2.27) but not significant in adjusted models (aOR: 1.40 97.5% CI: .86-2.29). The non-specific pyrethroid biomarker 3-PBA at baseline contributed the greatest weight to the index (45%). SIGNIFICANCE There were non-significant associations between pesticide biomarkers and respiratory outcomes in children with asthma. There was a suggestive association between urinary pesticide biomarkers and HCU. Further studies with larger sample sizes could help to confirm these findings. IMPACT STATEMENT Pesticide exposure among children in the urban environment is ubiquitous and there is a dearth of information on the impact of low-level chronic exposure in vulnerable populations. This study suggested that pesticide exposure at concentrations below the national average may not affect asthma morbidity in children. However, different biomarkers of pesticides showed different effects, but the mixture suggested increasing pesticide exposure results in asthma related HCU. The results may show that children with asthma may be at risk for negative health outcomes due to pesticides and the need to further examine this relationship.
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Affiliation(s)
- Derek W Werthmann
- Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA.
| | - Felicia A Rabito
- Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | - Tiina Reponen
- University of Cincinnati, Department of Environmental and Public Health Sciences, Cincinnati, OH, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Maria Ospina
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ginger L Chew
- Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Alsharairi NA. Antioxidant Intake and Biomarkers of Asthma in Relation to Smoking Status-A Review. Curr Issues Mol Biol 2023; 45:5099-5117. [PMID: 37367073 DOI: 10.3390/cimb45060324] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023] Open
Abstract
Asthma is considered a chronic inflammatory disorder associated with airway hyperresponsiveness (AHR). Increased oxidative stress (OS) is a clinical feature of asthma, which promotes the inflammatory responses in bronchial/airway epithelial cells. Smokers and nonsmokers with asthma have been shown to have increases in several OS and inflammatory biomarkers. However, studies suggest significant differences in OS and inflammation biomarkers between smokers and nonsmokers. A few studies suggest associations between antioxidant intake from diet/supplements and asthma in patients with different smoking status. Evidence is lacking on the protective role of antioxidant vitamin and/or mineral consumption against asthma by smoking status with respect to inflammation and OS biomarkers. Therefore, the aim of this review is to highlight current knowledge regarding the relations between antioxidant intake, asthma, and its associated biomarkers, according to smoking status. This paper can be used to guide future research directions towards the health consequences of antioxidant intake in smoking and nonsmoking asthmatics.
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Affiliation(s)
- Naser A Alsharairi
- Heart, Mind & Body Research Group, Griffith University, Gold Coast P.O. Box 4222, QLD, Australia
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Louis R, Satia I, Ojanguren I, Schleich F, Bonini M, Tonia T, Rigau D, Ten Brinke A, Buhl R, Loukides S, Kocks JWH, Boulet LP, Bourdin A, Coleman C, Needham K, Thomas M, Idzko M, Papi A, Porsbjerg C, Schuermans D, Soriano JB, Usmani OS. European Respiratory Society Guidelines for the Diagnosis of Asthma in Adults. Eur Respir J 2022; 60:2101585. [PMID: 35169025 DOI: 10.1183/13993003.01585-2021] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/10/2022] [Indexed: 12/20/2022]
Abstract
Although asthma is very common affecting 5-10% of the population, the diagnosis of asthma in adults remains a challenge in the real world that results in both over- and under-diagnosis. A task force (TF) was set up by the European Respiratory Society to systematically review the literature on the diagnostic accuracy of tests used to diagnose asthma in adult patients and provide recommendation for clinical practice.The TF defined eight PICO (Population, Index, Comparator, and Outcome) questions that were assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach, The TF utilised the outcomes to develop an evidenced-based diagnostic algorithm, with recommendations for a pragmatic guideline for everyday practice that was directed by real-life patient experiences.The TF support the initial use of spirometry followed, and if airway obstruction is present, by bronchodilator reversibility testing. If initial spirometry fails to show obstruction, further tests should be performed in the following order: FeNO, PEF variability or in secondary care, bronchial challenge. We present the thresholds for each test that are compatible with a diagnosis of asthma in the presence of current symptoms.The TF reinforce the priority to undertake spirometry and recognise the value of measuring blood eosinophils and serum IgE to phenotype the patient. Measuring gas trapping by body plethysmography in patients with preserved FEV1/FVC ratio deserves further attention. The TF draw attention on the difficulty of making a correct diagnosis in patients already receiving inhaled corticosteroids, the comorbidities that may obscure the diagnosis, the importance of phenotyping, and the necessity to consider the patient experience in the diagnostic process.
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Affiliation(s)
- Renaud Louis
- CHU de Liege University Hospital Centre Ville, Liege, Belgium
- First author, Task force chair
| | - Imran Satia
- McMaster University, Hamilton, Canada
- All authors contributed equally
| | - Inigo Ojanguren
- Vall d'Hebron University Hospital Barcelona, Barcelona, Spain
- All authors contributed equally
| | - Florence Schleich
- Department of Pulmonary Medicine, University of Liege, Liège, Belgium
- All authors contributed equally
| | - Matteo Bonini
- Sapienza University of Rome, Rome, Italy
- All authors contributed equally
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - David Rigau
- Iberoamerican Cochrane Centre, Barcelona, Spain
| | - Anne Ten Brinke
- CHU de Liege University Hospital Centre Ville, Liege, Belgium
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | | | | | - Louis-Philippe Boulet
- Pneumologie, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Quebec, Canada
| | | | | | | | - Mike Thomas
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Marco Idzko
- Department of Respiratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Alberto Papi
- Respiratory Medicine, University of Ferrara, Ferrara, Italy
| | - Celeste Porsbjerg
- Respiratory Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen NV, Denmark
| | - Daniel Schuermans
- Respiratory Division, Academic Hospital UZBrussel, Brussels, Belgium
| | - Joan B Soriano
- Universidad Autónoma de Madrid, Hospital Universitario de la Princesa, Madrid, Spain
| | - Omar S Usmani
- Asthma Lab, National Heart and Lung Institute, London, UK
- Corresponding author, Task force co-chair
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5
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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: 3] [Impact Index Per Article: 1.0] [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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Vinnikov D, Tulekov Z, Blanc PD. Fractional exhaled NO in a metalworking occupational cohort. Int Arch Occup Environ Health 2021; 95:701-708. [PMID: 34626220 DOI: 10.1007/s00420-021-01801-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/22/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Secondary metalworking carries exposure to relatively heavy levels of respirable particulate. We investigated the extent to which metalworking is associated with increased exhaled nitric oxide (FeNO), an established inflammatory biomarker. METHODS We studied 80 metalworking factory employees in Kazakhstan. Informed by industrial hygiene data, we categorized them into three groups: (1) machine operators (41%); (2) welders or assemblers (33%); and (3) all others, including administrative and ancillary staff (26%). Participants completed questionnaires covering occupational history, smoking, home particulate sources, respiratory symptoms, and comorbidities. We measured exhaled carbon monoxide (CO), exhaled fractional nitric oxide (FeNO), and spirometric function. We used mixed-effects modeling to test the associations of occupational group with FeNO, adjusted for covariates. RESULTS The median age was 51.5 (interquartile range 20.5) years; 7% were women. Occupational group (p < 0.01), daily current cigarette smoking intensity (p < 0.05), and age (p < 0.05), each was statistically associated with FeNO. Welders, or assemblers (Group 2), who had intermediate particulate exposure, manifested significantly higher exhaled FeNO compared to machinists (Group 1, with the highest particulate exposure) and all others (Groups 3, the lowest particulate): adjusted Group 2 mean 44.8 ppb (95% confidence interval (CI) 33.8-55.9) vs. Group 1 24.6 ppb (95% 20.5-28.7) and Group 3, 24.3 ppb (95% CI 17.7-30.9). Secondhand smoking and height were not associated with FeNO. CONCLUSION In a metalworking industrial cohort, welders/assemblers manifested significantly higher levels of FeNO. This may reflect respiratory tract inflammation associated with airborne exposures specific to this group.
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Affiliation(s)
- Denis Vinnikov
- Al-Farabi Kazakh National University, 71 al-Farabi avenue, 050040, Almaty, Kazakhstan. .,Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation.
| | - Zhangir Tulekov
- Al-Farabi Kazakh National University, 71 al-Farabi avenue, 050040, Almaty, Kazakhstan
| | - Paul D Blanc
- University of California San Francisco, San Francisco, CA, USA
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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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Validation of ATS clinical practice guideline cut-points for FeNO in asthma. Respir Med 2018; 144:22-29. [PMID: 30366580 DOI: 10.1016/j.rmed.2018.09.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/15/2018] [Accepted: 09/19/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND The American Thoracic society (ATS) has suggested using fractional exhaled nitric oxide (FeNO) to monitor the level of eosinophilic (EOS) airway inflammation in asthma, but validation of the proposed cut-points is required in real-life populations. OBJECTIVE To validate FeNO cut-points suggested by ATS in relation to sputum EOS count in a real life population of asthma patients. METHODS All patients referred consecutively over a 12-months period for specialist assessment of asthma, were examined with FeNO and induced sputum, and re-examined 12 months later. The predicted values of a positive and a negative test (PPV and NPV) for a cut off ≥3% EOS in sputum were calculated. Change in FeNO was defined in accordance with ATS (>20% or 10 ppb if FeNO was <50 ppb). RESULTS 144 adult asthma patients were examined (59% female). Low FeNO (<25 ppb) at baseline was found in 94 (65%), FeNO between 25 and 50 ppb in 34 (24%) subjects and high FeNO >50 ppb in 16 (11%) subjects. The PPV for FeNO >25 ppb and >50 ppb to predict EOS ≥3% was 45% and 77%, NPV was 88% and 83%. The sensitivity decreased from 70% to 37% at the >50 ppb cut-off. A significant reduction in FeNO was associated with a reduction in sputum EOS (p = 0.01). CONCLUSION The findings support the validity of the FeNO cut-points suggested by ATS to monitor eosinophilic airway inflammation in asthma. However, in this real-life population, a large proportion of patients had intermediate FeNO values, which may limit the clinical usefulness of the ATS FeNO cut-points.
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Wang Z, Pianosi PT, Keogh KA, Zaiem F, Alsawas M, Alahdab F, Almasri J, Mohammed K, Larrea-Mantilla L, Farah W, Daraz L, Barrionuevo P, Morrow AS, Prokop LJ, Murad MH. The Diagnostic Accuracy of Fractional Exhaled Nitric Oxide Testing in Asthma: A Systematic Review and Meta-analyses. Mayo Clin Proc 2018; 93:191-198. [PMID: 29275031 DOI: 10.1016/j.mayocp.2017.11.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of fractional exhaled nitric oxide (FeNO) measurement in individuals with suspected asthma. METHODS We searched MEDLINE, EMBASE, PsycINFO, Cochrane databases, and SciVerse Scopus from the databases' inception through April 4, 2017, for studies that enrolled patients aged 5 years and older with suspected asthma and evaluated FeNO diagnostic accuracy. Independent reviewers selected studies and extracted data. We used the symmetric hierarchical summary receiver operating characteristic models to estimate test performance. RESULTS We included 43 studies with a total of 13,747 patients. In adults, using FeNO cutoffs of less than 20, 20 to 29, 30 to 39, and 40 or more parts per billion, FeNO testing had sensitivities of 0.80, 0.69, 0.53, and 0.41, respectively, and specificities of 0.64, 0.78, 0.85, and 0.93, respectively. In children, using FeNO cutoffs of less than 20 and 20 to 29 parts per billion, FeNO testing had sensitivities of 0.78 and 0.61, respectively, and specificities of 0.79 and 0.89, respectively. Depending on the FeNO cutoff, the posttest odds of having asthma with a positive FeNO test result increased by 2.80- to 7.00-fold. Diagnostic accuracy was modestly better in corticosteroid-naive asthmatics, children, and nonsmokers than in the overall population. CONCLUSION Fractional exhaled nitric oxide measurement has moderate accuracy to diagnose asthma in individuals aged 5 years and older. Test performance may be modestly better in corticosteroid-naive asthmatics, children, and nonsmokers than in the general population with suspected asthma. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) Identifier: CRD42016047887.
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Affiliation(s)
- Zhen Wang
- Mayo Clinic Evidence-based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Paolo T Pianosi
- Division of Pediatric Pulmonology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN; Paediatric Respirology, King's College Hospital NHS Foundation Trust, London, UK
| | - Karina A Keogh
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Feras Zaiem
- Mayo Clinic Evidence-based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Mouaz Alsawas
- Mayo Clinic Evidence-based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Fares Alahdab
- Mayo Clinic Evidence-based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Jehad Almasri
- Mayo Clinic Evidence-based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Khaled Mohammed
- Mayo Clinic Evidence-based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Laura Larrea-Mantilla
- Mayo Clinic Evidence-based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Wigdan Farah
- Mayo Clinic Evidence-based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Lubna Daraz
- Mayo Clinic Evidence-based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Patricia Barrionuevo
- Mayo Clinic Evidence-based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Allison S Morrow
- Mayo Clinic Evidence-based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | | | - Mohammad Hassan Murad
- Mayo Clinic Evidence-based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
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Peck MJ, Sanders EB, Scherer G, Lüdicke F, Weitkunat R. Review of biomarkers to assess the effects of switching from cigarettes to modified risk tobacco products. Biomarkers 2018; 23:213-244. [PMID: 29297706 DOI: 10.1080/1354750x.2017.1419284] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Context: One approach to reducing the harm caused by cigarette smoking, at both individual and population level, is to develop, assess and commercialize modified risk alternatives that adult smokers can switch to. Studies to demonstrate the exposure and risk reduction potential of such products generally involve the measuring of biomarkers, of both exposure and effect, sampled in various biological matrices.Objective: In this review, we detail the pros and cons for using several biomarkers as indicators of effects of changing from conventional cigarettes to modified risk products.Materials and methods: English language publications between 2008 and 2017 were retrieved from PubMed using the same search criteria for each of the 25 assessed biomarkers. Nine exclusion criteria were applied to exclude non-relevant publications.Results: A total of 8876 articles were retrieved (of which 7476 were excluded according to the exclusion criteria). The literature indicates that not all assessed biomarkers return to baseline levels following smoking cessation during the study periods but that nine had potential for use in medium to long-term studies.Discussion and conclusion: In clinical studies, it is important to choose biomarkers that show the biological effect of cessation within the duration of the study.
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Affiliation(s)
| | | | | | - Frank Lüdicke
- Research & Development, Philip Morris International, Neuchâtel, Switzerland
| | - Rolf Weitkunat
- Research & Development, Philip Morris International, Neuchâtel, Switzerland
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High prevalence of severe asthma in a large random population study. J Allergy Clin Immunol 2017; 141:2256-2264.e2. [PMID: 28939411 DOI: 10.1016/j.jaci.2017.07.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 06/30/2017] [Accepted: 07/11/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND The prevalence of asthma severity is not well described at a population level. OBJECTIVE We sought to determine the prevalence of phenotypic signs of asthma severity among asthmatic patients in a general population and to describe risk factors for asthma severity. METHODS We performed an epidemiologic study conducted between 2008 and 2012 (West Sweden Asthma Study). A postal questionnaire was sent to a random population (n = 30,000) in west Sweden, with 18,087 responses. A total of 2,006 subjects were carefully phenotyped. Only subjects with "active asthma" (symptoms or medication in the last year, n = 744) were analyzed in this study to determine the degree of severity of the disease within an asthma cohort. Phenotypes of severity were calculated based on (1) multiple symptoms during the day despite ongoing use of asthma medications, (2) FEV1 of less than 70% of predicted value, (3) daily or almost daily use of rescue medications, (4) nighttime symptoms once a week or more, and (5) oral corticosteroid use/emergency department visits. Asthmatic patients were grouped as having nonsevere disease, 1 sign of severity, or 2 or more signs of severity. RESULTS A total of 36.2% of asthmatic patients expressed at least 1 sign of asthma severity, and 13.2% had 2 or more signs. The group with 2 or more signs was older in age and had higher body mass index, a higher rate of tobacco smoking, and lower lung function. Bronchial hyperreactivity, airway inflammation, and sensitization were significantly different among the 3 groups. At a population level, the prevalence of asthma severity was 3.1% for 1 sign and 1.3% for at least 2 signs. CONCLUSION More than 1 in 3 asthmatic patients show at least 1 sign of asthma severity. The phenotypes of asthma severity are highly diverse, which is important to consider when implementing personalized medicine in asthmatic patients.
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A novel statistical model for analyzing data of a systematic review generates optimal cutoff values for fractional exhaled nitric oxide for asthma diagnosis. J Clin Epidemiol 2017; 92:69-78. [PMID: 28916487 DOI: 10.1016/j.jclinepi.2017.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 08/22/2017] [Accepted: 09/01/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Measurement of fractional exhaled nitric oxide (FENO) might substitute bronchial provocation for diagnosing asthma. However, optimal FENO thresholds for diagnosing asthma remain unclear. We reanalyzed data collected for a systematic review investigating the diagnostic accuracy of FENO measurement to exploit all available thresholds under consideration of pretest probabilities using a newly developed statistical model. STUDY DESIGN AND SETTING One hundred and fifty data sets for a total of 53 different cutoffs extracted from 26 studies with 4,518 participants were analyzed with the multiple thresholds model. This model allows identifying thresholds at which the test is likely to perform best. RESULTS Diagnosing asthma might only be possible in a meaningful manner when the pretest probability of asthma is at least 30%. In that case, FENO > 50 ppb leads to a positive predictive value of 0.76 [95% confidence interval (CI): 0.29-0.96]. Excluding asthma might only be possible, when the pretest probability of asthma is 30% at maximum. Then, FENO < 20 ppb leads to a negative predictive value of 0.86 (95% CI 0.66-0.95). CONCLUSION The multiple thresholds model generates a more comprehensive and more clinically useful picture of the effects of different thresholds, which facilitates the determination of optimal thresholds for diagnosing or excluding asthma with FENO measurement.
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13
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Torén K, Murgia N, Schiöler L, Bake B, Olin AC. Reference values of fractional excretion of exhaled nitric oxide among non-smokers and current smokers. BMC Pulm Med 2017; 17:118. [PMID: 28841881 PMCID: PMC5574203 DOI: 10.1186/s12890-017-0456-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 08/04/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Fractional exhaled nitric oxide (FENO) is used to assess of airway inflammation; diagnose asthma and monitor adherence to advised therapy. Reliable and accurate reference values for FENO are needed for both non-smoking and current smoking adults in the clinical setting. The present study was performed to establish reference adult FENO values among never-smokers, former smokers and current smokers. METHODS FENO was measured in 5265 subjects aged 25-75 years in a general-population study, using a chemiluminescence (Niox ™) analyser according to the guidelines of the American Thoracic Society and the European Respiratory Society. Atopy was based on the presence of immunoglobulin E (IgE) antibodies to common inhalant allergens (measured using Phadiatop® test). Spirometry without bronchodilation was performed and forced vital capacity (FVC), forced expired volume in 1 s (FEV1) and the ratio of FEV1 to FVC values were obtained. After excluding subjects with asthma, chronic bronchitis, spirometric airway obstruction and current cold, 3378 subjects remained. Equations for predictions of FENO values were modelled using nonparametric regression models. RESULTS FENO levels were similar in never-smokers and former smokers, and these two groups were therefore merged into a group termed "non-smokers". Reference equations, including the 5th and 95th percentiles, were generated for female and male non-smokers, based on age, height and atopy. Regression models for current smokers were unstable. Hence, the proposed reference values for current smokers are based on the univariate distribution of FENO and fixed cut-off limits. CONCLUSIONS Reference values for FENO among respiratory healthy non-smokers should be outlined stratified for gender using individual reference values. For current smokers separate cut-off limits are proposed.
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Affiliation(s)
- Kjell Torén
- Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Section of Occupational medicine, Respiratory Diseases and Toxicology University of Perugia, Perugia, Italy
| | - Nicola Murgia
- Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Section of Occupational medicine, Respiratory Diseases and Toxicology University of Perugia, Perugia, Italy
| | - Linus Schiöler
- Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Bake
- Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna-Carin Olin
- Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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14
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Jacinto T, Malinovschi A, Janson C, Fonseca J, Alving K. Differential effect of cigarette smoke exposure on exhaled nitric oxide and blood eosinophils in healthy and asthmatic individuals. J Breath Res 2017; 11:036006. [PMID: 28825404 DOI: 10.1088/1752-7163/aa746b] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Tobacco smoking affects both the fraction of exhaled nitric oxide (FeNO) and blood eosinophil (B-Eos) count, two clinically useful biomarkers in respiratory disease that represent local and systemic type-2 inflammation, respectively. OBJECTIVE We aimed to study the influence of objectively measured smoke exposure on FeNO and B-Eos in a large population of subjects with and without asthma. METHODS We utilized the US National Health and Nutrition Examination Surveys 2007-2012 and included 10 669 subjects aged 6-80 years: 9869 controls and 800 asthmatics. Controls were defined as having no respiratory disease, no hay fever in the past year, and B-Eos count ≤0.3 × 109 l-1. Asthma was defined as self-reported current asthma and at least one episode of wheezing or an asthma attack in the past year, but no emphysema or chronic bronchitis. Tobacco use was collected via questionnaires and serum cotinine was measured with mass spectrometry. RESULTS Increasing cotinine levels were associated with a progressive reduction in FeNO in both controls and asthmatics. FeNO remained significantly higher in asthmatics than controls except in the highest cotinine decile, equivalent to an average reported consumption of 13 cigarettes/day. B-Eos count increased with cotinine in controls, but was unchanging in asthmatics. Interestingly, B-Eos count was significantly higher in presently non-exposed (cotinine below detection limit) former smokers than never smokers. CONCLUSION Smoke exposure decreases FeNO and increases B-Eos count. These effects should be considered in the development of normalized values and their interpretation in clinical practice. The persistence of elevated B-Eos in former smokers warrants further studies.
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Affiliation(s)
- Tiago Jacinto
- Department of Allergy: Instituto & Hospital CUF, Porto, Portugal. CINTESIS- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Portugal. Department of Cardiovascular and Respiratory Sciences, Porto Health School, Porto, Portugal
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15
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A new approach to the classification and management of airways diseases: identification of treatable traits. Clin Sci (Lond) 2017; 131:1027-1043. [PMID: 28487412 DOI: 10.1042/cs20160028] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/14/2016] [Accepted: 01/26/2017] [Indexed: 12/16/2022]
Abstract
This review outlines a new, personalized approach for the classification and management of airway diseases. The current approach to airways disease is, we believe, no longer fit for purpose. It is impractical, overgeneralizes complex and heterogeneous conditions and results in management that is imprecise and outcomes that are worse than they could be. Importantly, the assumptions we make when applying a diagnostic label have impeded new drug discovery and will continue to do so unless we change our approach. This review suggests a new mechanism-based approach where the emphasis is on identification of key causal mechanisms and targeted intervention with treatment based on possession of the relevant mechanism rather than an arbitrary label. We highlight several treatable traits and suggest how they can be identified and managed in different healthcare settings.
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16
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Giovannelli J, Chérot-Kornobis N, Hulo S, Ciuchete A, Clément G, Amouyel P, Matran R, Dauchet L. Both exhaled nitric oxide and blood eosinophil count were associated with mild allergic asthma only in non-smokers. Clin Exp Allergy 2016; 46:543-54. [PMID: 26542195 DOI: 10.1111/cea.12669] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 09/02/2015] [Accepted: 09/28/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND The fractional exhaled nitric oxide (FENO) and the blood eosinophil count (B-eos) are markers of eosinophilic inflammation used in the diagnosis and management of asthma. The relationships between smoking cigarette and both FENO and B-eos are complex and raise questions about the association between these markers and asthma in smokers. OBJECTIVE To determine the relationships between both FENO and B-eos on one hand and asthma and atopy on the other, according to smoking status. METHODS FENO and B-eos were measured in, respectively, 1579 and 1496 of the 1607 middle-aged adults randomly selected from the general population in the cross-sectional ELISABET survey. Allergic asthma was defined as asthma (a self-report of physician-diagnosed asthma, and wheezing in the previous 12 months or the use of asthma medications) with atopy (allergic rhinitis or hayfever in the previous 12 months, or a previous positive prick test or allergen desensitization therapy). Non-allergic asthma was defined as asthma without atopy. RESULTS The analysis included 812 (51.4%) never, 473 (30%) former and 294 (18.6%) current smokers. A total of 490 (32%) participants were atopic, 80 (5.1%) had allergic asthma, and 31 (2%) had non-allergic asthma. Only 16.2% (18/111) of asthmatics were treated with glucocorticoid inhalants, suggesting that among them a majority of participants had mild asthma. A positive interaction between smoking status and allergic asthma was observed in multivariate models explaining FENO (P = 0.003) and B-eos (P = 0.001). Thus, compared to those without allergic asthma, participants with allergic asthma had higher FENO values (+ 63.4%, 95% CI = [39; 92]) and higher B-eos (+ 63.2% [38.2; 92.7]) in never and former smokers, but not in current smokers. Lastly, an analysis of receiver-operating characteristic curves showed that each of the two markers was able to discriminate moderately allergic asthma but only in non-smokers. CONCLUSIONS & CLINICAL RELEVANCE FENO and B-eos were associated with the presence of mild allergic asthma only in non-smokers, not in current smokers. These findings raise questions about the clinical value of FENO and B-eos in smokers.
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Affiliation(s)
- J Giovannelli
- Faculté de Médecine Henri Warembourg, University of Lille, Lille Cedex, France.,University Hospital of Lille, Lille, France.,Pasteur Institute of Lille, INSERM U1167 RID-AGE, Lille, France
| | - N Chérot-Kornobis
- Faculté de Médecine Henri Warembourg, University of Lille, Lille Cedex, France.,University Hospital of Lille, Lille, France
| | - S Hulo
- Faculté de Médecine Henri Warembourg, University of Lille, Lille Cedex, France.,University Hospital of Lille, Lille, France
| | - A Ciuchete
- Pasteur Institute of Lille, INSERM U1167 RID-AGE, Lille, France
| | - G Clément
- Faculté de Médecine Henri Warembourg, University of Lille, Lille Cedex, France.,Pasteur Institute of Lille, INSERM U1167 RID-AGE, Lille, France
| | - P Amouyel
- Faculté de Médecine Henri Warembourg, University of Lille, Lille Cedex, France.,University Hospital of Lille, Lille, France.,Pasteur Institute of Lille, INSERM U1167 RID-AGE, Lille, France
| | - R Matran
- Faculté de Médecine Henri Warembourg, University of Lille, Lille Cedex, France.,University Hospital of Lille, Lille, France
| | - L Dauchet
- Faculté de Médecine Henri Warembourg, University of Lille, Lille Cedex, France.,University Hospital of Lille, Lille, France.,Pasteur Institute of Lille, INSERM U1167 RID-AGE, Lille, France
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17
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Korevaar DA, Westerhof GA, Bel EH. Biomarkers for diagnosing asthma: a smoking gun? Clin Exp Allergy 2016; 46:516-8. [PMID: 27021117 DOI: 10.1111/cea.12707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- D A Korevaar
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - G A Westerhof
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - E H Bel
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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18
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Karrasch S, Linde K, Rücker G, Sommer H, Karsch-Völk M, Kleijnen J, Jörres RA, Schneider A. Accuracy of FENO for diagnosing asthma: a systematic review. Thorax 2016; 72:109-116. [PMID: 27388487 DOI: 10.1136/thoraxjnl-2016-208704] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/02/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND Measurement of FENO might substitute bronchial provocation for diagnosing asthma. We aimed to investigate the diagnostic accuracy of FENO measurement compared with established reference standard. METHODS Systematic review and diagnostic meta-analysis. Data sources were Medline, Embase and Scopus up to 29 November 2015. Sensitivity and specificity were estimated using a bivariate model. Additionally, summary receiver-operating characteristic curves were estimated. RESULTS 26 studies with 4518 participants (median 113) were included. Risk of bias was considered low for six of seven items in five studies and for five items in seven studies. The overall sensitivity in the meta-analysis was 0.65 (95% CI 0.58 to 0.72), the overall specificity 0.82 (0.76 to 0.86), the diagnostic OR 9.23 (6.55 to 13.01) and the area under the curve 0.80 (0.77 to 0.85). In meta-regression analyses, higher cut-off values were associated with increasing specificity (OR 1.46 per 10 ppb increase in cut-off) while there was no association with sensitivity. Sensitivities varied significantly within the different FENO devices, but not specificities. Neither prevalence, age, use of bronchoprovocation in >90% of participants or as exclusive reference standard test, nor risk of bias were significantly associated with diagnostic accuracy. CONCLUSIONS There appears to be a fair accuracy of FENO for making the diagnosis of asthma. The overall specificity was higher than sensitivity, which indicates a higher diagnostic potential for ruling in than for ruling out the diagnosis of asthma.
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Affiliation(s)
- Stefan Karrasch
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Institute of Epidemiology I, Helmholtz Zentrum München-German Research Center for Environmental Health, Munich, Germany.,Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Klaus Linde
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Gerta Rücker
- Institute for Medical Biometry and Statistics, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Harriet Sommer
- Institute for Medical Biometry and Statistics, Medical Center-University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marlies Karsch-Völk
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, Escrick, York, UK.,School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Antonius Schneider
- Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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19
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Harnan SE, Tappenden P, Essat M, Gomersall T, Minton J, Wong R, Pavord I, Everard M, Lawson R. Measurement of exhaled nitric oxide concentration in asthma: a systematic review and economic evaluation of NIOX MINO, NIOX VERO and NObreath. Health Technol Assess 2016; 19:1-330. [PMID: 26484874 DOI: 10.3310/hta19820] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND High fractions of exhaled nitric oxide (FeNO) in the breath of patients with symptoms of asthma are correlated with high levels of eosinophils and indicate that a patient is likely to respond to inhaled corticosteroids. This may have a role in the diagnosis and management of asthma. OBJECTIVE To assess the diagnostic accuracy, clinical effectiveness and cost-effectiveness of the hand-held electrochemical devices NIOX MINO(®) (Aerocrine, Solna, Sweden), NIOX VERO(®) (Aerocrine) and NObreath(®) (Bedfont Scientific, Maidstone, UK) for the diagnosis and management of asthma. DATA SOURCES Systematic searches were carried out between March 2013 and April 2013 from database inception. Databases searched included MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, Science Citation Index Expanded and Conference Proceedings Citation Index - Science. Trial registers such as ClinicalTrials.gov and the metaRegister of Controlled Trials were also searched in March 2013. All searches were updated in September 2013. REVIEW METHODS A rapid review was conducted to assess the equivalence of hand-held and chemiluminescent FeNO monitors. Systematic reviews of diagnostic accuracy and management efficacy were conducted. A systematic review of economic analyses was also conducted and two de novo health economic models were developed. All three reviews were undertaken according to robust high-quality methodology. RESULTS The rapid review (27 studies) found varying levels of agreement between monitors (Bland-Altman 95% limits of agreement up to ±10 parts per billion), with better agreement at lower FeNO values. Correlation was good (generally r > 0.9). The diagnostic accuracy review identified 22 studies in adults (all ages) and four in children. No studies used NObreath or NIOX VERO and seven used NIOX MINO. Estimates of diagnostic accuracy varied widely. FeNO used in combination with another test altered diagnostic accuracy only slightly. High levels of heterogeneity precluded meta-analysis. Limited observations included that FeNO may be more reliable and useful as a rule-in than as a rule-out test; lower cut-off values in children and in smokers may be appropriate; and FeNO may be less reliable in the elderly. The management review identified five randomised controlled trials in adults, one in pregnant asthmatics and seven in children. Despite clinical heterogeneity, exacerbation rates were lower in all studies but not generally statistically significantly so. Effects on inhaled corticosteroid (ICS) use were inconsistent, possibly because of differences in management protocols, differential effectiveness in adults and children and differences in population severity. One UK diagnostic model and one management model were identified. Aerocrine also submitted diagnostic and management models. All had significant limitations including short time horizons and the selective use of efficacy evidence. The de novo diagnostic model suggested that the expected difference in quality-adjusted life-year (QALY) gains between diagnostic options is likely to be very small. Airway hyper-responsiveness by methacholine challenge test is expected to produce the greatest QALY gain but with an expected incremental cost-effectiveness ratio (ICER) compared with FeNO (NObreath) in combination with bronchodilator reversibility of £1.125M per QALY gained. All remaining options are expected to be dominated. The de novo management model indicates that the ICER of guidelines plus FeNO monitoring using NObreath compared with guidelines alone in children is expected to be approximately £45,200 per QALY gained. Within the adult subgroup, FeNO monitoring using NObreath compared with guidelines alone is expected to have an ICER of approximately £2100 per QALY gained. The results are particularly sensitive to assumptions regarding changes in ICS use over time, the number of nurse visits for FeNO monitoring and duration of effect. CONCLUSIONS Limitations of the evidence base impose considerable uncertainty on all analyses. Equivalence of devices was assumed but not assured. Evidence for diagnosis is difficult to interpret in the context of inserting FeNO monitoring into a diagnostic pathway. Evidence for management is also inconclusive, but largely consistent with FeNO monitoring resulting in fewer exacerbations, with a small or zero reduction in ICS use in adults and a possible increased ICS use in children or patients with more severe asthma. It is unclear which specific management protocol is likely to be most effective. The economic analysis indicates that FeNO monitoring could have value in diagnostic and management settings. The diagnostic model indicates that FeNO monitoring plus bronchodilator reversibility dominates many other diagnostic tests. FeNO-guided management has the potential to be cost-effective, although this is largely dependent on the duration of effect. The conclusions drawn from both models require strong technical value judgements with respect to several aspects of the decision problem in which little or no empirical evidence exists. There are many potential directions for further work, including investigations into which management protocol is best and long-term follow-up in both diagnosis and management studies. STUDY REGISTRATION This study is registered as PROSPERO CRD42013004149. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Sue E Harnan
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Paul Tappenden
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Munira Essat
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Tim Gomersall
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Jon Minton
- Advanced Quantitative Methods Network (AQMEN), University of Glasgow, Glasgow, UK
| | - Ruth Wong
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Ian Pavord
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Mark Everard
- School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital, WA, Australia
| | - Rod Lawson
- Department of Respiratory Medicine, Royal Hallamshire Hospital, Sheffield, UK
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20
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Al-Shamkhi N, Alving K, Dahlen SE, Hedlin G, Middelveld R, Bjerg A, Ekerljung L, Olin AC, Sommar J, Forsberg B, Janson C, Malinovschi A. Important non-disease-related determinants of exhaled nitric oxide levels in mild asthma - results from the Swedish GA(2) LEN study. Clin Exp Allergy 2016; 46:1185-93. [PMID: 27138350 DOI: 10.1111/cea.12749] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 04/17/2016] [Accepted: 04/23/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Fractional exhaled nitric oxide (FeNO) has a potential clinical role in asthma management. Constitutive factors such as age, height and gender, as well as individual characteristics, such as IgE sensitization and smoking, affect the levels of FeNO in population-based studies. However, their effect on FeNO in subjects with asthma has been scarcely studied. OBJECTIVE To study the effects on FeNO of these commonly regarded determinants, as demonstrated in healthy subjects, as well as menarche age and parental smoking, in a population of asthmatics. MATERIAL AND METHODS Fractional exhaled nitric oxide was measured in 557 subjects with asthma from the Swedish GA(2) LEN study. Allergic sensitization was assessed by skin prick tests to most common aeroallergens. Upper airway comorbidities, smoking habits, smoking exposure during childhood and hormonal status (for women) were questionnaire-assessed. RESULTS Male gender (P < 0.001), greater height (P < 0.001) and sensitization to both perennial allergens and pollen (P < 0.001) are related to higher FeNO levels. Current smoking (P < 0.001) and having both parents smoking during childhood, vs. having neither (P < 0.001) or only one parent smoking (P = 0.002), are related to lower FeNO. Women with menarche between 9 and 11 years of age had lower FeNO than those with menarche between 12 and 14 years of age (P = 0.03) or 15 and 17 years of age (P = 0.003). CONCLUSIONS AND CLINICAL RELEVANCE Interpreting FeNO levels in clinical practice is complex, and constitutional determinants, as well as smoking and IgE sensitisation, are of importance in asthmatic subjects and should be accounted for when interpreting FeNO levels. Furthermore, menarche age and parental smoking during childhood and their effects on lowering FeNO deserve further studies.
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Affiliation(s)
- N Al-Shamkhi
- Department of Medical Sciences: Lung- allergy- and sleep research, Uppsala University, Uppsala, Sweden
| | - K Alving
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - S E Dahlen
- Experimental Asthma and Allergy Research Unit, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - G Hedlin
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - R Middelveld
- Experimental Asthma and Allergy Research Unit, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - A Bjerg
- Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
| | - L Ekerljung
- Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden
| | - A C Olin
- Section of Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - J Sommar
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, University of Umeå, Umeå, Sweden
| | - B Forsberg
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, University of Umeå, Umeå, Sweden
| | - C Janson
- Department of Medical Sciences: Lung- allergy- and sleep research, Uppsala University, Uppsala, Sweden
| | - A Malinovschi
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
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21
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Cavaleiro Rufo J, Madureira J, Oliveira Fernandes E, Moreira A. Volatile organic compounds in asthma diagnosis: a systematic review and meta-analysis. Allergy 2016; 71:175-88. [PMID: 26476125 DOI: 10.1111/all.12793] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2015] [Indexed: 01/01/2023]
Abstract
We aimed to assess the value and classification rate of exhaled volatile organic compounds (VOCs) in asthma diagnosis. A PRISMA-oriented systematic search for published studies regarding exhaled VOCs in asthma diagnosis was conducted based on predefined criteria. Studies presenting sensitivity and specificity values for the test were included in the meta-analysis. Pooled diagnosis odds ratios (DOR), area under the curve (AUC) and positive and negative likelihood ratios (LR) for exhaled VOC profiles were calculated; and publication bias, threshold effect and heterogeneity were estimated. Eighteen studies were selected for the qualitative analysis and six met the criteria for inclusion in the quantitative analysis. Mean (95% CI) pooled DOR, positive and negative LR were 49.3 (15.9-153.3), 5.86 (3.07-11.21) and 0.16 (0.10-0.26), respectively. The AUC value was 0.94. Only three of the 18 reviewed studies performed an external validation of the model using a different data set. The results from the revised studies suggest that exhaled VOCs are promising biomarkers for asthma diagnosis and that several compounds, mainly alkanes, may be significantly associated with asthma inflammation. However, there are still various constraints associated with standardization and externally validated studies are needed to introduce exhaled VOC profiling in a clinical scenario.
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Affiliation(s)
- J. Cavaleiro Rufo
- GEAC; INEGI - Institute of Science and Innovation in Mechanical Engineering and Industrial Management; Porto Portugal
- Faculty of Medicine of the University of Porto; Portugal & Centro Hospitalar São João E.P.E.; Porto Portugal
| | - J. Madureira
- GEAC; INEGI - Institute of Science and Innovation in Mechanical Engineering and Industrial Management; Porto Portugal
| | - E. Oliveira Fernandes
- GEAC; INEGI - Institute of Science and Innovation in Mechanical Engineering and Industrial Management; Porto Portugal
| | - A. Moreira
- Faculty of Medicine of the University of Porto; Portugal & Centro Hospitalar São João E.P.E.; Porto Portugal
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22
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Guo Z, Wang Y, Xing G, Wang X. Diagnostic accuracy of fractional exhaled nitric oxide in asthma: a systematic review and meta-analysis of prospective studies. J Asthma 2016; 53:404-12. [PMID: 26796787 DOI: 10.3109/02770903.2015.1101132] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Fractional exhaled nitric oxide (FeNO) has been proposed as a non-invasive measure of airway inflammation in asthma. However, its accuracy for the diagnosis of asthma in different populations is not completely clear. The aim of this study was to investigate the accuracy of FeNO measurement for the diagnosis of asthma through a systematic review and meta-analysis of prospective studies. METHODS A systematic search current to July 2014 was performed in Pubmed, EMBASE, Medline, the Cochrane databases, CNKI, Wanfang and Weipu to find relevant studies. All prospective studies on the use of FeNO for the diagnosis of asthma were included. RESULTS Twenty-five studies including 3983 subjects were analyzed. The pooled sensitivity, specificity and diagnostic odds ratio (DOR) for the entire population was 72% (95% CI, 70-74%), 78% (95% CI, 76-80%) and 15.92 (95% CI, 10.70-23.68), respectively. The area under the summary receiver operating characteristic (sROC) curves revealed a receiver-operating characteristic of 0.88. In subgroup analysis, the DOR for patients using corticosteroids, as well as those for steroid-naïve, non-smoking, smoking, chronic cough and allergic rhinitis patients were 4.47 (95% CI, 3.39-5.90), 21.40 (95% CI, 15.38-29.76), 19.84 (95% CI, 15.63-25.19), 5.41 (95% CI, 2.97-9.86), 35.36 (95% CI, 23.90-52.29), and 2.99 (95% CI, 0.85-10.45), respectively. CONCLUSION FeNO is accurate for the diagnosis of asthma in steroid-naive or non-smoking patients, particularly in chronic cough patients.
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Affiliation(s)
- Zhi Guo
- a Department of Pulmonary Diseases , Jinan Military General Hospital , Jinan , Shandong , China
| | - Ying Wang
- a Department of Pulmonary Diseases , Jinan Military General Hospital , Jinan , Shandong , China
| | - Guohong Xing
- a Department of Pulmonary Diseases , Jinan Military General Hospital , Jinan , Shandong , China
| | - Xin Wang
- a Department of Pulmonary Diseases , Jinan Military General Hospital , Jinan , Shandong , China
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Kobayashi Y, Asako M, Ooka H, Kanda A, Tomoda K, Yasuba H. Residual exhaled nitric oxide elevation in asthmatics is associated with eosinophilic chronic rhinosinusitis. J Asthma 2015; 52:1060-4. [PMID: 26288109 DOI: 10.3109/02770903.2015.1054404] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Eosinophilic chronic rhinosinusitis (ECRS) is as a subgroup of chronic rhinosinusitis (CRS) with nasal polyps. ECRS is a refractory disease closely related to bronchial asthma. Fractionated exhaled nitric oxide (FeNO) levels were reportedly elevated in some asthmatics with CRS after adequate treatment, suggesting that residual eosinophilic airway inflammation or ECRS might affect FeNO levels. METHODS To investigate the association between asthma with ECRS and FeNO levels, we examined FeNO levels in 133 asthmatics (99 with ECRS and 34 without ECRS) and 13 patients with ECRS without asthma. The severity of asthma was defined by the Global Initiative for Asthma guidelines and that of sinusitis was evaluated by the sinus CT score based on the Lund-Mackay scale. RESULTS AND CONCLUSIONS FeNO levels were elevated even in well-controlled asthmatics with ECRS, whereas asthmatics without ECRS and ECRS patients without asthma did not have high FeNO levels (>50 ppb). Although FeNO levels were not correlated with asthma severity, they were positively correlated with the sinus CT score. In asthmatics with ECRS, patients with higher FeNO levels had more severe ECRS and asthma. There is a possibility of having comorbid ECRS, particularly in asthmatics with high FeNO levels even after adequate treatment, including ICS, suggesting that asthma and ECRS may be closely associated as one airway disease with eosinophilic inflammation. Continual awareness of the coexistent ECRS is ideally recommended for asthmatics with high FeNO levels.
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Affiliation(s)
- Yoshiki Kobayashi
- a Department of Otolaryngology , Kansai Medical University , Osaka , Japan and.,b Department of Airway Medicine , Mitsubishi Kyoto Hospital , Kyoto , Japan
| | - Mikiya Asako
- a Department of Otolaryngology , Kansai Medical University , Osaka , Japan and
| | - Hisashi Ooka
- a Department of Otolaryngology , Kansai Medical University , Osaka , Japan and
| | - Akira Kanda
- a Department of Otolaryngology , Kansai Medical University , Osaka , Japan and
| | - Koichi Tomoda
- a Department of Otolaryngology , Kansai Medical University , Osaka , Japan and
| | - Hirotaka Yasuba
- b Department of Airway Medicine , Mitsubishi Kyoto Hospital , Kyoto , Japan
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Porsbjerg C, Sverrild A, Backer V. Combining the Mannitol Test and FeNO in the Assessment of Poorly Controlled Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:553-9. [PMID: 25824441 DOI: 10.1016/j.jaip.2015.02.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/01/2015] [Accepted: 02/11/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND International guidelines recommend up-titration of anti-inflammatory treatment in asthmatic patients with poor symptom control, but patients without eosinophilic airway inflammation are less likely to benefit from this. The mannitol bronchoprovocation test and fractional exhaled nitric oxide (FeNO) are increasingly used in the diagnostic assessment of asthma, but the utility of combining these tests has not been evaluated. AIM The aim of this study was to determine the value of combining FeNO and the mannitol test to assess patients with asthma referred for specialist assessment because of poor symptom control. METHODS All patients referred consecutively over a 12-month period for the assessment of asthma at the Respiratory Outpatient Clinic at Bispebjerg Hospital in Copenhagen were examined with bronchial provocation to mannitol, FeNO, and induced sputum. RESULTS Among asthmatic patients with partly controlled or uncontrolled symptoms according to Global Initiative for Asthma criteria, only 23% had sputum eosinophilia (eosinophils >2.99%). A positive mannitol test did not increase the likelihood of airway eosinophilia significantly (positive test: 32% vs negative test: 18%, P = .12). However, a positive mannitol test combined with a FeNO > 25 ppb indicated a high likelihood of airway eosinophilia (73%), compared with FeNO > 25 ppb and a negative mannitol test (29%) (P < .05). In contrast, in patients with FeNO < 25 ppb, a positive mannitol test was not associated with airway eosinophilia (sputum eosinophils > 2.99%: positive mannitol test: 0%, negative test: 11%, ns). CONCLUSION Combining the mannitol test and FeNO may aid in the differentiation between eosinophilic and noneosinophilic asthma in patients referred for specialist management because of poorly controlled asthma symptoms.
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Affiliation(s)
- Celeste Porsbjerg
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
| | - Asger Sverrild
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Vibeke Backer
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
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Different Patterns in Changes of Exhaled Breath Condensate pH and Exhaled Nitric Oxide After Ozone Exposure. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 834:39-47. [DOI: 10.1007/5584_2014_63] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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26
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Bjermer L, Alving K, Diamant Z, Magnussen H, Pavord I, Piacentini G, Price D, Roche N, Sastre J, Thomas M, Usmani O. Current evidence and future research needs for FeNO measurement in respiratory diseases. Respir Med 2014; 108:830-41. [PMID: 24636813 DOI: 10.1016/j.rmed.2014.02.005] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 01/12/2014] [Accepted: 02/08/2014] [Indexed: 12/18/2022]
Abstract
Although not yet widely implemented, fraction of exhaled nitric oxide (FeNO) has emerged in recent years as a potentially useful biomarker for the assessment of airway inflammation both in undiagnosed patients with non-specific respiratory symptoms and in those with established airway disease. Research to date essentially suggests that FeNO measurement facilitates the identification of patients exhibiting T-helper cell type 2 (Th2)-mediated airway inflammation, and effectively those in whom anti-inflammatory therapy, particularly inhaled corticosteroids (ICS), is beneficial. In some studies, FeNO-guided management of patients with established airway disease is associated with lower exacerbation rates, improvements in adherence to anti-inflammatory therapy, and the ability to predict risk of future exacerbations or decline in lung function. Despite these data, concerns regarding the applicability and utility of FeNO in clinical practice still remain. This article reviews the current evidence, both supportive and critical of FeNO measurement, in the diagnosis and management of asthma and other inflammatory airway diseases. It additionally provides suggestions regarding the practical application of FeNO measurement: how it could be integrated into routine clinical practice, how its utility could be assessed and its true value to both clinicians and patients could be established. Although some unanswered questions remain, current evidence suggests that FeNO is potentially a valuable tool for improving the personalised management of inflammatory airway diseases.
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Affiliation(s)
- Leif Bjermer
- Department of Respiratory Medicine and Allergology, Skane University Hospital, 22185 Lund, Sweden.
| | - Kjell Alving
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Zuzana Diamant
- Department of Respiratory Medicine and Allergology, Skane University Hospital, 22185 Lund, Sweden; Department of General Practice & QPS-NL, Groningen, The Netherlands
| | - Helgo Magnussen
- Pulmonary Research Institute at Lung Clinic Grosshansdorf, Germany
| | - Ian Pavord
- Department of Respiratory Medicine, Thoracic Surgery and Allergy, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Giorgio Piacentini
- Faculty of Medicine, University of Verona, Italy; Department of Paediatrics, Policlinico GB Rossi, Verona, Italy
| | | | - Nicolas Roche
- University Paris Descartes, Respiratory and Intensive Care Medicine Department, Cochin Hospital Group, Paris, France
| | - Joaquin Sastre
- Fundacion Jimenez Diaz, Allergy Service and CIBERES, Institute Carlos III, Madrid, Spain
| | | | - Omar Usmani
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
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Lehnert M, Hoffmeyer F, Gawrych K, Lotz A, Heinze E, Berresheim H, Merget R, Harth V, Van Gelder R, Hahn JU, Hartwig A, Weiß T, Pesch B, Brüning T. Effects of Exposure to Welding Fume on Lung Function: Results from the German WELDOX Study. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 834:1-13. [PMID: 25315619 DOI: 10.1007/5584_2014_65] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The association between exposure to welding fume and chronic obstructive pulmonary disease (COPD) has been insufficiently clarified. In this study we assessed the influence of exposure to welding fume on lung function parameters. We investigated forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, and expiratory flow rates in 219 welders. We measured current exposure to respirable particles and estimated a worker's lifetime exposure considering welding techniques, working conditions and protective measures at current and former workplaces. Multiple regression models were applied to estimate the influence of exposure to welding fume, age, and smoking on lung function. We additionally investigated the duration of working as a welder and the predominant welding technique. The findings were that age- and smoking-adjusted lung function parameters showed no decline with increasing duration, current exposure level, and lifetime exposure to welding fume. However, 15% of the welders had FEV1/FVC below the lower limit of normal, but we could not substantiate the presence of an association with the measures of exposure. Adverse effects of cigarette smoking were confirmed. In conclusion, the study did not support the notion of a possible detrimental effect of exposure to welding fume on lung function in welders.
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Affiliation(s)
- M Lehnert
- Institute of Prevention and Occupational Medicine, German Social Accident Insurance (IPA), Institute of the Ruhr-University Bochum, 1 Bürkle-de-la-Camp-Platz, 44789, Bochum, Germany,
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Elevated levels of exhaled nitric oxide in patients with anorexia nervosa. Eur Child Adolesc Psychiatry 2014; 23:845-50. [PMID: 24276672 PMCID: PMC4152618 DOI: 10.1007/s00787-013-0467-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 08/15/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND Nitric oxide (NO) is involved in eating behavior and inflammatory response. Moreover, there is evidence that NO production is altered in patients with anorexia nervosa (AN). AIM To assess whether the overproduction of NO in AN can affect NO level in exhaled air. MATERIALS AND METHODS Exhaled NO level was studied in 23 girls with AN and compared with that of healthy age- and gender-matched nonatopic controls. RESULTS Exhaled NO levels were significantly higher in girls with AN compared with healthy age-matched controls. CONCLUSIONS It appears that anorexia nervosa was accompanied by a higher level of exhaled NO, likely resulting from a systemic increase in NO production because of the severe catabolic state.
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Induced Sputum, Exhaled Nitric Oxide, and Particles in Exhaled Air in Assessing Airways Inflammation in Occupational Exposures. Clin Chest Med 2012; 33:771-82. [DOI: 10.1016/j.ccm.2012.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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