1
|
McLaughlin K, Jensen ME, Foureur M, Gibson P, Murphy VE. The acceptability and feasibility of implementing a Fractional exhaled Nitric Oxide (FeNO)-based asthma management strategy into antenatal care: The perspective of pregnant women with asthma. Midwifery 2020; 88:102757. [PMID: 32480322 DOI: 10.1016/j.midw.2020.102757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 04/14/2020] [Accepted: 05/13/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Karen McLaughlin
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre, Grow Up Well, Hunter Medical Research Centre, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
| | - Megan E Jensen
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre, Grow Up Well, Hunter Medical Research Centre, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
| | - Maralyn Foureur
- Hunter New England Nursing & Midwifery Research Centre, James Fletcher Campus, Watt St, Newcastle, NSW 2300, Australia; University of Newcastle, School of Nursing and Midwifery, University Drive, Callaghan, NSW 2308, Australia.
| | - Peter Gibson
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre, Grow Up Well, Hunter Medical Research Centre, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; Hunter New England Local Health District Dept. respiratory and Sleep medicine, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW 2305, Australia.
| | - Vanessa E Murphy
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW 2308, Australia; Priority Research Centre, Grow Up Well, Hunter Medical Research Centre, 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
| |
Collapse
|
2
|
Lodin K, Lekander M, Syk J, Alving K, Andreasson A. Associations between self-rated health, sickness behaviour and inflammatory markers in primary care patients with allergic asthma: a longitudinal study. NPJ Prim Care Respir Med 2017; 27:67. [PMID: 29255205 PMCID: PMC5735192 DOI: 10.1038/s41533-017-0068-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/17/2017] [Accepted: 11/23/2017] [Indexed: 01/02/2023] Open
Abstract
Allergic asthma is a chronic inflammatory disorder associated with elevated levels of immunoglobulin E (IgE), serum eosinophilic cationic protein (S-ECP), plasma eosinophil-derived neurotoxin (P-EDN) and fraction of exhaled nitric oxide (FENO). Poor self-rated health and sickness behaviour has repeatedly been associated with inflammatory markers, but the nature of this relationship in chronic inflammatory disease is not known. Likewise, such findings largely rely on cross-sectional investigations. Self-rated health (How would you rate your general state of health?), sickness behaviour (mean rating of satisfaction with energy, sleep, fitness, appetite and memory), IgE, S-ECP, P-EDN, and FENO were assessed in 181 non-smoking primary care patients with asthma in a 1-year longitudinal study. Associations between repeated measurements were calculated using mixed regression models and Spearman's correlations for change scores. Poor self-rated health was associated with high levels of seasonal IgE (p = 0.05) and food IgE (p = 0.04), but not total IgE or inflammatory markers. An increase over 1 year in perennial IgE was associated with a worsening of self-rated health (ρ = 0.16, p = 0.04). Poor self-rated health was associated with more pronounced sickness behaviour (p < 0.001), and a worsening in sickness behaviour was associated with a worsening of self-rated health over time (ρ = 0.21, p = 0.007). The study corroborates the importance of sickness behaviour as a determinant of self-rated health by showing that these factors co-vary over a 1-year period in a group of patients with allergic asthma. The importance of specific IgE for perceived health in primary care patients with mild to moderate asthma needs further investigation.
Collapse
Affiliation(s)
- Karin Lodin
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
| | - Mats Lekander
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Jörgen Syk
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Centre for Allergy Research, Karolinska Institute, Stockholm, Sweden
- Academic Primary Health Care Centre, Stockholm, Sweden
| | - Kjell Alving
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Andreasson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
- Department of Psychology, Macquarie University, North Ryde, Australia
| |
Collapse
|
3
|
Kavitha V, Mohan A, Madan K, Hadda V, Khilnani GC, Guleria R. Fractional exhaled nitric oxide is a useful adjunctive modality for monitoring bronchial asthma. Lung India 2017; 34:132-137. [PMID: 28360460 PMCID: PMC5351354 DOI: 10.4103/0970-2113.201322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and Objective: To evaluate the utility of fractional exhaled nitric oxide (FeNO) in monitoring asthma control. Materials and Methods: Steroid naïve nonsmoking asthmatics were recruited and followed for 6–8 weeks on standard treatment. Serial measurements of FeNO, peak expiratory flow rate (PEFR) variability, forced expiratory volume in 1 s (FEV1), bronchodilator reversibility (BDR), and asthma control test (ACT) score were measured at baseline and after 6–8 weeks of treatment. Results: One hundred and fifty-one patients were recruited over an 18-month period. These comprised 79 males (52.3%) with mean (standard deviation) age of 34.2 (11.6). Mean (SD) FeNO levels at baseline and after therapy were 45.4 (35.9) and 38.4 (23.7) ppb, respectively (P = 0.01). Baseline FeNO correlated strongly with FEV1 (r = −0.78, P < 0.001), ACT score (r = −0.76, P < 0.001), PEFR variability (r = −0.74, P < 0.001), and moderately with BDR (r = 0.50, P < 0.001). After treatment with inhaled steroids, the correlation remained strong with ACT score (r = −0.68, P < 0.001) but weakened with PEFR variability (r = −0.34, P = 0.01) and FEV1 (r = −0.36, P = 0.01). Conclusions: FeNO may be useful as an adjunctive noninvasive modality to assess asthma control in both steroid naïve asthmatics and asthmatics on treatment. However, the suboptimal sensitivity and specificity may limit its utility as a point-of-care single monitoring tool.
Collapse
Affiliation(s)
- Venkatnarayan Kavitha
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - G C Khilnani
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
4
|
Thorhallsdottir AK, Gislason D, Malinovschi A, Clausen M, Gislason T, Janson C, Benediktsdottir B. Exhaled nitric oxide in a middle-aged Icelandic population cohort. J Breath Res 2016; 10:046015. [PMID: 27902492 DOI: 10.1088/1752-7155/10/4/046015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The prevalence of atopy and asthma is relatively low in Iceland. The purpose of this study was to describe exhaled nitric oxide (FeNO) levels in the general population in correlation with demographic characteristics, smoking status, asthma, rhinitis, atopic status and lung function tests. Altogether 403 subjects, from the European Community Respiratory Health Survey (ECRHS) III who answered the main questionnaire and were checked by FeNO measurements, lung function testing, skin prick testing and measurement of total IgE and specific IgE were included. The geometric mean (95% CI) of FeNO was 16.2 ppb (15.2-17.1) and the prevalence of higher FeNO (⩾25 ppb) was 19.5% in the random sample. Subjects with higher FeNO levels were less likely to be current smokers and more likely to have asthma and rhinitis. Having higher FeNO values was also associated with higher total IgE, having specific IgE to at least one allergen and being skin prick test positive. Current smokers had significantly lower levels of FeNO, geometric mean (95% CI) 9.6 ppb (8.4-11.0), than ex-smokers 18.2 ppb (16.6-20.0) and never smokers 17.3 ppb (16.1-18.5). In multivariable models, having asthma (OR (95% CI) 2.10 (1.20-3.67)), having a specific IgE (OR 2.30 (1.25-4.23)) and being skin prick test positive (OR 2.06 (1.18-3.60)) were independently positively associated with a higher FeNO (⩾25) whereas current smoking was independently negatively associated with a higher FeNO (OR 0.19 (0.06-0.63)). Higher levels of FeNO (⩾25 ppb) were found in one out of five Icelanders; FeNO was positively associated with asthma and allergy and negatively with smoking.
Collapse
Affiliation(s)
- Anna Kristin Thorhallsdottir
- Primary Health Care Centre, Gardabaer, Iceland. Department of Respiratory Medicine and Sleep, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland. Author to whom any correspondence should be addressed. Primary Health Care Centre, Gardabaer, Iceland
| | | | | | | | | | | | | |
Collapse
|
5
|
Simultaneously increased fraction of exhaled nitric oxide levels and blood eosinophil counts relate to increased asthma morbidity. J Allergy Clin Immunol 2016; 138:1301-1308.e2. [PMID: 27113848 DOI: 10.1016/j.jaci.2016.01.044] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 01/18/2016] [Accepted: 01/26/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND We have previously described that fraction of exhaled nitric oxide (Feno) levels and blood eosinophil counts offer additive information in relation to asthma and asthma exacerbations when analyzing data from a large population study. OBJECTIVE We sought to investigate increased Feno levels and blood eosinophil counts in relation to lung function, bronchial hyperresponsiveness (BHR), and asthma control in a cohort of young asthmatic patients. METHODS Measurements of Feno levels and blood eosinophil counts were available in 406 subjects (208 women) aged 10 to 35 years. Asthma control was assessed through the Asthma Control Test. Moderate-to-severe BHR was defined as a cumulative dose of methacholine of less than 0.3 mg causing an FEV1 decrease of 20%. RESULTS Subjects with simultaneously increased Feno levels (≥20-25 ppb) and blood eosinophil counts (≥0.3 × 109/L) had a higher prevalence of uncontrolled asthma (Asthma Control Test score, <20) than subjects with singly increased blood eosinophil counts (40.5% vs 21.1%, P = .01). This difference remained significant (P = .006), and a significant difference was also found between subjects with both increased Feno levels and blood eosinophil counts and subjects with normal Feno levels and blood eosinophil counts (P = .02) after adjusting for confounders. Having increased Feno levels and blood eosinophil counts related to a higher prevalence of moderate-to-severe BHR than having normal Feno levels and blood eosinophil counts or singly increased Feno levels or blood eosinophil counts (85.7% vs 35.8% or 63.3% or 60%, P < .05 all comparisons). CONCLUSION We have shown that simultaneously increased local (Feno) and systemic (blood eosinophil) markers of type 2 inflammation related to a higher likelihood of BHR and uncontrolled asthma in a large cohort of young asthmatic patients.
Collapse
|
6
|
Jacinto T, Alving K, Correia R, Costa-Pereira A, Fonseca J. Setting reference values for exhaled nitric oxide: a systematic review. CLINICAL RESPIRATORY JOURNAL 2016; 7:113-20. [PMID: 22789005 DOI: 10.1111/j.1752-699x.2012.00309.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The values obtained when the fraction of exhaled nitric oxide (FeNO) is measured are affected by several factors that are specific to the individual patient, making interpretation difficult, especially in the initial assessment of patients with respiratory symptoms. METHODS Systematic review of studies on FeNO reference values and individual-specific factors that influence them. RESULTS From 3739 references, 15 studies were included. Four studies included children and adolescents. In nine studies, samples were selected from the general population. Most studies reported objective measures for atopy (nine studies), but not for smoking status (one). Significant determinants of FeNO values reported were age and height (seven studies), atopy (six), smoking (four), weight (four), sex (three) and race (three). Additional factors were included in eight studies. R2 was reported in only five studies. The logarithmic transformation of FeNO was inadequately described in seven studies. CONCLUSION There are several equations for FeNO reference values that may be used in clinical practice, although the factors they include and the statistical methods they use vary considerably. We recommend the development of standard methods for the evaluation of normal FeNO data and that reference equations should be formulated based on a predetermined physiological model.
Collapse
Affiliation(s)
- Tiago Jacinto
- CINTESIS – Center for Research in Health Technologies and Information Systems, Faculty of Medicine, University of Porto, Porto, Portugal.
| | | | | | | | | |
Collapse
|
7
|
Yao TC, Tsai HJ, Tu YL, Chang SW, Hua MC, Liao SL, Tsai MH, Chiu CY, Lai SH, Yeh KW, Huang JL. Multiplexed immunoglobulin E sensitization in relation to exhaled nitric oxide in a population sample of children. Allergy 2014; 69:678-82. [PMID: 24576320 DOI: 10.1111/all.12378] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2014] [Indexed: 11/28/2022]
Abstract
This study investigated the relationship between the specific immunoglobulin E (IgE) profile for 40 allergens using a novel microarray technique (BioIC) and fraction of exhaled nitric oxide (FeNO) in a population sample of 1321 children. Significant positive associations were found between FeNO and sensitization to mites (P < 0.001), animals (P = 0.001), cockroaches (P < 0.001), and foods (P = 0.042), and furthermore, between FeNO and the number of sensitizations (all P < 0.05) or the sum of specific IgE (all P ≤ 0.01) against the aforementioned allergen categories. Specifically, sensitization to the following allergens was significantly related to higher FeNO: Dermatophagoides pteronyssinus, Dermatophagoides farina, Blomia tropicalis, cat, German cockroach, Oriental cockroach, codfish, crab, shrimp, and cheese (all P ≤ 0.01). In conclusion, IgE sensitization to mites, pets, cockroaches, seafood, and cheese, respectively, is significantly associated with elevated FeNO levels in a dose-dependent fashion in children. Our results provide new evidence that sensitization to certain food allergens may contribute to prompt inflammation in the airways.
Collapse
Affiliation(s)
- T.-C. Yao
- Division of Allergy, Asthma, and Rheumatology; Department of Pediatrics; Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Taoyuan Taiwan
- Community Medicine Research Center; Chang Gung Memorial Hospital at Keelung; Keelung Taiwan
| | - H.-J. Tsai
- Division of Biostatistics and Bioinformatics; Institutes of Population Health Sciences; National Health Research Institutes; Miaoli Taiwan
- Department of Pediatrics; Feinberg School of Medicine; Northwestern University; Chicago IL USA
- Department of Genome Medicine; Kaohsiung University; Kaohsiung Taiwan
| | - Y.-L. Tu
- Division of Allergy, Asthma, and Rheumatology; Department of Pediatrics; Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Taoyuan Taiwan
- Community Medicine Research Center; Chang Gung Memorial Hospital at Keelung; Keelung Taiwan
- Graduate Institute of Clinical Medical Sciences; Chang Gung University College of Medicine; Taoyuan Taiwan
| | - S.-W. Chang
- Clinical Informatics and Medical Statistics Research Center; Chang Gung University College of Medicine; Taoyuan Taiwan
| | - M.-C. Hua
- Community Medicine Research Center; Chang Gung Memorial Hospital at Keelung; Keelung Taiwan
- Department of Pediatrics; Chang Gung Memorial Hospital at Keelung; Keelung Taiwan
| | - S.-L. Liao
- Community Medicine Research Center; Chang Gung Memorial Hospital at Keelung; Keelung Taiwan
- Department of Pediatrics; Chang Gung Memorial Hospital at Keelung; Keelung Taiwan
| | - M.-H. Tsai
- Community Medicine Research Center; Chang Gung Memorial Hospital at Keelung; Keelung Taiwan
- Department of Pediatrics; Chang Gung Memorial Hospital at Keelung; Keelung Taiwan
| | - C.-Y. Chiu
- Community Medicine Research Center; Chang Gung Memorial Hospital at Keelung; Keelung Taiwan
- Department of Pediatrics; Chang Gung Memorial Hospital at Keelung; Keelung Taiwan
| | - S.-H. Lai
- Community Medicine Research Center; Chang Gung Memorial Hospital at Keelung; Keelung Taiwan
- Division of Pediatric Pulmonology; Department of Pediatrics; Chang Gung Memorial Hospital; Taoyuan Taiwan
| | - K.-W. Yeh
- Division of Allergy, Asthma, and Rheumatology; Department of Pediatrics; Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Taoyuan Taiwan
- Community Medicine Research Center; Chang Gung Memorial Hospital at Keelung; Keelung Taiwan
| | - J.-L. Huang
- Division of Allergy, Asthma, and Rheumatology; Department of Pediatrics; Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Taoyuan Taiwan
- Community Medicine Research Center; Chang Gung Memorial Hospital at Keelung; Keelung Taiwan
| | | |
Collapse
|
8
|
Patelis A, Janson C, Borres MP, Nordvall L, Alving K, Malinovschi A. Aeroallergen and food IgE sensitization and local and systemic inflammation in asthma. Allergy 2014; 69:380-7. [PMID: 24397423 DOI: 10.1111/all.12345] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND We recently reported an independent association between IgE sensitization to food allergens and increased airway inflammation, assessed by fraction of exhaled nitric oxide (FeNO), in a population-based study (J Allergy Clin Immunol, 130, 2012, 397). Similar studies have not been performed in populations with asthma. The aim of the present study was to investigate the allergic sensitization profile in asthmatics and examine FeNO, airway responsiveness and blood eosinophilia in relation to type and degree of IgE sensitization. METHOD FeNO, airway responsiveness, blood eosinophil count (B-Eos) and IgE sensitization to food allergens and aeroallergens were determined in 408 subjects with asthma, aged 10-34 years. RESULTS Asthmatics had higher prevalence of IgE sensitization against all allergens than controls (P < 0.001). Mite, pollen, furry animal, mould and food sensitizations were each associated with increased FeNO, airway responsiveness and B-Eos in asthmatics. IgE sensitization to mould, furry animals and food allergens was independently related to FeNO (all P < 0.05) after adjustment for age, sex, height, smoking history and medication. IgE sensitization to mould (P < 0.001) and furry animals (P = 0.02) was related to airway responsiveness in a similar model. Finally, IgE sensitization to mould (P = 0.001), furry animals (P < 0.001) and food allergens (P < 0.001) was independently related to B-Eos. CONCLUSION Independent effects of IgE sensitization to aeroallergens (furry animals and mould) and food allergens were found on both local and systemic markers of inflammation in asthma. The finding regarding food IgE sensitization is novel, and a clinical implication might be that even food sensitization must be assessed to fully understand inflammation patterns in asthma.
Collapse
Affiliation(s)
- A. Patelis
- Department of Medical Sciences, Respiratory Medicine & Allergology; Uppsala University; Uppsala Sweden
| | - C. Janson
- Department of Medical Sciences, Respiratory Medicine & Allergology; Uppsala University; Uppsala Sweden
| | - M. P. Borres
- Immunodiagnostics; Thermo Fischer Scientific; Uppsala Sweden
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - L. Nordvall
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - K. Alving
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - A. Malinovschi
- Department of Medical Sciences, Clinical Physiology; Uppsala University; Uppsala Sweden
| |
Collapse
|
9
|
Anti-inflammatory treatment of atopic asthma guided by exhaled nitric oxide: a randomized, controlled trial. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2013; 1:639-48.e1-8. [PMID: 24565712 DOI: 10.1016/j.jaip.2013.07.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 06/24/2013] [Accepted: 07/30/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Atopic asthma is characterized by Th2 cytokine-driven inflammation of the airway mucosa, which is signaled by the fraction of exhaled nitric oxide (FENO). OBJECTIVE We tested whether an FENO-guided anti-inflammatory treatment algorithm could improve asthma-related quality of life and asthma symptom control, and reduce exacerbations in atopic asthmatics within primary care. METHODS Altogether, 187 patients with asthma and who were nonsmokers (age range, 18-64 years) with perennial allergy and who were on regular inhaled corticosteroid treatment were recruited at 17 primary health care centers, randomly assigned to 2 groups and followed up for 1 year. For the controls (n = 88), FENO measurement was blinded to both operator and patient, and anti-inflammatory treatment was adjusted according to usual care. In the active group (n = 93), treatment was adjusted according to FENO. Questionnaires on asthma-related quality of life (Mini Asthma Quality of Life Questionnaire) and asthma control (Asthma Control Questionnaire) were completed, and asthma events were noted. RESULTS The Asthma Control Questionnaire score change over 1 year improved significantly more in the FENO-guided group (-0.17 [interquartile range {IQR}, -0.67 to 0.17] vs 0 [-0.33 to 0.50]; P = .045), whereas the Mini Asthma Quality of Life Questionnaire score did not (0.23 [IQR, 0.07-0.73] vs 0.07 [IQR, -0.20 to 0.80]; P = .197). The change in Asthma Control Questionnaire was clinically important in subpopulations with poor control at baseline (P = .03). Furthermore, the exacerbation rate (exacerbations/patient/y) was reduced by almost 50% in the FENO-guided group (0.22 [CI, 0.14-0.34] vs 0.41 [CI, 0.29-0.58]; P = .024). Mean overall inhaled corticosteroid use was similar in both groups (P = .95). CONCLUSION Use of FENO to guide anti-inflammatory treatment within primary care significantly reduced the exacerbation rate and improved asthma symptom control without increasing overall inhaled corticosteroid use.
Collapse
|
10
|
Ludviksdottir D, Diamant Z, Alving K, Bjermer L, Malinovschi A. Clinical aspects of using exhaled NO in asthma diagnosis and management. CLINICAL RESPIRATORY JOURNAL 2012; 6:193-207. [DOI: 10.1111/crj.12001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | | | - Kjell Alving
- Department of Women's and Children's Health; Uppsala University; Uppsala; Sweden
| | - Leif Bjermer
- Department of Respiratory Diseases and Allergology; Skane University; Lund; Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences: Clinical Physiology; Uppsala University; Uppsala; Sweden
| |
Collapse
|
11
|
Patelis A, Gunnbjörnsdottir M, Malinovschi A, Matsson P, Onell A, Högman M, Alving K, Janson C. Population-based study of multiplexed IgE sensitization in relation to asthma, exhaled nitric oxide, and bronchial responsiveness. J Allergy Clin Immunol 2012; 130:397-402.e2. [PMID: 22633327 DOI: 10.1016/j.jaci.2012.03.046] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 03/21/2012] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND IgE sensitization is an important risk factor for the development of asthma. OBJECTIVE The aim of this study was to investigate the IgE antibody profile for a broad spectrum of allergen molecules in asthmatic patients. METHODS Participants from the European Community Respiratory Health Survey II (n=467) were tested with ImmunoCAP ISAC against 103 allergen molecules. The presence of bronchial hyperresponsiveness was measured with a methacholine challenge test and bronchial inflammation with fraction of exhaled nitric oxide (Feno). RESULTS A total of 38% of the controls and 72% of the asthmatic patients were sensitized against at least 1 of the allergen components (P<.0001). Asthma was independently related to having IgE antibodies against pollen (odds ratio=2.2) and perennial airway allergens (odds ratio=5.6), increased Feno was independently related to having IgE antibodies against food allergens and perennial allergens, while bronchial responsiveness was independently associated with having IgE antibodies against only perennial allergens. Sensitization to food allergens was related to asthma and increased Feno if IgE antibody against pollen allergens was present. Simultaneous sensitization to perennial, pollen, and food allergens involves the highest risk of asthma (odds ratio=18.3), bronchial inflammation, and responsiveness. CONCLUSIONS Feno, bronchial responsiveness, and the risk of asthma increase with multiple sensitizations to different allergen groups. We show for the first time that the presence of IgE antibodies against food allergens is independently associated with increased Feno and increases the risk of asthma in subjects with simultaneous sensitization to pollen allergens.
Collapse
Affiliation(s)
- Antonios Patelis
- Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Comparison of online single-breath vs. online multiple-breath exhaled nitric oxide in school-age children. Pediatr Res 2012; 71:605-11. [PMID: 22322384 DOI: 10.1038/pr.2012.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Standards for online multiple-breath (mb) exhaled nitric oxide (eNO) measurements and studies comparing them with online single-breath (sb) eNO measurements are lacking, although eNOmb requires less cooperation in children at school age or younger. METHODS Online eNOmb and eNOsb were measured in 99 healthy children and (in order to observe higher values) in 21 children with suspected asthma at a median age of 6.1 and 11.7 y, respectively. For eNOmb, we aimed for 20 tidal breathing maneuvers; eNOsb was measured according to standards. The two techniques were compared by standard methods after computing NO output or extrapolating eNOmb to the standard flow of 50 ml/s (eNOmb(50)). RESULTS Measurements were acceptable in 82 (eNOmb) and 81 (eNOsb) children. Paired data were available for 65 children. On a log-log scale, eNOmb(50) (geometric mean ± SD 13.1 ± 15.5 parts per billion, ppb) was correlated with eNOsb (12.5 ± 15.8 ppb), with r(2) = 0.87. The mean difference between eNOsb and eNOmb(50) was -0.7 ppb, with limits of agreement (LOAs) of 4.0 and -5.3 ppb. DISCUSSION Despite its correlation with eNOsb, the LOA range hampers eNOmb use in research, where exact values across the whole range are warranted. However, eNOmb might be an alternative tool especially at preschool age, when cooperation during measurements is crucial.
Collapse
|
13
|
Duvoix A, Miranda E, Perez J, Sorensen GL, Holmskov U, Trapnell BC, Madsen J, Clark HW, Edwards LD, Miller BE, Tal-Singer RM, Lomas DA. Evaluation of Full-length, Cleaved and Nitrosylated Serum Surfactant Protein D as Biomarkers for COPD. COPD 2011; 8:79-95. [DOI: 10.3109/15412555.2011.558542] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
14
|
Zeiger RS, Schatz M, Zhang F, Crawford WW, Kaplan MS, Roth RM, Chen W. Association of exhaled nitric oxide to asthma burden in asthmatics on inhaled corticosteroids. J Asthma 2010; 48:8-17. [PMID: 21155706 DOI: 10.3109/02770903.2010.539295] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Fractional exhaled nitric oxide (FENO) is a marker of airway inflammation. Its role in assessing asthma burden in clinical practice needs more study. OBJECTIVE To determine whether higher FENO levels are associated with greater asthma burden. METHODS This was a multicenter cross-sectional retrospective study of atopic 12- to 56-year-old persistent asthmatics on inhaled corticosteroids (ICS). Questionnaire and 1-year retrospective administrative data were used to analyze by unadjusted and adjusted robust Poisson regression (relative risks) and negative binomial regression [incidence rate ratios (IRRs)] the associations of masked FENO levels (NIOX MINO®) to short-acting beta-agonist (SABA) dispensings and oral corticosteroid (OCS) use in the past year independent of spirometry and an asthma control tool [Asthma Control Test (ACT)]. RESULTS FENO levels ranged from 7-215 ppb (median 28 ppb) in 325 patients. Higher FENO levels significantly correlated with more SABA dispensings and OCS courses in the past year, lower FEV(1)% predicted levels, but not ACT score. FENO highest (≥48 ppb) versus lowest (≤19 ppb) quartile values were associated independently in the past year with ≥7 SABA canisters dispensed (relative risk=2.40, 95% CI=1.25-4.62) and total number of SABA canisters dispensed (IRR=1.46, 95% CI=1.12-1.99) and with ≥1 OCS course (relative risk=1.48, 95% CI=1.06-2.07) and total number of OCS courses (IRR=1.71, 95% CI=1.09-2.66). The significant independent relationship of higher FENO levels to increasing SABA dispensings and OCS courses was confirmed by linear trend analyses. CONCLUSIONS Independent and clinically meaningful associations between higher FENO levels and greater asthma burden during a prior year in persistent asthmatics on ICS suggest that FENO measurement may be a complementary tool to help clinicians assess asthma burden.
Collapse
Affiliation(s)
- Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Harbor City, Los Angeles and Orange County, CA, USA.
| | | | | | | | | | | | | |
Collapse
|