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Anand A, Castiglia E, Zamora ML. The Association Between Personal Air Pollution Exposures and Fractional Exhaled Nitric Oxide (FeNO): A Systematic Review. Curr Environ Health Rep 2024; 11:210-224. [PMID: 38386269 PMCID: PMC11180488 DOI: 10.1007/s40572-024-00430-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE OF REVIEW Airway inflammation is a common biological response to many types of environmental exposures and can lead to increased nitric oxide (NO) concentrations in exhaled breath. In recent years, several studies have evaluated airway inflammation using fractional exhaled nitric oxide (FeNO) as a biomarker of exposures to a range of air pollutants. This systematic review aims to summarize the studies that collected personal-level air pollution data to assess the air pollution-induced FeNO responses and to determine if utilizing personal-level data resulted in an improved characterization of the relationship between air pollution exposures and FeNO compared to using only ambient air pollution exposure data. RECENT FINDINGS Thirty-six eligible studies were identified. Overall, the studies included in this review establish that an increase in personal exposure to particulate and gaseous air pollutants can significantly increase FeNO. Nine out of the 12 studies reported statistically significant FeNO increases with increasing personal PM2.5 exposures, and up to 11.5% increase in FeNO per IQR increase in exposure has also been reported between FeNO and exposure to gas-phase pollutants, such as ozone, NO2, and benzene. Furthermore, factors such as chronic respiratory diseases, allergies, and medication use were found to be effect modifiers for air pollution-induced FeNO responses. About half of the studies that compared the effect estimates using both personal and ambient air pollution exposure methods reported that only personal exposure yielded significant associations with FeNO response. The evidence from the reviewed studies confirms that FeNO is a sensitive biomarker for air pollutant-induced airway inflammation. Personal air pollution exposure assessment is recommended to accurately assess the air pollution-induced FeNO responses. Furthermore, comprehensive adjustments for the potential confounding factors including the personal exposures of the co-pollutants, respiratory disease status, allergy status, and usage of medications for asthma and allergies are recommended while assessing the air pollution-induced FeNO responses.
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Affiliation(s)
- Abhay Anand
- Department of Public Health Sciences, UConn School of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA
| | - Elliana Castiglia
- Department of Public Health Sciences, UConn School of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA
| | - Misti Levy Zamora
- Department of Public Health Sciences, UConn School of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA.
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Lelieveld S, Lelieveld J, Mishra A, Daiber A, Pozzer A, Pöschl U, Berkemeier T. Endogenous Nitric Oxide Can Enhance Oxidative Stress Caused by Air Pollutants and Explain Higher Susceptibility of Individuals with Inflammatory Disorders. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:1823-1831. [PMID: 38235527 PMCID: PMC10832043 DOI: 10.1021/acs.est.3c07010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/22/2023] [Accepted: 01/07/2024] [Indexed: 01/19/2024]
Abstract
Air pollution causes morbidity and excess mortality. In the epithelial lining fluid of the respiratory tract, air pollutants trigger a chemical reaction sequence that causes the formation of noxious hydroxyl radicals that drive oxidative stress. For hitherto unknown reasons, individuals with pre-existing inflammatory disorders are particularly susceptible to air pollution. Through detailed multiphase chemical kinetic analysis, we show that the commonly elevated concentrations of endogenous nitric oxide in diseased individuals can increase the production of hydroxyl radicals via peroxynitrite formation. Our findings offer a molecular rationale of how adverse health effects and oxidative stress caused by air pollutants may be exacerbated by inflammatory disorders.
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Affiliation(s)
- Steven Lelieveld
- Multiphase
Chemistry Department, Max Planck Institute
for Chemistry, Mainz 55128, Germany
| | - Jos Lelieveld
- Atmospheric
Chemistry Department, Max Planck Institute
for Chemistry, Mainz 55128, Germany
- Climate and Atmosphere
Research Center, the Cyprus Institute, Nicosia 2121, Cyprus
| | - Ashmi Mishra
- Multiphase
Chemistry Department, Max Planck Institute
for Chemistry, Mainz 55128, Germany
| | - Andreas Daiber
- Department
of Cardiology, University Medical Center
of the Johannes Gutenberg University, Mainz 55131, Germany
- German
Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz 55131, Germany
| | - Andrea Pozzer
- Atmospheric
Chemistry Department, Max Planck Institute
for Chemistry, Mainz 55128, Germany
- Climate and Atmosphere
Research Center, the Cyprus Institute, Nicosia 2121, Cyprus
| | - Ulrich Pöschl
- Multiphase
Chemistry Department, Max Planck Institute
for Chemistry, Mainz 55128, Germany
| | - Thomas Berkemeier
- Multiphase
Chemistry Department, Max Planck Institute
for Chemistry, Mainz 55128, Germany
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3
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Murugesan N, Saxena D, Dileep A, Adrish M, Hanania NA. Update on the Role of FeNO in Asthma Management. Diagnostics (Basel) 2023; 13:diagnostics13081428. [PMID: 37189529 DOI: 10.3390/diagnostics13081428] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
Asthma is a heterogenous disorder characterized by presence of different phenotypes and endotypes. Up to 10% of the individuals suffer from severe asthma and are at increased risk of morbidity and mortality. Fractional exhaled nitric oxide (FeNO) is a cost-effective, point of care biomarker that is used to detect type 2 airway inflammation. Guidelines have proposed to measure FeNO as an adjunct to diagnostic evaluation in individuals with suspected asthma and to monitor airway inflammation. FeNO has lower sensitivity, suggesting that it may not be a good biomarker to rule out asthma. FeNO may also be used to predict response to inhaled corticosteroids, predict adherence and deciding on biologic therapy. Higher levels of FeNO have been associated with lower lung function and increased risk for future asthma exacerbations and its predictive value increases when combined with other standard measurements of asthma assessment.
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Affiliation(s)
- Neveda Murugesan
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Damini Saxena
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Arundhati Dileep
- Division of Pulmonary & Critical Care Medicine, Bronx Care Health System, Bronx, NY 10457, USA
| | - Muhammad Adrish
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Nicola A Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX 77030, USA
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4
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Weng J, Molshatzki N, Marjoram P, Gauderman WJ, Gilliland FD, Eckel SP. Longitudinal hierarchical Bayesian models of covariate effects on airway and alveolar nitric oxide. Sci Rep 2023; 13:5346. [PMID: 37005426 PMCID: PMC10067946 DOI: 10.1038/s41598-023-31774-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 03/16/2023] [Indexed: 04/04/2023] Open
Abstract
Biomarkers such as exhaled nitric oxide (FeNO), a marker of airway inflammation, have applications in the study of chronic respiratory disease where longitudinal studies of within-participant changes in the biomarker are particularly relevant. A cutting-edge approach to assessing FeNO, called multiple flow FeNO, repeatedly assesses FeNO across a range of expiratory flow rates at a single visit and combines these data with a deterministic model of lower respiratory tract NO to estimate parameters quantifying airway wall and alveolar NO sources. Previous methodological work for multiple flow FeNO has focused on methods for data from a single participant or from cross-sectional studies. Performance of existing ad hoc two-stage methods for longitudinal multiple flow FeNO in cohort or panel studies has not been evaluated. In this paper, we present a novel longitudinal extension to a unified hierarchical Bayesian (L_U_HB) model relating longitudinally assessed multiple flow FeNO to covariates. In several simulation study scenarios, we compare the L_U_HB method to other unified and two-stage frequentist methods. In general, L_U_HB produced unbiased estimates, had good power, and its performance was not sensitive to the magnitude of the association with a covariate and correlations between NO parameters. In an application relating height to longitudinal multiple flow FeNO in schoolchildren without asthma, unified analysis methods estimated positive, statistically significant associations of height with airway and alveolar NO concentrations and negative associations with airway wall diffusivity while estimates from two-stage methods were smaller in magnitude and sometimes non-significant.
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Affiliation(s)
- Jingying Weng
- Department of Population and Public Health Sciences, University of Southern California, 2001 N. Soto Street, SSB 202B, MC-9234, Los Angeles, CA, 90089, USA
| | - Noa Molshatzki
- Department of Population and Public Health Sciences, University of Southern California, 2001 N. Soto Street, SSB 202B, MC-9234, Los Angeles, CA, 90089, USA
| | - Paul Marjoram
- Department of Population and Public Health Sciences, University of Southern California, 2001 N. Soto Street, SSB 202B, MC-9234, Los Angeles, CA, 90089, USA
| | - W James Gauderman
- Department of Population and Public Health Sciences, University of Southern California, 2001 N. Soto Street, SSB 202B, MC-9234, Los Angeles, CA, 90089, USA
| | - Frank D Gilliland
- Department of Population and Public Health Sciences, University of Southern California, 2001 N. Soto Street, SSB 202B, MC-9234, Los Angeles, CA, 90089, USA
| | - Sandrah P Eckel
- Department of Population and Public Health Sciences, University of Southern California, 2001 N. Soto Street, SSB 202B, MC-9234, Los Angeles, CA, 90089, USA.
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Tay TR, Yii A, Chan YH, Choo XN. Interval change in fractional exhaled nitric oxide (FENO) reflects short-term change in adherence following electronic inhaler reminders. J Asthma 2023:1-9. [PMID: 36647191 DOI: 10.1080/02770903.2023.2169931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND In asthma, suppression of fractional exhaled nitric oxide (FENO) is a marker of adherence in the short-term. The usefulness of FENO to indicate change in adherence in the longer term is unknown. The aims of this study were to determine the relationship between changes in adherence and corresponding changes in FENO over short (1 week) and long-term (3 month) periods. METHODS After establishing initial ICS adherence using electronic inhaler monitor (EIM) devices, reminders were switched on for 1 week ('short-term') to optimize adherence. Reminders were then switched off and patients followed up after 3 months ('long-term'). FENO was measured at the start and end of each period. Using linear regression, we analyzed change in FENO in relation to change in adherence. RESULTS Forty-two patients contributed complete data for analysis. In the short-term, change in adherence was independently associated with change in FENO (β = -0.36, p = 0.036) even after adjusting for initial adherence and ICS dose. The higher the initial FENO, the greater the decline in FENO with improved adherence. This relationship between change in adherence and change in FENO was not observed in the long-term. CONCLUSION Change in adherence over 1 week following the use of EIM reminders independently predicted change in FENO. This relationship was not maintained at 3 months.
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Affiliation(s)
- Tunn Ren Tay
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Anthony Yii
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Xue Ning Choo
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
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Guida G, Bagnasco D, Carriero V, Bertolini F, Ricciardolo FLM, Nicola S, Brussino L, Nappi E, Paoletti G, Canonica GW, Heffler E. Critical evaluation of asthma biomarkers in clinical practice. Front Med (Lausanne) 2022; 9:969243. [PMID: 36300189 PMCID: PMC9588982 DOI: 10.3389/fmed.2022.969243] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
The advent of personalized medicine has revolutionized the whole approach to the management of asthma, representing the essential basis for future developments. The cornerstones of personalized medicine are the highest precision in diagnosis, individualized prediction of disease evolution, and patient-tailored treatment. To this aim, enormous efforts have been established to discover biomarkers able to predict patients' phenotypes according to clinical, functional, and bio-humoral traits. Biomarkers are objectively measured characteristics used as indicators of biological or pathogenic processes or clinical responses to specific therapeutic interventions. The diagnosis of type-2 asthma, prediction of response to type-2 targeted treatments, and evaluation of the risk of exacerbation and lung function impairment have been associated with biomarkers detectable either in peripheral blood or in airway samples. The surrogate nature of serum biomarkers, set up to be less invasive than sputum analysis or bronchial biopsies, has shown several limits concerning their clinical applicability. Routinely used biomarkers, like peripheral eosinophilia, total IgE, or exhaled nitric oxide, result, even when combined, to be not completely satisfactory in segregating different type-2 asthma phenotypes, particularly in the context of severe asthma where the choice among different biologics is compelling. Moreover, the type-2 low fraction of patients is not only an orphan of biological treatments but is at risk of being misdiagnosed due to the low negative predictive value of type-2 high biomarkers. Sputum inflammatory cell analysis, considered the highest specific biomarker in discriminating eosinophilic inflammation in asthma, and therefore elected as the gold standard in clinical trials and research models, demonstrated many limits in clinical applicability. Many factors may influence the measure of these biomarkers, such as corticosteroid intake, comorbidities, and environmental exposures or habits. Not least, biomarkers variability over time is a confounding factor leading to wrong clinical choices. In this narrative review, we try to explore many aspects concerning the role of routinely used biomarkers in asthma, applying a critical view over the "state of the art" and contemporarily offering an overview of the most recent evidence in this field.
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Affiliation(s)
- Giuseppe Guida
- Severe Asthma and Rare Lung Disease Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Torino, Turin, Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, Department of Internal Medicine (DIMI), University of Genoa, Genoa, Italy
| | - Vitina Carriero
- Severe Asthma and Rare Lung Disease Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Torino, Turin, Italy
| | - Francesca Bertolini
- Severe Asthma and Rare Lung Disease Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Torino, Turin, Italy
| | - Fabio Luigi Massimo Ricciardolo
- Severe Asthma and Rare Lung Disease Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Torino, Turin, Italy
| | - Stefania Nicola
- Allergy and Immunology, AO Mauriziano Hospital, University of Turin, Turin, Italy
| | - Luisa Brussino
- Allergy and Immunology, AO Mauriziano Hospital, University of Turin, Turin, Italy
| | - Emanuele Nappi
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giovanni Paoletti
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giorgio Walter Canonica
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Enrico Heffler
- IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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7
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Pistelli F, Sherrill DL, Di Pede F, Baldacci S, Simoni M, Maio S, Carrozzi L, Viegi G. Single breath nitrogen test as predictor of lung function decline and COPD over an 8-year follow-up. Pulmonology 2022:S2531-0437(22)00212-4. [PMID: 36216737 DOI: 10.1016/j.pulmoe.2022.09.001] [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: 04/21/2022] [Revised: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The single breath nitrogen (SBN2) test was proposed for early detection of "small airways disease" in the seventies. Few longitudinal studies have subsequently evaluated the relationships between SBN2 test measurements and lung function decline or COPD incidence. AIM This study evaluates whether SBN2 test abnormalities may be significant predictors of lung function decline and COPD incidence over an 8-year follow-up. STUDY DESIGN AND METHODS In this longitudinal study, 907 adults (20+ years old; 56% males) from the prospective Po River Delta epidemiological study underwent SBN2 test at baseline and spirometry testing at both baseline and follow-up 8-year apart. Multinomial and multiple regression models were used to assess associations of SBN2 indexes and rates of FEV1 decline or risk of COPD incidence over time, after adjusting for sex, height and baseline age, FEV1 and smoking status. COPD was defined according to either GOLD or ATS-ERS criteria. RESULTS Among SBN2 indexes, only the slope of alveolar plateau (N2-slope) was significantly associated with rates of FEV1 decline (7.93 mL/year for a one-unit change in N2-slope, p<0.0001), and with an increased risk of developing COPD as defined by GOLD (RR 1.81, 95%CI 1.29-2.52, mild; RR 2.78, 95%CI 1.70-4.53, moderate or severe obstruction) and ATS-ERS criteria (RR 1.62, 95%CI 1.14-2.29, mild; RR 3.40, 95%CI 1.72-6.73, moderate or severe obstruction). CONCLUSION In this population-based study, N2-slope from SBN2 test is a significant predictor of lung function decline and COPD incidence over an 8-year follow-up, confirming the role of the "small airways disease" in the natural history of COPD.
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Affiliation(s)
- F Pistelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa; Via P. Savi, 10 56126 Pisa (Italy); Pulmonary Unit, Cardiothoracic and Vascular Department, Pisa University Hospital; Via Paradisa, 2 56124 Pisa (Italy).
| | - D L Sherrill
- Asthma and Airway Disease Research Center, University of Arizona; 1501 N. Campbell Avenue - 85724 Tucson, AZ (USA)
| | - F Di Pede
- Pulmonary Unit, Cardiothoracic and Vascular Department, Pisa University Hospital; Via Paradisa, 2 56124 Pisa (Italy); Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy, Via Trieste, 41 56126 Pisa (Italy)
| | - S Baldacci
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy, Via Trieste, 41 56126 Pisa (Italy)
| | - M Simoni
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy, Via Trieste, 41 56126 Pisa (Italy)
| | - S Maio
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy, Via Trieste, 41 56126 Pisa (Italy)
| | - L Carrozzi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa; Via P. Savi, 10 56126 Pisa (Italy); Pulmonary Unit, Cardiothoracic and Vascular Department, Pisa University Hospital; Via Paradisa, 2 56124 Pisa (Italy)
| | - G Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy, Via Trieste, 41 56126 Pisa (Italy)
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Runnstrom M, Pitner H, Xu J, Lee FEH, Kuruvilla M. Utilizing Predictive Inflammatory Markers for Guiding the Use of Biologicals in Severe Asthma. J Inflamm Res 2022; 15:241-249. [PMID: 35068937 PMCID: PMC8769207 DOI: 10.2147/jir.s269297] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022] Open
Abstract
Asthma is a chronic respiratory disease characterized by chronic airway inflammation and airflow obstruction. Up to ten percent of asthmatics have severe asthma, and many remain uncontrolled despite optimal medical management. With our increased understanding of the heterogeneity of asthma and its complex pathophysiology, several biomarkers have been developed and in the recent past, several biologic therapies for severe asthma have been developed and are now in widespread use. Although these biological agents have shown great benefit in treating severe asthma, not all patients respond equally well, and some do not derive any benefit. As much of the current literature of these medications have not assessed biomarkers or have used different cutoffs, it is often challenging to decide the best medication for an individual patient. Here, we review common asthma subtypes, current available biologic therapies for asthma, the clinical application of currently available type 2 biomarkers, as well as summarizing the evidence on how patient characteristics and biomarkers can help with choosing the optimal biologic for a patient that has the highest likelihood of success.
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Affiliation(s)
- Martin Runnstrom
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA, USA
| | - Hilary Pitner
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Jennifer Xu
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - F Eun-Hyung Lee
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA, USA
| | - Merin Kuruvilla
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA, USA
- Correspondence: Merin Kuruvilla Email
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Li JH, Han R, Wang YB, Cheng M, Chen HY, Lei WH, Li L, Gao C, Zhao NN, Nie NF, Li ZY, Yin GQ, Huang S, He Y. Diagnostic possibility of the combination of exhaled nitric oxide and blood eosinophil count for eosinophilic asthma. BMC Pulm Med 2021; 21:259. [PMID: 34372824 PMCID: PMC8351446 DOI: 10.1186/s12890-021-01626-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 08/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tests to identify reversible airflow limitation are important in asthma diagnosis, but they are time-consuming and it may be difficult for patients to cooperate. We aimed to evaluate whether the combination of fractional exhaled nitric oxide (FeNO) and blood eosinophil (B-Eos) can be used to distinguish some asthma patients who could avoid objective tests. METHODS We conducted a retrospective cohort study on 7463 suspected asthma cases between January 2014 and December 2019 in Chongqing, China, and identified 2349 patients with complete FeNO, B-Eos count, and spirometry data. Asthma was diagnosed by clinicians by the criteria of recurrent respiratory symptoms and a positive bronchial-provocation or bronchodilation test (BPT, BPD). We evaluated the diagnostic accuracy of FeNO or B-Eos alone or both in combination for asthma using receiver operating characteristic (ROC) curve analysis. RESULTS In this study, 824 patients were diagnosed with asthma. When FeNO and B-Eos counts were used in combination, the area under the ROC curve (AUC) for diagnosing asthma increased slightly (0.768 vs. 0.745 [FeNO] or 0.728 [B-Eos]; both P < 0.001). The odds ratio for having asthma increased progressively with a gradual increase in FeNO or B-Eos count (both P < 0.001; assessed using the Cochran-Armitage trend test). Further analysis of in-series combinations of different threshold values for these biomarkers indicated that moderately elevated biomarker levels (FeNO > 40 ppb and B-Eos > 300 cells/μl) support a diagnosis of asthma because diagnostic specificity was > 95% and the positive likelihood ratio (PLR) was > 10. This conclusion was verified when selecting the 2017-2019 data as the internal validation dataset. CONCLUSION FeNO or B-Eos count alone is insufficient to accurately diagnose asthma. Patients with moderately elevated biomarkers (FeNO > 40 ppb and B-Eos > 300 cells/μl) could be diagnosed with asthma and avoid objective tests when such tests are not feasible.
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Affiliation(s)
| | - Rui Han
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Yu-Bo Wang
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Min Cheng
- Department of Cardiology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Heng-Yi Chen
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Wen-Hui Lei
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Li Li
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Chen Gao
- Department of Clinical Laboratory Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Na-Na Zhao
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Nai-Fu Nie
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Zhong-Yan Li
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Guo-Qing Yin
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Shuai Huang
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Yong He
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China.
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10
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Wang R, Murray CS, Fowler SJ, Simpson A, Durrington HJ. Asthma diagnosis: into the fourth dimension. Thorax 2021; 76:624-631. [PMID: 33504564 PMCID: PMC8223645 DOI: 10.1136/thoraxjnl-2020-216421] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/18/2020] [Accepted: 12/31/2020] [Indexed: 02/06/2023]
Abstract
Asthma is the most common chronic respiratory disease in the UK; however, the misdiagnosis rate is substantial. The lack of consistency in national guidelines and the paucity of data on the performance of diagnostic algorithms compound the challenges in asthma diagnosis. Asthma is a highly rhythmic disease, characterised by diurnal variability in clinical symptoms and pathogenesis. Asthma also varies day to day, seasonally and from year to year. As much as it is a hallmark for asthma, this variability also poses significant challenges to asthma diagnosis. Almost all established asthma diagnostic tools demonstrate diurnal variation, yet few are performed with standardised timing of measurements. The dichotomous interpretation of diagnostic outcomes using fixed cut-off values may further limit the accuracy of the tests, particularly when diurnal variability straddles cut-off values within a day, and careful interpretation beyond the 'positive' and 'negative' outcome is needed. The day-to-day and more long-term variations are less predictable and it is unclear whether performing asthma diagnostic tests during asymptomatic periods may influence diagnostic sensitivities. With the evolution of asthma diagnostic tools, home monitoring and digital apps, novel strategies are needed to bridge these gaps in knowledge, and circadian variability should be considered during the standardisation process. This review summarises the biological mechanisms of circadian rhythms in asthma and highlights novel data on the significance of time (the fourth dimension) in asthma diagnosis.
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Affiliation(s)
- Ran Wang
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK,Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Clare S Murray
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK,Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Stephen J Fowler
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK,Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Angela Simpson
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK,Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Hannah Jane Durrington
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK .,Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
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11
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Wang R, Alahmadi F, Niven R, Fowler SJ. Same-day repeatability of fractional exhaled nitric oxide in severe asthma. Eur Respir J 2021; 57:13993003.03391-2020. [PMID: 33542054 DOI: 10.1183/13993003.03391-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/11/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Ran Wang
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, and Manchester University NHS Foundation Trust, Manchester, UK
| | - Fahad Alahmadi
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, and Manchester University NHS Foundation Trust, Manchester, UK.,Dept of Respiratory Therapy, College of Medical Science and Rehabilitation, Taibah University, Madinah, Saudi Arabia
| | - Robert Niven
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, and Manchester University NHS Foundation Trust, Manchester, UK
| | - Stephen J Fowler
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, and Manchester University NHS Foundation Trust, Manchester, UK
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12
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Vincken S, Sylvia V, Daniel S, Thomas E, Eef V. The role of FeNO in stable COPD patients with eosinophilic airway inflammation. Respir Med 2021; 181:106377. [PMID: 33838525 DOI: 10.1016/j.rmed.2021.106377] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/02/2021] [Accepted: 03/24/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Stefanie Vincken
- Division of Respiratory Diseases, Department of Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Verbanck Sylvia
- Division of Respiratory Diseases, Department of Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Schuermans Daniel
- Division of Respiratory Diseases, Department of Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Evenepoel Thomas
- Division of Respiratory Diseases, Department of Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Vanderhelst Eef
- Division of Respiratory Diseases, Department of Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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13
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Braithwaite IE, Cai F, Tom JA, Galanter JM, Owen RP, Zhu R, Williams M, McGregor AG, Eliahu A, Durk MR, Dengler HS, Zak M, Kenny JR, Wilson ME, Beasley R, Chen H. Inhaled JAK inhibitor GDC-0214 reduces exhaled nitric oxide in patients with mild asthma: A randomized, controlled, proof-of-activity trial. J Allergy Clin Immunol 2021; 148:783-789. [PMID: 33744327 DOI: 10.1016/j.jaci.2021.02.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/01/2021] [Accepted: 02/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Janus kinase (JAK) pathway mediates the activity of many asthma-relevant cytokines, including IL-4 and IL-13. GDC-0214 is a potent, inhaled, small-molecule JAK inhibitor being developed for the treatment of asthma. OBJECTIVE We sought to determine whether GDC-0214 reduces fractional exhaled nitric oxide (Feno), a JAK1-dependent biomarker of airway inflammation, in patients with mild asthma. METHODS We conducted a double-blind, randomized, placebo-controlled, phase 1 proof-of-activity study in adults with mild asthma and Feno higher than 40 parts per billion (ppb). Subjects were randomized 2:1 (GDC-0214:placebo) into 4 sequential ascending-dose cohorts (1 mg once daily [QD], 4 mg QD, 15 mg QD, or 15 mg twice daily). All subjects received 4 days of blinded placebo, then 10 days of either active drug or placebo. The primary outcome was placebo-corrected percent reduction in Feno from baseline to day 14. Baseline was defined as the average Feno during the blinded placebo period. Pharmacokinetics, safety, and tolerability were also assessed. RESULTS Thirty-six subjects (mean age, 28 years; 54% females) were enrolled. Mean Feno at baseline across all subjects was 93 ± 43 ppb. At day 14, placebo-corrected difference in Feno was -23% (95% CI, -37.3 to -9) for 15 mg QD and -42% (95% CI, -57 to -27.4) for 15 mg twice daily. Higher plasma exposure was associated with greater Feno reduction. No dose-limiting adverse events, serious adverse events, or treatment discontinuations occurred. There were no major imbalances in adverse events or laboratory findings, or evidence of systemic JAK inhibition. CONCLUSIONS GDC-0214, an inhaled JAK inhibitor, caused dose-dependent reductions in Feno in mild asthma and was well tolerated without evidence of systemic toxicity.
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Affiliation(s)
| | - Fang Cai
- Genentech, Inc, South San Francisco, Calif
| | | | | | | | - Rui Zhu
- Genentech, Inc, South San Francisco, Calif
| | - Mathew Williams
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Avi Eliahu
- Genentech, Inc, South San Francisco, Calif
| | | | | | - Mark Zak
- Genentech, Inc, South San Francisco, Calif
| | | | | | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
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14
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Mandlik DS, Mandlik SK. New perspectives in bronchial asthma: pathological, immunological alterations, biological targets, and pharmacotherapy. Immunopharmacol Immunotoxicol 2020; 42:521-544. [PMID: 32938247 DOI: 10.1080/08923973.2020.1824238] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Asthma is the most common, long-lasting inflammatory airway disease that affects more than 10% of the world population. It is characterized by bronchial narrowing, airway hyperresponsiveness, vasodilatation, airway edema, and stimulation of sensory nerve endings that lead to recurring events of breathlessness, wheezing, chest tightness, and coughing. It is the main reason for global morbidity and occurs as a result of the weakening of the immune system in response to exposure to allergens or environmental exposure. In asthma condition, it results in the activation of numerous inflammatory cells like the mast and dendritic cells along with the accumulation of activated eosinophils and lymphocytes at the inflammation site. The structural cells such as airway epithelial cells and smooth muscle cells release inflammatory mediators that promote the bronchial inflammation. Long-lasting bronchial inflammation can cause pathological alterations, viz. the improved thickness of the bronchial epithelium and friability of airway epithelial cells, epithelium fibrosis, hyperplasia, and hypertrophy of airway smooth muscle, angiogenesis, and mucus gland hyperplasia. The stimulation of bronchial epithelial cell would result in the release of inflammatory cytokines and chemokines that attract inflammatory cells into bronchial airways and plays an important role in asthma. Asthma patients who do not respond to marketed antiasthmatic drugs needed novel biological medications to regulate the asthmatic situation. The present review enumerates various types of asthma, etiological factors, and in vivo animal models for the induction of asthma. The underlying pathological, immunological mechanism of action, the role of inflammatory mediators, the effect of inflammation on the bronchial airways, newer treatment approaches, and novel biological targets of asthma have been discussed in this review.
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Affiliation(s)
- Deepa S Mandlik
- Department of Pharmacology, Bharat Vidyapeeth Deemed University, Poona College of Pharmacy, Erandawane, India
| | - Satish K Mandlik
- Department of Pharmaceutics, Sinhgad College of Pharmacy, Vadgaon, Maharashtra, India
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Higaki N, Iwamoto H, Yamaguchi K, Sakamoto S, Horimasu Y, Masuda T, Miyamoto S, Nakashima T, Ohshimo S, Fujitaka K, Hamada H, Hattori N. Correlations of forced oscillometric bronchodilator response with airway inflammation and disease duration in asthma. CLINICAL RESPIRATORY JOURNAL 2020; 15:48-55. [PMID: 32860340 DOI: 10.1111/crj.13268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 07/16/2020] [Accepted: 08/12/2020] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Airway resistance and reactance, measured by forced oscillometry, are used to measure the airway obstruction in patients with asthma. OBJECTIVES This study aimed to investigate the oscillometric bronchodilator responses in treated and untreated asthma and evaluate its association with airway inflammation and disease duration. MATERIALS AND METHODS This study included 30 nonsmoking patients with mild to moderate treated asthma, 25 patients with newly diagnosed untreated asthma and 29 control subjects. Spirometric and oscillometric measurements were performed before and after inhalation of 400 µg salbutamol. Disease duration was defined as the number of years since asthma diagnosis. RESULTS At airway resistance of 5 Hz (R5) and 20 Hz (R20), bronchodilator responses in patients with untreated and treated asthma were greater than those in control subjects. In patients with untreated asthma, higher fractional exhaled nitric oxide concentration (FeNO) levels were strongly correlated with greater reversibility of R20 (rs = -0.621, P < 0.001). In patients with treated asthma, there was no significant association between FeNO and oscillometric reversibility, whereas longer disease duration was significantly associated with lesser bronchodilator response at R20 (rs = 0.441, P < 0.05). Treated asthma patients with longer disease duration (≥10 years) showed significantly higher post-bronchodilator R5 and R20 than the treated asthma patients with shorter disease duration (<10 years). CONCLUSION The present study provides further evidence of an association between airway inflammation and variable airway obstruction in asthma patients and indicates that long-term disease duration could be related to poorly reversible airway resistance in patients with mild to moderate asthma.
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Affiliation(s)
- Naoko Higaki
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hiroshi Iwamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kakuhiro Yamaguchi
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinjiro Sakamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasushi Horimasu
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takeshi Masuda
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shintaro Miyamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Taku Nakashima
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazunori Fujitaka
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hironobu Hamada
- Department of Physical Analysis and Therapeutic Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Chen XC, Chuang HC, Ward TJ, Tian L, Cao JJ, Ho SSH, Lau NC, Hsiao TC, Yim SH, Ho KF. Indoor, outdoor, and personal exposure to PM 2.5 and their bioreactivity among healthy residents of Hong Kong. ENVIRONMENTAL RESEARCH 2020; 188:109780. [PMID: 32554275 DOI: 10.1016/j.envres.2020.109780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 05/03/2023]
Abstract
Direct evidence about associations between fine particles (PM2.5) components and the corresponding PM2.5 bioreactivity at the individual level is limited. We conducted a panel study with repeated personal measurements involving 56 healthy residents in Hong Kong. Fractional exhaled nitric oxide (FeNO) levels were measured from these subjects. Out of 56 subjects, 27 (48.2%) participated in concurrent outdoor, indoor, and personal PM2.5 monitoring. Organic carbon (OC), elemental carbon (EC), particle bound-polycyclic aromatic hydrocarbons (PAHs), and phthalates were analyzed. Alteration in cell viability, lactic dehydrogenase (LDH), interleukin-6 (IL-6), and 8-isoprostane by 50 μg/mL PM2.5 extracts was determined in A549 cells in vitro. Moderate heterogeneities were shown in PM2.5 exposures and the corresponding PM2.5 bioreactivity across different sample types. Associations between the analyzed components and PM2.5 bioreactivity were assessed using the multiple regression models. Toxicological results revealed that indoor and personal exposure to OC as well as PAH compounds and their derivatives (e.g., Alkyl-PAHs, Oxy-PAHs) induced cell viability reduction and increase in levels of LDH, IL-6, and 8-isoprostane. Overall, OC in personal exposure played a dominant role in PM2.5-induced bioreactivity. Subsequently, we examined the associations of FeNO with IL-6 and 8-isoprostane levels using mixed-effects models. The results showed that per interquartile change in IL-6 and 8-isoprostane were associated with a 6.4% (p < 0.01) and 11.1% (p < 0.01) increase in FeNO levels, respectively. Our study explored the toxicological properties of chemical components in PM2.5 exposure, which suggested that residential indoors and personal OC and PAHs should be of great concern for human health. These findings indicated that further studies in inflammation and oxidative stress-related illnesses due to particle exposure would benefit from the assessment of in vitro PM2.5 bioreactivity.
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Affiliation(s)
- Xiao-Cui Chen
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China; Now at: Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Hong Kong, China
| | - Hsiao-Chi Chuang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tony J Ward
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Linwei Tian
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Jun-Ji Cao
- Key Laboratory of Aerosol, SKLLQG, Institute of Earth Environment, Chinese Academy of Sciences, Xi'an, China; Institute of Global Environmental Change, Xi'an Jiaotong University, Xi'an, China
| | - Steven Sai-Hang Ho
- Division of Atmosphere Sciences, Desert Research Institute, Reno, NV, 89512, United States; Hong Kong Premium Services and Research Laboratory, Cheung Sha Wan, Kowloon, Hong Kong, China
| | - Ngar-Cheung Lau
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong Kong, China; Department of Geography and Resource Management, The Chinese University of Hong Kong, Hong Kong, China
| | - Ta-Chih Hsiao
- Graduate Institute of Environmental Engineering, National Taiwan University, Taipei, Taiwan
| | - Steve Hl Yim
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong Kong, China; Department of Geography and Resource Management, The Chinese University of Hong Kong, Hong Kong, China
| | - Kin-Fai Ho
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong Kong, China; The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
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17
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Airway inflammation and lung function recovery after lobectomy in patients with primary lung cancer. Gen Thorac Cardiovasc Surg 2020; 69:297-302. [PMID: 32857335 DOI: 10.1007/s11748-020-01464-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Fractional exhaled nitric oxide (FeNO), which represents airway inflammation, is an indicator of postoperative complication after lung surgery. However, its effects in the late postoperative period are unknown. The aim of this prospective study was to clarify the impact of FeNO on postoperative lung function in patients with lung cancer. METHODS We measured preoperative FeNO using NIOX VERO® in patients with primary lung cancer. Patients were divided into two groups according to their potential airway inflammatory status: preoperative FeNO levels below 25 ppb (N group) and above 25 ppb (H group). They were evaluated by spirometry at 3 and 6 months after surgery during follow-up. The relationship between postoperative lung function and preoperative FeNO was evaluated. RESULTS Between September 2017 and March 2019, 61 participants were enrolled. All of them underwent lobectomy as a curative surgery. There were no significant background variables between the two groups. Postoperative vital capacity (VC) and forced expiratory volume in 1 s (FEV1) in the H group achieved less predictive values than those in the N group, which were not significant. The postoperative VC and FEV1 from 3 to 6 months in the H group were significantly increased as compared to those in the N group (p < 0.001). CONCLUSIONS Preoperative FeNO is a predictor of delayed lung function recovery 3 months after lobectomy in lung cancer patients. The impact had extended to VC and FEV1. Although this impact is temporary, early postoperative intervention is expected to reduce the adverse effect.
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Hoshino M, Akitsu K, Kubota K, Ohtawa J. Association between biomarkers and house dust mite sublingual immunotherapy in allergic asthma. Clin Exp Allergy 2020; 50:1035-1043. [PMID: 32557974 DOI: 10.1111/cea.13686] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND House dust mite (HDM) sublingual immunotherapy (SLIT) has demonstrated efficacy in clinical trials of patients with asthma. Airway inflammation is a characteristic of respiratory allergy, but its relationship to SLIT remains unclear. OBJECTIVE We evaluate the association between clinical outcomes with pulmonary function and biomarkers in before and after HDM SLIT (UMIN Number 000022390). METHODS One hundred twelve patients with asthma sensitized to HDM were randomized to add-on 6 standardized quality (SQ)-HDM SLIT to pharmacotherapy or pharmacotherapy alone for 48 weeks. At baseline and end of study, biomarkers, blood eosinophils, serum IgE, serum periostin, fractional exhaled nitric oxide (FeNO), and spirometry and clinical symptoms were measured. Association between biomarkers and an increase in FEV1 of 120 mL or greater were analysed. RESULTS Sublingual immunotherapy (SLIT) demonstrated a significant reduction of serum periostin (P < .001), FeNO (P < .01), and increase in HDM-specific IgE (P < .05), FEV1 (P < .001) and improvement of clinical symptom scores, when compared to pharmacotherapy. The change in FEV1 correlated with the changes in serum periostin (r = .696, P < .001) and the changes in FeNO (r = .682, P < .001). The independent predictor of improvement in airflow limitation was changed in serum periostin (r2 = .753, P = .013) and FeNO (P = .038). Based on cut-off values derived by receiver operating characteristic analysis (periostin 30.9 ng/mL, FeNO 28.0 ppb), patients were distinguished responders from non-responders, but with no predictive value for blood eosinophils or total IgE. The proportion of patients with both high periostin and FeNO levels was significantly higher in responder than in non-responder (P = .026). CONCLUSIONS AND CLINICAL RELEVANCE Adding HDM SLIT to pharmacotherapy resulted in reduced serum periostin and FeNO, and improved pulmonary function. Serum periostin and FeNO may be useful biomarkers for prediction of SLIT.
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Affiliation(s)
- Makoto Hoshino
- Division of Clinical Allergy, Department of Internal Medicine, Atami Hospital, International University of Health and Welfare, Atami, Japan
| | - Kenta Akitsu
- Department of Radiology, Atami Hospital, International University of Health and Welfare, Atami, Japan
| | - Kengo Kubota
- Department of Radiology, Atami Hospital, International University of Health and Welfare, Atami, Japan
| | - Junichi Ohtawa
- Department of Radiology, Atami Hospital, International University of Health and Welfare, Atami, Japan
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Carpagnano GE, Scioscia G, Lacedonia D, Soccio P, Quarato CMI, Cotugno G, Palumbo MG, Foschino Barbaro MP. Searching for Inflammatory and Oxidative Stress Markers Capable of Clustering Severe Asthma. Arch Bronconeumol 2020; 57:338-344. [PMID: 32593535 DOI: 10.1016/j.arbres.2020.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Asthma inflammation may feature an imbalance between oxidative stress and antioxidant defenses. Oxidative stress induces propagation of airways inflammation and corticosteroid insensitivity contributing to poor asthma control, and frequent severe acute exacerbations. This study assessed inflammation and oxidative stress in severe asthmatic subjects and evaluated the possible correlations between inflammatory and oxidative stress markers investigated and asthma severity. MATERIAL AND METHOD Fifty-three patients with severe asthma, 11 patients with mild-moderate asthma and 12 healthy subjects were enrolled and underwent fractional exhaled nitric oxide (FENO) analysis and blood and sputum count cell collection. The content of mitochondrial DNA (MtDNA) and nuclear DNA (nDNA) was measured in exhaled breath condensate (EBC) by Real Time PCR and the ratio between MtDNA/nDNA was calculated. We detected MtDNA/nDNA in the EBC of severe asthmatics. RESULTS We found higher exhaled MtDNA/nDNA in severe asthmatics respectively compared to mild-moderate ones and to healthy controls (10.4±2.2 vs 7.9±2.5, p<0.05 and 10.4±2.2 vs 6.51±0.21, p<0.05). The level of exhaled MtDNA/nDNA was significantly higher in Non-T2 endotype severe asthmatics than T2 (14.07±10. 8 vs 6.5±5.5, p<0.05). CONCLUSION Oxidative stress marker (MtDNA/nDNA) is increased significantly with asthma severity and may be useful for endotyping severe asthma.
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Affiliation(s)
- Giovanna E Carpagnano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Policlinico "OO Riuniti", Foggia, Italy.
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Policlinico "OO Riuniti", Foggia, Italy
| | - Piera Soccio
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Policlinico "OO Riuniti", Foggia, Italy
| | - Carla M I Quarato
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Policlinico "OO Riuniti", Foggia, Italy
| | - Grazia Cotugno
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Policlinico "OO Riuniti", Foggia, Italy
| | - Maria G Palumbo
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Policlinico "OO Riuniti", Foggia, Italy
| | - Maria P Foschino Barbaro
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, Policlinico "OO Riuniti", Foggia, Italy
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20
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Okamoto K, Hayashi K, Kaku R, Kawaguchi Y, Oshio Y, Hanaoka J. Impact of fractional exhaled nitric oxide on the outcomes of lung resection surgery: a prospective study. J Thorac Dis 2020; 12:2663-2671. [PMID: 32642174 PMCID: PMC7330331 DOI: 10.21037/jtd.2020.03.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Fractional exhaled nitric oxide (FeNO), which is representative of airway inflammation, is an indicator of chronic lung disease. However, its effect on the outcome of lung resection is unknown. The aim of this prospective study was to evaluate FeNO in patients who underwent lung resection, to analyze the perioperative dynamics, and clarify the impact on postoperative complications. Methods We measured FeNO using NIOX VERO® once before and on days 1, 3, 5–7 after surgery in participants who were candidates for lung cancer surgery. The primary endpoint was the relationship between postoperative morbidity and preoperative FeNO. The secondary endpoint was the relationship between postoperative FeNO and additional treatment, including readmission. Results We enrolled 105 patients between September 2017 and March 2019. Anatomical lung resection was the predominant treatment (87%) for primary lung cancer. Postoperative pulmonary complications developed in 16 patients. Multivariate analysis revealed that preoperative FeNO was a significant predictor of postoperative pulmonary complications (P=0.002, OR: 1.004, 95% CI: 1.016–1.074). FeNO levels increased significantly after surgery (P=0.011). Postoperative FeNO was a significant predictor of the need for additional medical treatment within 30 days of surgery (P=0.001, OR: 1.068, 95% CI: 1.028–1.110). Conclusions Perioperative FeNO was a significant predictor of surgical outcome among patients who underwent lung resection. The measurement of FeNO is expected to be a simple and useful method for preventing subsequent deterioration in these patients.
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Affiliation(s)
- Keigo Okamoto
- Department of Cardiothoracic Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Kazuki Hayashi
- Department of Cardiothoracic Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Ryosuke Kaku
- Department of Cardiothoracic Surgery, Shiga University of Medical Science, Shiga, Japan
| | - You Kawaguchi
- Department of Cardiothoracic Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Yasuhiko Oshio
- Department of Cardiothoracic Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Jun Hanaoka
- Department of Cardiothoracic Surgery, Shiga University of Medical Science, Shiga, Japan
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Ai Y, Li J, Li Q, Sun M, Li Y, Wang C. Cavity ringdown spectroscopy of nitric oxide in the ultraviolet region for human breath test. J Breath Res 2020; 14:037101. [PMID: 32191922 DOI: 10.1088/1752-7163/ab8184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We report the spectrum of nitric oxide (NO) in the ultraviolet (UV) (225.4-227.0 nm) region based on cavity ringdown spectroscopy (CRDS). A cavity ringdown system, which consisted of a tunable UV laser source and a vacuum-pumped ringdown cavity, was constructed to measure NO at room temperature and atmospheric or reduced pressure. The measured spectra were validated using LIFBase simulations. The absorption cross-section of NO at the strongest absorption peak at 226.255 nm was measured to be 7.64 × 10-18 cm2 molecule-1. Using the measured mirror reflectivity of 99.55% at 226.255 nm, the detection limit of NO was determined to be 7.4 ppb (parts per billion) based on the standard 3-σ criteria. The stability and reproducibility of this CRDS system were also tested. Furthermore, exhaled gas samples from 203 human subjects (105 healthy people and 98 lung cancer patients) were measured using the system. Results demonstrated that the cavity ringdown spectroscopy in the deep-UV region has potential for breath NO test.
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Affiliation(s)
- Yukai Ai
- Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, People's Republic of China. Department of Physics and Astronomy, Mississippi State University, Starkville, Mississippi, United States of America
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Heffler E, Carpagnano GE, Favero E, Guida G, Maniscalco M, Motta A, Paoletti G, Rolla G, Baraldi E, Pezzella V, Piacentini G, Nardini S. Fractional Exhaled Nitric Oxide (FENO) in the management of asthma: a position paper of the Italian Respiratory Society (SIP/IRS) and Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC). Multidiscip Respir Med 2020; 15:36. [PMID: 32269772 PMCID: PMC7137762 DOI: 10.4081/mrm.2020.36] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/05/2020] [Indexed: 02/08/2023] Open
Abstract
Asthma prevalence in Italy is on the rise and is estimated to be over 6% of the general population. The diagnosis of asthma can be challenging and elusive, especially in children and the last two decades has brought evidences that asthma is not a single disease but consists of various phenotypes. Symptoms can be underestimated by the patient or underreported to the clinician and physical signs can be scanty. Usual objective measures, like spirometry, are necessary but sometimes not significant. Despite proper treatment, asthma can be a very severe condition (even leading to death), however new drugs have recently become available which can be very effective in its control. Since asthma is currently thought to be caused by inflammation, a direct measure of the latter can be of paramount importance. For this purpose, the measurement of Fractional Exhaled Nitric Oxide (FENO) has been used since the early years of the current century as a non-invasive, easy-to-assess tool useful for diagnosing and managing asthma. This SIP-IRS/SIAAIC Position Paper is a narrative review which summarizes the evidence behind the usefulness of FENO in the diagnosis, management and phenotypization of asthma.
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Affiliation(s)
- Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano (MI).,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI)
| | - Giovanna Elisiana Carpagnano
- Department of Medical and Surgical Sciences, University of Foggia; Section of Respiratory Diseases, Hospital d'Avanzo, Foggia
| | - Elisabetta Favero
- Department of Medicine-DIMED, Immunological and Respiratory Rare Disease, Allergologic Clinic Ca' Foncello Hospital, Treviso
| | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O. S. Croce e Carle, Cuneo
| | - Mauro Maniscalco
- Respiratory Rehabilitation Unit, ICS Maugeri, Institute of Telese Terme IRCCS
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, Pozzuoli (NA)
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano (MI).,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI)
| | - Giovanni Rolla
- Allergy and Clinical Immunology, University of Turin and A.O. Mauriziano, Turin
| | - Eugenio Baraldi
- Department of Woman's and Child's Health, University Hospital of Padua
| | - Vincenza Pezzella
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples
| | - Giorgio Piacentini
- Paediatric Section, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona
| | - Stefano Nardini
- Italian Respiratory Society-Società Italiana di Pneumologia, Milan, Italy
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Karvonen T, Lehtimäki L. Repeatability and variation of the flow independent nitric oxide parameters. J Breath Res 2020; 14:026002. [PMID: 31550699 DOI: 10.1088/1752-7163/ab4784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Fractional exhaled nitric oxide (FENO) is a non-invasive marker of airway inflammation. Measuring FENO at several flow rates enables the calculation of flow independent NO-parameters (alveolar NO concentration (CANO), bronchial flux of NO (JawNO), bronchial mucosal NO concentration (CawNO) and bronchial wall NO diffusion capacity (DawNO)) that are capable of partitioning the source and release mechanism of NO from the lower respiratory tract. However, the current literature on repeatability and normal variation of the NO-parameters is deficient, and this information is needed to develop the method towards clinical use. METHODS We calculated NO-parameters in 28 healthy subjects using two different mathematical methods and used three different study protocols to investigate: (i) repeatability of two consecutive measurements of NO-parameters, (ii) within-day variation of the NO-parameters over one working day and (iii) day-to-day variation of the NO-parameters between consecutive days during course of a working week. RESULTS JawNO was the most repeatable among the NO-parameters, whereas DawNO and CawNO were notably least repeatable. CANO was higher during the second consecutive measurement (1.22 versus 1.57 ppb, p = 0.017). Both investigated mathematical methods yielded equally repeatable results. JawNO was slightly higher in the afternoon compared to morning (716 versus 881 pl/s, p = 0.01), but other parameters showed no diurnal variation. Upper 95% limit for the day-to-day difference in the parameters in healthy subjects was about 1.2 ppb in CANO, 400 pl/s in JawNO, 92 ppb in CawNO and 16 pl/s/ppb in DawNO. CONCLUSIONS This is the first study assessing short-time repeatability of the NO-parameters. Repeatability of the NO-parameters was good and day-to-day variation in NO-parameters was quite low. We recommend scheduling FENO-measurements at the same time of day, if possible, and in clinical use variation in NO-parameters above the normal limits found in this study suggest changes in the disease's activity.
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Affiliation(s)
- Tuomas Karvonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Kokelj S, Kim JL, Andersson M, Runström Eden G, Bake B, Olin AC. Intra-individual variation of particles in exhaled air and of the contents of Surfactant protein A and albumin. PLoS One 2020; 15:e0227980. [PMID: 31978133 PMCID: PMC6980535 DOI: 10.1371/journal.pone.0227980] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/04/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Particles in exhaled air (PEx) provide samples of respiratory tract lining fluid from small airways containing, for example, Surfactant protein A (SP-A) and albumin, potential biomarkers of small airway disease. We hypothesized that there are differences between morning, noon, and afternoon measurements and that the variability of repeated measurements is larger between days than within days. METHODS PEx was obtained in sixteen healthy non-smoking adults on 11 occasions, within one day and between days. SP-A and albumin were quantified by ELISA. The coefficient of repeatability (CR), intraclass correlation coefficient (ICC), and coefficient of variation (CV) were used to assess the variation of repeated measurements. RESULTS SP-A and albumin increased significantly from morning towards the noon and afternoon by 13% and 25% on average, respectively, whereas PEx number concentration and particle mean mass did not differ significantly between the morning, noon and afternoon. Between-day CRs were not larger than within-day CRs. CONCLUSIONS Time of the day influences the contents of SP-A and albumin in exhaled particles. The variation of repeated measurements was rather high but was not influenced by the time intervals between measurements.
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Affiliation(s)
- Spela Kokelj
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Jeong-Lim Kim
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marianne Andersson
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunilla Runström Eden
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Bake
- Unit of Respiratory Medicine and Allergy, Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna-Carin Olin
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Duong-Quy S. Clinical Utility Of The Exhaled Nitric Oxide (NO) Measurement With Portable Devices In The Management Of Allergic Airway Inflammation And Asthma. J Asthma Allergy 2019; 12:331-341. [PMID: 31632093 PMCID: PMC6789173 DOI: 10.2147/jaa.s190489] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 09/12/2019] [Indexed: 01/11/2023] Open
Abstract
Nitric oxide (NO) is a potential bioactive gas produced continuously and constantly in the airways of healthy subjects. In allergic airway inflammation, the level of exhaled NO is usually increased and mediated by inducible nitric oxide synthase (iNOS) enzyme presenting in the epithelium and different inflammatory cells. The measurement of NO concentration in the airway is possible with portable devices which use an electroluminescence technique. In subjects with upper airway with allergic inflammation such as in allergic rhinitis, the measurement of nasal NO (nNO) may help to diagnose and manage the disease. In the lower airway, increased fractional exhaled NO (FENO) reflects directly the inflammatory process that occurs in the airways that are typically seen in asthma. It has been shown that there is a strong correlation between FENO levels and increased activity of airway inflammation mediated by immuno-allergic cells and mediators. Thus, FENO has higher specificity and sensitivity than other methods in diagnosing the severity of inflammation in asthmatic patients. Moreover, the correlation between increased FENO levels and a high risk of bronchial hyperresponsiveness has also been demonstrated. FENO is also a relevant biomarker to evaluate asthma status due to the change of its values occurring earlier than clinical manifestations and spirometry parameters. In addition, the measurement of FENO with portable devices helps to support the diagnosis of asthma, to follow-up the control of asthma and to personalize asthmatic patients for target treatment with biologic therapy. Therefore, measuring FENO with portable devices in the diagnosis and treatment of allergic airway inflammation, especially in asthma, is one of the most essential applications of NO biomarkers in exhaled breath.
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Affiliation(s)
- Sy Duong-Quy
- Department of Respiratory Diseases, Medical and Biological Research Centre, Lam Dong Medical College, Dalat City, Lam Dong Province, Vietnam
- Department of Immuno-Allergology, Penn State Medical College, Hershey, PA, USA
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Korn S, Wilk M, Voigt S, Weber S, Keller T, Buhl R. Measurement of Fractional Exhaled Nitric Oxide: Comparison of Three Different Analysers. Respiration 2019; 99:1-8. [PMID: 31288246 DOI: 10.1159/000500727] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/30/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Fractional exhaled nitric oxide (FeNO) is a surrogate marker for airway inflammation, supporting the diagnostic pathway and treatment decisions for asthma patients. OBJECTIVES Aim of this study was to compare the new analyser Vivatmo pro (Bosch, BV) with NIOX VERO (Circassia, CN) and CLD (Ecomedics, EC). METHODS In 100 asthmatics (median 53 years [range 20-87], 62% female, 86% on inhaled corticosteroids [mean 1,300 μg beclomethasone dipropionate or equivalent], 35% treated with biologics) 2 FeNO measurements per device were performed. Additionally, the success rate to achieve a valid NO value was evaluated. RESULTS Sixty-eight percent of the patients had FeNO values below 50 ppb. Median NO concentrations were 31 ppb (range 6-194) for BV, 33 ppb (9-164) for CN and 31ppb (7-353) for EC. Bland-Altman plots suggested an agreement within the predefined limits of ±5 ppb for all analysers within the therapeutically relevant range (0-70 ppb). The highest agreement in FeNO levels were between BV and EC with mean differences of -0.26 (95% CI -1.48 to 0.95) vs. 1.52 (95% CI 0.4-2.6) ppb for CN and EC. The results indicate an equivalence of the methods (two-one sided t test-equivalence test: p < 0.0001, ±5 ppb margins). Acceptance of the measurements was high for all devices (97%). The highest success rate to obtain 2 valid NO values without failed attempts was achieved with the BV analyser (73 vs. 62% for the CN analyser and 46% for the EC analyser). CONCLUSIONS For the range between 0 and 70 ppb, FeNO concentrations measured with all 3 devices were statistically equivalent within predefined acceptance criteria and did not differ in a clinically relevant way.
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Affiliation(s)
- Stephanie Korn
- Department of Pulmonary, Mainz University Hospital, Mainz, Germany,
| | - Maike Wilk
- Department of Pulmonary, Mainz University Hospital, Mainz, Germany
| | - Stefanie Voigt
- Department of Pulmonary, Mainz University Hospital, Mainz, Germany
| | | | | | - Roland Buhl
- Department of Pulmonary, Mainz University Hospital, Mainz, Germany
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Ma'pol A, Hashim JH, Norbäck D, Weislander G, Hashim Z, Isa ZM. FeNO level and allergy status among school children in Terengganu, Malaysia. J Asthma 2019; 57:842-849. [PMID: 31155989 DOI: 10.1080/02770903.2019.1614614] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Almost one third of the world population suffers from allergic conditions. Respiratory symptoms are common in Malaysian children but there are few studies on fractional exhaled nitric oxide (FeNO), inclusive of field clinical test for asthma among children in Malaysia. The aim was to provide insight on factors related to level of FeNO among students in Terengganu, Malaysia.Methods: In total, 487 randomly selected students from eight secondary schools participated (13-14 years old). A Standardized questionnaire was used to obtained information on doctors' diagnosed asthma, current asthma and respiratory symptoms. FeNO measurement and skin prick test (SPT to common allergen) were conducted.Results: The geometric mean FeNO was 16.7 ppb. Totally, 38.4% of students had elevated FeNO level (>20 ppb) and 40.3% had had positive SPT to house dust mites allergens (HDM), Dermatophagoides pteronyssinus (Der p 1), Dermatophagoides farinae (Der f 1) or Felis domisticus (cat). Male gender, height, parental history of allergy, self-reported allergy, and atopy were associated with FeNO. In particular, a combination of sensitization to HDM or cat and elevated FeNO were associated with doctor-diagnosed asthma and self-reported allergy to food, pollen and cat.Conclusion: Asthma, respiratory symptoms and sensitization to HDM and cat are common among students and presence of elevated FeNO levels indicate ongoing airway inflammation.
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Affiliation(s)
- Aminnuddin Ma'pol
- Gombak District Health Office, Ministry of Health, Batu Caves, Selangor Darul Ehsan, Malaysia
| | - Jamal Hisham Hashim
- United Nations University-International Institute for Global Health (UNU-IIGH), Kuala Lumpur, Malaysia
| | - Dan Norbäck
- Department of Medical Science, Occupational and Environmental Medicine, University Hospital, Uppsala University, Uppsala, Sweden
| | - Gunilla Weislander
- Department of Medical Science, Occupational and Environmental Medicine, University Hospital, Uppsala University, Uppsala, Sweden
| | - Zailina Hashim
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Selangor, Selangor, Malaysia
| | - Zaleha Md Isa
- Department of Community Health, UKM Medical Centre, National University of Malaysia, Kuala Lumpur, Cheras, Malaysia
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Yuan Y, Li B, Huang M, Peng X, Zhao W, Ye Y, Zhang P, Yu C, Dong H, Cai S, Zhao H. Fractional exhaled nitric oxide was not associated with the future risk of exacerbations in Chinese asthmatics: a non-interventional 1-year real-world study. J Thorac Dis 2019; 11:2438-2447. [PMID: 31372281 DOI: 10.21037/jtd.2019.05.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Exacerbations are recognized as the most relevant predictor of future risk in asthmatics. We aimed to evaluate the association between asthma exacerbations, fractional exhaled nitric oxide (FENO), spirometry indices, and other potential risk factors in a non-interventional, real-world study performed in Guangzhou, China. Methods We performed a prospective 12 months follow-up of Chinese asthmatics. Spirometry and FENO measurements were performed at baseline. Adherence to inhaled corticosteroids (ICS) use was divided into two categories (>80% and <80%). Patients were seen 4 times after the initial baseline visit. Results A total of 222 patients with asthma (49.1% males) completed the study, of which 51 (23.0%) experienced exacerbations during the study period. Of the patients, 117 (52.7%) had good compliance. We compared lung function indices between the patients with and without exacerbations. There was no difference of forced expiratory volume in 1 s (FEV1) predicted, forced vital capacity (FVC) predicted, and FEVI/FVC (all, P>0.05) between the groups. There was also no significant difference in FENO level between the two groups. Compared to those that had exacerbations, patients without exacerbations had better treatment compliance (P<0.001). Logistic regression analysis identified an association between asthma exacerbations, poor control of symptom [odds ratio (OR) =2.295; 95% confidence interval (CI): 1.130-4.663; P=0.022], and nonadherence to asthma medications (OR =4.718; 95% CI: 2.149-10.359; P<0.001). Conclusions Poor adherence rather than baseline FENO and FEV1% predicted was associated with the future risk of exacerbations in Chinese asthmatics in real world.
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Affiliation(s)
- Yafei Yuan
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Chronic Airways Diseases Laboratory, Guangzhou 510515, China
| | - Bohou Li
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Chronic Airways Diseases Laboratory, Guangzhou 510515, China
| | - Minyu Huang
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Chronic Airways Diseases Laboratory, Guangzhou 510515, China
| | - Xianru Peng
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Chronic Airways Diseases Laboratory, Guangzhou 510515, China
| | - Wenqu Zhao
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Chronic Airways Diseases Laboratory, Guangzhou 510515, China
| | - Yanmei Ye
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Chronic Airways Diseases Laboratory, Guangzhou 510515, China
| | - Peifang Zhang
- Department of Respiratory Medicine, The First People's Hospital of Foshan, Foshan 528314, China
| | - Changhui Yu
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Chronic Airways Diseases Laboratory, Guangzhou 510515, China
| | - Hangming Dong
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Chronic Airways Diseases Laboratory, Guangzhou 510515, China
| | - Shaoxi Cai
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Chronic Airways Diseases Laboratory, Guangzhou 510515, China
| | - Haijin Zhao
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Chronic Airways Diseases Laboratory, Guangzhou 510515, China
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Fasola S, Ferrante G, Sabatini A, Santonico M, Zompanti A, Grasso S, Antonelli Incalzi R, La Grutta S. Repeatability of exhaled breath fingerprint collected by a modern sampling system in asthmatic and healthy children. J Breath Res 2019; 13:036007. [PMID: 30965288 DOI: 10.1088/1752-7163/ab1765] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
E-noses provide potential non-invasive metabolic biomarkers for diagnosing and monitoring pulmonary diseases. The primary aim of the present study was to assess the within-day and between-day repeatability of a modern breath sampling system (Pneumopipe® plus an array of e-nose sensors) in asthmatic and healthy children. The secondary aim was to compare the repeatability of the breath sampling system, spirometry and exhaled nitric oxide (eNO). Fifteen children (age 6-11 years) with asthma and thirty healthy children matched by age and gender (1:2 allocation) were recruited; of them, three healthy children did not complete the study. All measurements were collected twice during the baseline visit, 30 min apart, and once during the final visit, after 7 d. Repeatability was assessed through the intra-cluster correlation coefficient (ICC), and a significance test was performed to detect an at least 'fair' repeatability (ICC > 0.2). In asthmatic children, the within-day (0-30 min) ICCs for e-nose sensors (8 sensors × 4 desorption temperatures) ranged from 0.24 to 0.84 (median 0.57, IQR 0.47-0.71), while the between-day (0-7 d) ICCs ranged from 0.25 to 0.83 (median 0.66, IQR 0.55-0.72). In healthy children, the within-day ICCs for e-nose sensors ranged from 0.29 to 0.85 (median 0.58, IQR 0.49-0.63), while the between-day ICCs ranged from 0.33 to 0.82 (median 0.55, IQR 0.49-0.63). In both groups, most of the within-day and between-day ICCs for e-nose sensors were statistically significant. Moreover, the within-day and between-day ICCs for all spirometry parameters and eNO were significant and similar to those of the most reliable sensors. The modern breath sampling system showed more than acceptable within-day and between-day repeatability, in both asthmatic and healthy children. The present study was registered on the central registration system ClinicalTrials.gov (ID: NCT03025061).
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Affiliation(s)
- Salvatore Fasola
- National Research Council of Italy, Institute of Biomedicine and Molecular Immunology, Palermo, Italy
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Barański K, Zejda JE. Between-occasion repeatability of fractional exhaled nitric oxide measurements in children. ACTA ACUST UNITED AC 2019. [PMID: 29538544 PMCID: PMC6104541 DOI: 10.1590/s1806-37562017000000127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The aim of the study was to assess short-term repeatability of measurements of fractional exhaled nitric oxide (FENO) and its correlates in children in the 6- to 9-year age bracket participating in a respiratory epidemiological survey. FENO was measured in two sessions one week apart in 101 children. Participants were divided into three groups: asymptomatic (n = 76); symptomatic (n = 14); and asthma (n = 11). Absolute and relative differences between the measurements, as well as concordance correlation coefficients, were used in order to assess repeatability. The two FENO measurements were strongly correlated (0.98). Although intragroup comparisons of the two measurements were not significantly different (p = 0.2), intergroup comparisons were. FENO measurements are reproducible in children in epidemiological settings.
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Affiliation(s)
- Kamil Barański
- . Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Jan E Zejda
- . Department of Epidemiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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Fractional Exhaled Nitric Oxide Measurements and Screening of Obstructive Sleep Apnea in a Sleep-Laboratory Setting: A Cross-Sectional Study. Lung 2019; 197:131-137. [PMID: 30600394 DOI: 10.1007/s00408-018-0190-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/16/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is a common condition characterized by repetitive collapse of the upper airways and intermittent oxygen desaturation, which may lead to airway inflammation. Here, we explored whether fractional exhaled nitric oxide (FeNO) levels provide a non-invasive screening tool of OSA. METHODS Over a 3-month period, FeNO levels were measured in consecutive non-smoking patients referred for a sleep laboratory. All patients underwent full polysomnography. OSA severity was classified based on the apnea/hypopnea index: ≥ 5.0/h as any OSA, ≥ 15.0/h as moderate/severe OSA, and ≥ 30.0/h as severe OSA. FeNO was measured by a portable device (NIOX-MINO®; Aerocrine AB, Solna, Sweden) and expressed as parts per billion (ppb). Discrimination by area under the curve (AUC) and binary logistic regression were performed. RESULTS A total of 229 subjects were evaluated. Mean FeNO values were similar among subjects without OSA or with OSA: 16.9 ± 10.6 ppb versus 20.2 ± 14.5 ppb, p = 0.221; respectively. FeNO was not an inclusionary parameter to predict any OSA, moderate/severe OSA, and severe OSA: odds ratio (OR) 1.023 (95% confidence interval [CI]: 0.986-1.062); OR 1.012 (95% CI: 0.991-1.034); and OR 0.999 (95% CI: 0.980-1.018), respectively. The AUC values for FeNO in the diagnosis of any OSA, moderate/severe OSA, and severe OSA showed no discriminatory properties: AUC: 0.567 (95% CI: 0.464-0.670), AUC: 0.541 (95% CI: 0.465-0.618), and AUC: 0.535 (95% CI: 0.459-0.610); respectively. CONCLUSIONS In a sleep-lab setting, our findings suggest that FeNO measurements are inconsequential in the screening of OSA in adults.
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Kamimura M, Ibe T, Fukusumi M, Mouri A, Hamamoto Y. Influence of oral care on fractional exhaled nitric oxide. Asia Pac Allergy 2018; 8:e23. [PMID: 30079301 PMCID: PMC6073185 DOI: 10.5415/apallergy.2018.8.e23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 06/26/2018] [Indexed: 11/04/2022] Open
Abstract
Background Fractional exhaled nitric oxide (FeNO) is an indicator of bronchial inflammation in asthma patients. However, nitric oxide is also produced in the oral cavity, with production depending on the local anaerobic flora and intraoral acidity. Objective To evaluate the influence of oral care on measurement of FeNO, to investigate the influence of sleep when the oral environment changes dramatically, and to assess the impact of oral care on FeNO in the real clinical setting. Methods FeNO was measured before and after oral care in 14 subjects on awakening and at bedtime on 2 consecutive days to investigate variation of nitric oxide derived from the oral cavity. It was also measured before and after oral care in 62 outpatients with asthma to assess the clinical relevance of oral cavity nitric oxide. Results On both days, FeNO was significantly decreased by oral care on awakening (day 1: decrease = 10.6 ± 12.4 ppb, p = 0.0020; day 2: decrease = 11.6 ± 23.7 ppb, p = 0.0009), and the decrease was larger than at bedtime. In addition, FeNO was significantly reduced by oral care in asthma outpatients (decrease = 1.73 ± 0.95 ppb, p = 0.0090), and older age was significantly correlated with the decrease (p = 0.0261). Conclusion Oral care resulted in a decrease of FeNO, especially on awakening. While nitric oxide derived from the oral cavity generally has a limited impact in outpatients with asthma, its influence on measurement of FeNO may need to be considered, especially in elderly patients.
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Affiliation(s)
- Mitsuhiro Kamimura
- Department of Pulmonology, National Hospital Organization Disaster Medical Center, Tokyo 190-0014, Japan
| | - Tatsuya Ibe
- Department of Pulmonology, National Hospital Organization Disaster Medical Center, Tokyo 190-0014, Japan
| | - Munehisa Fukusumi
- Department of Pulmonology, National Hospital Organization Disaster Medical Center, Tokyo 190-0014, Japan
| | - Atsuto Mouri
- Department of Pulmonology, National Hospital Organization Disaster Medical Center, Tokyo 190-0014, Japan
| | - Yoichiro Hamamoto
- Department of Pulmonology, National Hospital Organization Disaster Medical Center, Tokyo 190-0014, Japan
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Biomarkers of Human Cardiopulmonary Response After Short-Term Exposures to Medical Laser-Generated Particulate Matter From Simulated Procedures: A Pilot Study. J Occup Environ Med 2018; 58:940-5. [PMID: 27465102 DOI: 10.1097/jom.0000000000000832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We conducted an exposure chamber study in humans using a simulated clinical procedure lasing porcine tissue to demonstrate evidence of effects of exposure to laser-generated particulate matter (LGPM). METHODS We measured pre- and post-exposure changes in exhaled nitric oxide (eNO), spirometry, heart rate variability (HRV), and blood markers of inflammation in five volunteers. RESULTS Change in pre- and post-exposure measurements of eNO and spirometry was unremarkable. Neutrophil and lymphocyte counts increased and fibrinogen levels decreased in four of the five subjects. Measures of HRV showed decreases in the standard deviation of normal between beat intervals and sequential 5-minute intervals. CONCLUSION These data represent the first evidence of human physiologic response to LGPM exposure. Further exploration of coagulation effects and HRV is warranted.
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Wang D, Wang Y, Liang H, David JE, Bray CL. Race and ethnicity have significant influence on fractional exhaled nitric oxide. Ann Allergy Asthma Immunol 2018; 120:272-277.e1. [PMID: 29398244 DOI: 10.1016/j.anai.2017.11.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 11/10/2017] [Accepted: 11/27/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Race and ethnicity have been shown to influence fractional exhaled nitric oxide (FeNO). There is a need to investigate cutoff points for different races and ethnicities to improve clinical application. OBJECTIVE To investigate cutoff points for different races and ethnicities by analyzing the FeNO data collected by the National Health and Nutrition Examination Survey from 2007 to 2012. METHODS This study included 23,433 participants. After excluding participants with confounding factors, 11,084 participants were eligible for data analysis. Based on age and the probability of having allergic airway inflammation, participants were divided into 4 groups. The geometric mean and 5th, 50th, and 95th percentiles of FeNO in Hispanic, white, black, and other races were analyzed in all groups. RESULTS Compared with white participants, the geometric mean for FeNO in black participants was 36% to 41% higher in children and 5% to 8% higher in adults. Hispanic children had significantly higher FeNO values (14% to 19%) compared with non-Hispanic white children; however, those differences were not significant in adults. Other races had significantly higher FeNO values in children (24-54%) and adults (9-29%) compared with white participants. Further, for normal healthy black children, the 95th percentile was 40.2 parts per billion (ppb), which is significantly higher than the cutoff point recommended by current guidelines. CONCLUSION Although there are significant differences in FeNO values among races and ethnicities, the current cutoff point at 50 ppb is sufficient to separate healthy from asthmatic populations in adults. However, for black children, we suggest increasing the cutoff point from 35 to 40 ppb to avoid unnecessary diagnosis and treatment.
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Affiliation(s)
- Dong Wang
- University of Central Florida, College of Medicine, Hospital Corporation of American Graduate Medical Education Program in Internal Medicine at North Florida Regional Medical Center, Gainesville, Florida.
| | - Yanning Wang
- University of Central Florida, College of Medicine, Hospital Corporation of American Graduate Medical Education Program in Internal Medicine at North Florida Regional Medical Center, Gainesville, Florida
| | - Hong Liang
- University of Central Florida, College of Medicine, Hospital Corporation of American Graduate Medical Education Program in Internal Medicine at North Florida Regional Medical Center, Gainesville, Florida
| | - John E David
- University of Central Florida, College of Medicine, Hospital Corporation of American Graduate Medical Education Program in Internal Medicine at North Florida Regional Medical Center, Gainesville, Florida
| | - Christopher L Bray
- University of Central Florida, College of Medicine, Hospital Corporation of American Graduate Medical Education Program in Internal Medicine at North Florida Regional Medical Center, Gainesville, Florida
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Park SH, Im MJ, Eom SY, Hahn YS. Accuracy of maximal expiratory flow-volume curve curvilinearity and fractional exhaled nitric oxide for detection of children with atopic asthma. KOREAN JOURNAL OF PEDIATRICS 2017; 60:290-295. [PMID: 29042872 PMCID: PMC5638835 DOI: 10.3345/kjp.2017.60.9.290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/18/2017] [Accepted: 08/24/2017] [Indexed: 11/29/2022]
Abstract
Purpose Airway pathology in children with atopic asthma can be reflected by the concave shape of the maximal expiratory flow-volume (MEFV) curve and high fractional exhaled nitric oxide (FeNO) values. We evaluated the capacity of the curvilinearity of the MEFV curve, FeNO, and their combination to distinguish subjects with atopic asthma from healthy individuals. Methods FeNO and angle β, which characterizes the general configuration of the MEFV curve, were determined in 119 steroid-naïve individuals with atopic asthma aged 8 to 16 years, and in 92 age-matched healthy controls. Receiver operating characteristic (ROC) curve analyses were performed to determine the cutoff points of FeNO and angle β that provided the best combination of sensitivity and specificity for asthma detection. Results Asthmatic patients had a significantly smaller angle β and higher FeNO compared with healthy controls (both, P<0.001). For asthma detection, the best cutoff values of angle β and FeNO were observed at 189.3° and 22 parts per billion, respectively. The area under the ROC curve for the combination of angle β and FeNO improved to 0.91 (95% confidence interval [CI], 0.87–0.95) from 0.80 (95% CI, 0.75–0.86; P<0.001) for angle β alone and 0.86 (95% CI, 0.82–0.91; P=0.002) for FeNO alone. In addition, the combination enhanced sensitivity with no significant decrease in specificity. Conclusion These data suggest that the combined use of the curvilinearity of the MEFV curve and FeNO is a useful tool to differentiate between children with and without atopic asthma.
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Affiliation(s)
- Sang Hoo Park
- Department of Pediatrics, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Min Ji Im
- Department of Pediatrics, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sang-Yong Eom
- Department of Preventive Medicine, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Youn-Soo Hahn
- Department of Pediatrics, Medical Research Institute, Chungbuk National University College of Medicine, Cheongju, Korea
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Menou A, Babeanu D, Paruit HN, Ordureau A, Guillard S, Chambellan A. Normal values of offline exhaled and nasal nitric oxide in healthy children and teens using chemiluminescence. J Breath Res 2017; 11:036008. [PMID: 28579561 DOI: 10.1088/1752-7163/aa76ef] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Nitric oxide (NO) can be used to detect respiratory or ciliary diseases. Fractional exhaled nitric oxide (FeNO) measurement can reflect ongoing eosinophilic airway inflammation and has a diagnostic utility as a test for asthma screening and follow-up while nasal nitric oxide (nNO) is a valuable screening tool for the diagnosis of primary ciliary dyskinesia. The possibility of collecting airway gas samples in an offline manner offers the advantage to extend these measures and improve the screening and management of these diseases, but normal values from healthy children and teens remain sparse. METHODS Samples were consecutively collected using the offline method for eNO and nNO chemiluminescence measurement in 88 and 31 healthy children and teens, respectively. Offline eNO measurement was also performed in 30 consecutive children with naïve asthma and/or respiratory allergy. RESULTS The normal offline eNO value was determined by the following regression equation -8.206 + 0.176 × height. The upper limit of the norm for the offline eNO value was 27.4 parts per billion (ppb). A separate analysis was performed in children, pre-teens and teens, for which offline eNO was 13.6 ± 4.7 ppb, 16.3 ± 13.7 ppb and 20.0 ± 7.2 ppb, respectively. The optimal cut-off value of the offline eNO to predict asthma or respiratory allergies was 23.3 ppb, with a sensitivity and specificity of 77% and 91%, respectively. Mean offline nNO was determined at 660 ppb with the lower limit of the norm at 197 ppb. CONCLUSION The use of offline eNO and nNO normal values should favour the widespread screening of respiratory diseases in children of school age in their usual environment.
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Affiliation(s)
- A Menou
- Faculte des Sciences, Université de Nantes, Nantes, France
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Asano T, Takemura M, Fukumitsu K, Takeda N, Ichikawa H, Hijikata H, Kanemitsu Y, Uemura T, Takakuwa O, Ohkubo H, Maeno K, Ito Y, Oguri T, Nakamura A, Niimi A. Diagnostic utility of fractional exhaled nitric oxide in prolonged and chronic cough according to atopic status. Allergol Int 2017; 66:344-350. [PMID: 27693513 DOI: 10.1016/j.alit.2016.08.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/17/2016] [Accepted: 08/22/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Cough-variant asthma (CVA) and cough-predominant asthma (CPA) are the major causes of persistent cough in Japan. The utility of fractional exhaled nitric oxide (FeNO) measurement in the differential diagnosis of persistent cough has been reported, but the influence of atopic status, which is associated with higher FeNO levels, on the diagnostic utility of FeNO has been unknown. METHODS We retrospectively analyzed 105 non-smoking patients with prolonged and chronic cough that were not treated with corticosteroids and anti-leukotrienes. RESULTS CPA was diagnosed in 37 patients, CVA in 40, and non-asthmatic cough (NAC) in 28. FeNO levels were significantly higher in the CPA [35.8 (7.0-317.9) ppb] and CVA [24.9 (3.1-156.0) ppb] groups than in the NAC group [18.2 (6.9-49.0) ppb] (p < 0.01 by Kruskal-Wallis test). The optimal cut-off for distinguishing asthmatic cough (AC; CPA and CVA) from NAC was 29.2 ppb [area under the curve (AUC) 0.74, p < 0.01]. Ninety-one percent of subjects with FeNO levels ≥29.2 ppb had AC. Meanwhile, 40% of AC patients had FeNO levels <29.2 ppb. Stratified cut-off levels were 31.1 ppb (AUC 0.83) in atopic subjects vs. 19.9 ppb (AUC 0.65) in non-atopic subjects (p = 0.03 for AUC). CONCLUSIONS Although high FeNO levels suggested the existence of AC, lower FeNO levels had limited diagnostic significance. Atopic status affects the utility of FeNO levels in the differential diagnosis of prolonged and chronic cough.
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Affiliation(s)
- Takamitsu Asano
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masaya Takemura
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Kensuke Fukumitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Norihisa Takeda
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroya Ichikawa
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hisatoshi Hijikata
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshihiro Kanemitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takehiro Uemura
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Osamu Takakuwa
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hirotsugu Ohkubo
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ken Maeno
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yutaka Ito
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tetsuya Oguri
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Atsushi Nakamura
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Comparison of the Fractional Exhaled Nitric Oxide Levels in Adolescents at Three Schools Located Three Different Distances from a Large Steel Mill. Can Respir J 2017; 2017:6231309. [PMID: 28265181 PMCID: PMC5317111 DOI: 10.1155/2017/6231309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 12/04/2016] [Accepted: 12/27/2016] [Indexed: 11/17/2022] Open
Abstract
Objectives. Exposure to ambient metals and air pollutants in urban environments has been associated with impaired lung health and inflammation in the lungs. Fractional exhaled nitric oxide (FeNO) is a reliable marker of airway inflammation. In this study, we aimed to compare the FeNO levels of three schools that have different distances from iron and steel industry zone for assessing the effects of heavy metals and air pollution on their respiratory health. Methods. Pulmonary function test and FeNO measurements were evaluated in 387 adolescents in three schools which have different distance from plant. Results. FeNO levels were significantly higher in School I (n = 142; 18.89 ± 12.3 ppb) and School II (n = 131; 17.68 ± 7.7 ppb) than School III (n = 114; 4.28 ± 3.9 ppb). Increased FeNO concentration was related to the distance of iron and steel industry zone in young adults. Conclusion. The FeNO concentrations in school children were inversely proportional to the distance from the steel mill. There are needed some studies that can evaluate the safe distance and legislation must consider these findings.
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Molshatski N, Eckel SP. Optimal flow rate sampling designs for studies with extended exhaled nitric oxide analysis. J Breath Res 2017; 11:016012. [PMID: 28104897 DOI: 10.1088/1752-7163/aa5ad0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The fractional concentration of exhaled nitric oxide (FeNO) is a biomarker of airway inflammation. Repeat FeNO maneuvers at multiple fixed exhalation flow rates (extended NO analysis) can be used to estimate parameters quantifying proximal and distal sources of NO in mathematical models of lower respiratory tract NO. A growing number of studies use extended NO analysis, but there is no official standard flow rate sampling protocol. In this paper, we provide information for study planning by deriving theoretically optimal flow rate sampling designs. METHODS First, we reviewed previously published designs. Then, under a nonlinear regression framework for estimating NO parameters in the steady-state two compartment model of NO, we identified unbiased optimal four flow rate designs (within the range of 10-400 ml s-1) using theoretical derivations and simulation studies. Optimality criteria included NO parameter standard errors (SEs). A simulation study was used to estimate sample sizes required to detect associations with NO parameters estimated from studies with different designs. RESULTS Most designs (77%) were unbiased. NO parameter SEs were smaller for designs with: more target flows, more replicate maneuvers per target flow, and a larger range of target flows. High flows were most important for estimating alveolar NO concentration, while low flows were most important for the proximal NO parameters. The Southern California Children's Health Study design (30, 50, 100 and 300 ml s-1) had ≥1.8 fold larger SEs and required 1.1-3.2 fold more subjects to detect the association of a determinant with each NO parameter as compared to an optimal design of 10, 50, 100 and 400 ml s-1. CONCLUSIONS There is a class of reasonable flow rate sampling designs with good theoretical performance. In practice, designs should be selected to balance the tradeoffs between optimality and feasibility of the flow range and total number of maneuvers.
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Affiliation(s)
- Noa Molshatski
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States of America
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MacNeil J, Loves RH, Aaron SD. Addressing the misdiagnosis of asthma in adults: where does it go wrong? Expert Rev Respir Med 2016; 10:1187-1198. [PMID: 27677224 DOI: 10.1080/17476348.2016.1242415] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Asthma is diagnosed based on patients' respiratory symptoms of wheeze, cough, chest tightness and/or dyspnea together with physiologic evidence of variable and reversible expiratory airflow limitation. A high prevalence of overdiagnosis, underdiagnosis and misdiagnosis of adult asthma has been reported in the literature. Areas covered: Misdiagnosis of asthma in adults can occur in the community due to physicians' failure to confirm airflow limitation using spirometry, the relatively poor sensitivity of spirometry to absolutely rule in asthma, the complexity of multiple asthma phenotypes and endotypes, and the inherent day to day variability of asthma symptoms and airflow limitation. Consequences of asthma misdiagnosis to the patient and to the healthcare system include increased medication costs, increased potential side effects related to unnecessary use of medications and lost opportunities to diagnose the true cause of patients' respiratory symptoms. Expert commentary: Here we provide a review of the problem of misdiagnosis of adult asthma and suggestions for how to decrease the risk of misdiagnosis.
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Affiliation(s)
- Jenna MacNeil
- a Department of Medicine , The Ottawa Hospital Research Institute, University of Ottawa , Ottawa , Canada
| | - Robyn H Loves
- a Department of Medicine , The Ottawa Hospital Research Institute, University of Ottawa , Ottawa , Canada
| | - Shawn D Aaron
- a Department of Medicine , The Ottawa Hospital Research Institute, University of Ottawa , Ottawa , Canada
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Udesen PB, Westergaard CG, Porsbjerg C, Backer V. Stability of FeNO and airway hyperresponsiveness to mannitol in untreated asthmatics. J Asthma 2016; 54:530-536. [PMID: 27668981 DOI: 10.1080/02770903.2016.1238928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Airway hyperresponsiveness and airway inflammation are important hallmarks of asthma and are useful in asthma diagnosing, monitoring and treatment. The aim of the study was to assess whether two commonly used clinical tests, the mannitol challenge and Fraction of exhaled NO (FeNO), were stable clinical indicators over time in stable untreated asthmatics. METHODS 54 non-smoking, asthma patients not treated with steroids were enrolled in the study and assessed at baseline and a median of 6 months later. At baseline and follow-up, FeNO and airway hyperesponsiveness to mannitol were measured, and asthma control was assessed with the Asthma Control Questionnaire (ACQ). RESULTS A total of 41 subjects completed both visits. Mean (SD) FEV1% at baseline was 94.1% (17.7) and at re-examination 94.6% (19.7) (ns). The ACQ score was unchanged from baseline (Mean (SD): 0.90 (± 0.73)) to follow-up 0.90 (± 0.74) (ns), as was the FEV1% (94.1% (±17.1%) vs 94.6% (19.7%)(ns) indicating that patients were clinically stable during follow-up. The response to mannitol was unchanged at follow-up (Geometric mean (CI) of Response Dose Ratio (RDR) to mannitol: 0.026(0.013-0.046) vs 0.026(0.012-0.050) (ns). There was a slight decrease in FeNO at follow-up (25.5 ppb (19.7-32.9) to 21.9 ppb (17.1-28.2) (p < 0.001). CONCLUSIONS In steroid-free non-smoking asthmatics with constant symptom scores and lung function, airway responsiveness to mannitol remained at the same level over a period of months, while a minor change in exhaled FeNO was reported. These results suggest that mannitol is a stable, reliable marker of clinical disease activity.
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Affiliation(s)
| | | | - Celeste Porsbjerg
- a Respiratory Research Unit , Bispebjerg University Hospital , Copenhagen , Denmark
| | - Vibeke Backer
- a Respiratory Research Unit , Bispebjerg University Hospital , Copenhagen , Denmark
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Qian L, Pan S, Shi J, Du Y, Huang Q, Jie Z. Association between fractional exhaled nitric oxide (FeNO) cutoff values (25 ppb) and risk factors of cough. CLINICAL RESPIRATORY JOURNAL 2016; 12:193-199. [PMID: 27249415 DOI: 10.1111/crj.12512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 03/31/2016] [Accepted: 05/29/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Cough is among the most common symptoms for patients to seek medical attention. OBJECTIVES The purpose of this study is to evaluate the association between fractional exhaled nitric oxide (FeNO) cutoff values (25 ppb) and risk factors related to cough, hoping to evaluate the feasibility of the FeNO cut point values (25 ppb) for clinical prediction of cough in etiology. METHODS In 107 adult patients with acute, subacute, or chronic cough, the FeNO, forced expiratory volume for 1 second (FEV1), forced vital capacity (FVC), blood routine (white blood cell and neutrophil), immunoglobulin E (IgE), lymphocyte eosinophils, and hemoglobin were measured. The Student's t-test was used to test the differences of FeNO levels compared with FEV1/FVC, lymphocyte, and hemoglobin level. For evaluating the correlation of FeNO levels with IgE, eosinophil, blood routine, pulmonary infection, and smoking status, the chi-square test was performed. RESULTS FeNO cutoff value (25 ppb) significantly correlated with serum IgE (P < .0001) between ≥200 IU/mL and <200 IU/mL level, eosinophil (P = .039) between ≥5% and <5% level, lymphocyte percentage (P = .032) and the ratio of FEV1/FVC (P = .032), while weakly correlated with pulmonary infection, blood routine (white blood cell and neutrophil), hemoglobin, and smoking. CONCLUSION The cutoff values of FeNO (≥25 ppb or <25 ppb) are useful for etiological detection of cough with high sensitivity.
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Affiliation(s)
- Ling Qian
- Department of Respiratory Medicine, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, 200240, China
| | - Shiying Pan
- Department of Respiratory Medicine, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, 200240, China
| | - Jingdong Shi
- Department of Respiratory Medicine, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, 200240, China
| | - Yong Du
- Department of Respiratory Medicine, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, 200240, China
| | - Qihui Huang
- Department of Respiratory Medicine, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, 200240, China
| | - Zhijun Jie
- Department of Respiratory Medicine, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, 200240, China
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Silkoff PE, Laviolette M, Singh D, FitzGerald JM, Kelsen S, Backer V, Porsbjerg C, Girodet PO, Berger P, Kline JN, Khatri S, Chanez P, Susulic VS, Barnathan ES, Baribaud F, Loza MJ. Longitudinal stability of asthma characteristics and biomarkers from the Airways Disease Endotyping for Personalized Therapeutics (ADEPT) study. Respir Res 2016; 17:43. [PMID: 27107814 PMCID: PMC4842260 DOI: 10.1186/s12931-016-0360-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 04/15/2016] [Indexed: 12/15/2022] Open
Abstract
Background Asthma is a biologically heterogeneous disease and development of novel therapeutics requires understanding of pathophysiologic phenotypes. There is uncertainty regarding the stability of clinical characteristics and biomarkers in asthma over time. This report presents the longitudinal stability over 12 months of clinical characteristics and clinically accessible biomarkers from ADEPT. Methods Mild, moderate, and severe asthma subjects were assessed at 5 visits over 12 months. Assessments included patient questionnaires, spirometry, bronchodilator reversibility, fractional exhaled nitric oxide (FENO), and biomarkers measured in induced sputum. Results Mild (n = 52), moderate (n = 55), and severe (n = 51) asthma cohorts were enrolled from North America and Western Europe. For all clinical characteristics and biomarkers, group mean data showed no significant change from visit to visit. However, individual data showed considerable variability. FEV1/FVC ratio showed excellent reproducibility while pre-bronchodilator FEV1 and FVC were only moderately reproducible. Of note bronchodilator FEV1 reversibility showed low reproducibility, with the nonreversible phenotype much more reproducible than the reversible phenotype. The 7-item asthma control questionnaire (ACQ7) demonstrated moderate reproducibility for the combined asthma cohorts, but the uncontrolled asthma phenotype (ACQ7 > 1.5) was inconstant in mild and moderate asthma but stable in severe asthma. FENO demonstrated good reproducibility, with the FENO-low phenotype (FENO < 35 ppb) more stable than the FENO-high phenotype (FENO ≥ 35 ppb). Induced sputum inflammatory phenotypes showed marked variability across the 3 sputum samples taken over 6 months. Conclusions The ADEPT cohort showed group stability, individual stability in some parameters e.g. low FEV1/FVC ratio, and low FENO, but marked individual variability in other clinical characteristics and biomarkers e.g. type-2 biomarkers over 12 months. This variability is possibly related to seasonal variations in climate and allergen exposure, medication changes and acute exacerbations. The implications for patient selection strategies based on clinical biomarkers may be considerable.
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Affiliation(s)
- P E Silkoff
- Janssen Research & Development LLC, Spring House, PA, USA. .,, Present Address: 715 Bryn Mawr Avenue, Penn Valley, PA, 19072, USA.
| | - M Laviolette
- Institut Universitaire de Cardiologie et Pneumologie de Québec (IUCPQ), 2725, Chemin Ste-Foy, Quebec, QC, G1V 4G5, Canada
| | - D Singh
- Centre for Respiratory Medicine and Allergy, the University of Manchester, Medicines Evaluation Unit, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester, M23 9QZ, UK
| | - J M FitzGerald
- Institute for Heart and Lung Health, The Lung Centre, Gordon and Leslie Diamond Health Care Centre, 7th Floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - S Kelsen
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine, 401N. Broad St., Philadelphia, PA, 19140, USA
| | - V Backer
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Bispebjerg bakke 23, DK-2400, Copenhagen, NV, Denmark
| | - C Porsbjerg
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Bispebjerg bakke 23, DK-2400, Copenhagen, NV, Denmark
| | - P O Girodet
- Centre de Recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, U1045, CIC 1401, F-33000, Bordeaux, France
| | - P Berger
- Centre de Recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, U1045, CIC 1401, F-33000, Bordeaux, France
| | - J N Kline
- Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, W219B GH UIHC, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - S Khatri
- Department of Pulmonary and Critical Care, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - P Chanez
- Pneumologie, Aix Marseille University, APHM/INSERM U1067, Chemin des Bourellys 13015, Marseille, France
| | - V S Susulic
- Janssen Research & Development LLC, Spring House, PA, USA
| | - E S Barnathan
- Janssen Research & Development LLC, Spring House, PA, USA
| | - F Baribaud
- Janssen Research & Development LLC, Spring House, PA, USA
| | - M J Loza
- Janssen Research & Development LLC, Spring House, PA, USA
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Carpagnano GE, Lacedonia D, Malerba M, Palmiotti GA, Cotugno G, Carone M, Foschino-Barbaro MP. Analysis of mitochondrial DNA alteration in new phenotype ACOS. BMC Pulm Med 2016; 16:31. [PMID: 26867569 PMCID: PMC4751730 DOI: 10.1186/s12890-016-0192-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 02/03/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Mitochondria contain their own DNA (MtDNA) that is very sensitive to oxidative stress and as a consequence could be damaged in quantity. Oxidative stress is largely recognized to play a key role in the pathogenesis of asthma and COPD and might have a role in the new intermediate phenotype ACOS (asthma-COPD overlap syndrome). The aim of this study was to investigate MtDNA alterations, as an expression of mitochondrial dysfunction, in ACOS and to verify whether they might help in the identification of this new phenotype and in its differentiation from asthma and COPD. METHODS Ten (10) ACOS according to Spanish guidelines, 13 ACOS according to GINA guidelines, 13 COPD, 14 asthmatic patients and ten normal subjects were enrolled. They further underwent a blood, induced sputum and exhaled nitric oxide collection. Content of MtDNA and nuclear DNA (nDNA) were measured in the blood cells of patients by Real Time PCR. RESULTS ACOS patients showed an increase of MtDNA/nDNA ratio. Dividing ACOS according to guidelines, those from the Spanish showed a higher value of MtDNA/nDNA compared to those from GINA/GOLD (92.69 ± 7.31 vs 80.68 ± 4.16). Spanish ACOS presented MtDNA/nDNA ratio closer to COPD than asthma. MtDNA was higher in asthmatic, COPD, GINA and Spanish ACOS patients compared to healthy subjects (73.30 ± 4.47-137.0 ± 19.45-80.68 ± 4.16-92.69 ± 7.31 vs 65.97 ± 20.56). CONCLUSION We found an increase of MtDNA/nDNA ratio in ACOS subjects that led us to conclude that there is presence of mitochondrial dysfunction in this disease, that makes it closer to COPD than to asthma. Although the MtDNA/nDNA ratio results are a useful marker for differential diagnosis from asthma, COPD and ACOS, further studies are needed to confirm the potentiality of MtDNA/nDNA ratio and to a better characterization of ACOS.
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Affiliation(s)
- G E Carpagnano
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, viale degli Aviatori, Foggia, 71100, Italy.
| | - D Lacedonia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, viale degli Aviatori, Foggia, 71100, Italy.
| | - M Malerba
- Department of Internal Medicine, University of Brescia and AO Spedali Civili, Brescia, Italy.
| | - G A Palmiotti
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, viale degli Aviatori, Foggia, 71100, Italy.
| | - G Cotugno
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, viale degli Aviatori, Foggia, 71100, Italy.
| | - M Carone
- Division of Respiratory Disease, Fondazione Salvatore Maugeri, Cassano Murge, Italy.
| | - M P Foschino-Barbaro
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, viale degli Aviatori, Foggia, 71100, Italy.
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Ojanguren I, Cruz MJ, Villar A, Barrecheguren M, Morell F, Muñoz X. Utility of Exhaled Nitric Oxide Fraction for the Diagnosis of Hypersensitivity Pneumonitis. Lung 2015; 194:75-80. [DOI: 10.1007/s00408-015-9824-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/03/2015] [Indexed: 01/05/2023]
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Heijkenskjöld-Rentzhog C, Kalm-Stephens P, Nordvall L, Malinovschi A, Alving K. New method for single-breath fraction of exhaled nitric oxide measurement with improved feasibility in preschool children with asthma. Pediatr Allergy Immunol 2015; 26:662-7. [PMID: 26184580 DOI: 10.1111/pai.12447] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Respiratory societies recommend use of standardized methodologies for fraction of exhaled nitric oxide (FeNO) measurements in adults and children, but in preschoolers, feasibility remains a problem. The exhalation time needed to obtain steady-state FeNO is unclear. Our primary aim was to study the feasibility of an adapted single-breath FeNO method with age-adjusted exhalation times. We also studied the association between time to steady-state NO level and height, as well as FeNO in relation to asthma and current treatment with inhaled corticosteroids (ICS). METHODS Sixty-three children aged 3-10 years performed FeNO measurements with a hand-held electrochemical device with a newly developed flow-control unit. Exhalation times were pre-adapted to age. Exhaled air was simultaneously sampled to a chemiluminescence analyzer to measure time to steady-state NO level. RESULTS Eighty-one percent of the children achieved at least one approved measurement. From 4 years upwards, success rate was high (96%). Time to steady-state [NO] (median and interquartile range) was 2.5 s (2.4-3.5) at the age of 3-4 years and 3.5 s (2.7-3.8) at the age of 5-6 years. Height was associated with time to steady state (r(2) = 0.13, p = 0.02). FeNO (geometric mean [95% CI]) was higher in ICS-naïve asthmatic children (n = 19): 15.9 p.p.b. (12.2-20.9), than in both healthy controls (n = 8) 9.1 p.p.b. (6.6-12.4) and asthmatic subjects on treatment (n = 24) 11.5 p.p.b. (9.7-13.6). CONCLUSION We found this adapted single-breath method with age-adjusted exhalation times highly feasible for children aged 4-10 years. ICS-naïve asthmatic children had FeNO levels under the current guideline cutoff level (20 p.p.b.), highlighting the importance of taking age into account when setting reference values.
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Affiliation(s)
| | - Pia Kalm-Stephens
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Lennart Nordvall
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Kjell Alving
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Gochicoa-Rangel L, Rojas-Cisneros F, Miguel-Reyes JL, Guerrero-Zúñiga S, Mora-Romero U, Maldonado-Mortera AK, Torre-Bouscoulet L. Variability of FeNO in healthy subjects at 2240 meters above sea level. J Clin Monit Comput 2015; 30:445-9. [PMID: 26174797 DOI: 10.1007/s10877-015-9737-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 07/08/2015] [Indexed: 10/23/2022]
Abstract
Fraction of exhaled nitric oxide (FeNO) is a marker of eosinophilic airway inflammation. Altitude above sea level can affect measurements of this index, but there is only limited information regarding the diurnal variation (ante meridiem vs. post meridiem) and reproducibility of FeNO on consecutive days at moderate altitudes. To evaluate the diurnal variability of FeNO and assess its reproducibility over five consecutive days in healthy individuals living at 2240 m, and to compare the FeNO readings taken with two different analyzers. Healthy non-smoking adults were measured using NIOX MINO(®) or NOA 280i(®) devices. One group (n = 10) had readings taken morning and afternoon for five consecutive days with the NIOX MINO(®) equipment; while the second group (n = 17) was measured on only one morning but by both the electrochemical analyzer (NIOX MINO(®)) and the chemiluminescence method (NOA 280i(®)). The study group consisted of 27 subjects aged 28.7 ± 6 years. Morning and afternoon FeNO measurements were 15.2 ± 7.5 ppb and 15.2 ± 7.9 ppb (p = 0.9), respectively. The coefficient of variation (CV) of these measurements (a.m. vs. p.m.) was 10.7 %, and the coefficient of repeatability (CR), 4.2 ppb. The concordance correlation coefficient (CCC) between the two measures (morning vs. afternoon) was 0.91. The CV and CR of the five morning readings were 15.4 % and 4.3 ppb, respectively; while those of the five afternoon measures were 13.6 % and 3.5 ppb, respectively. The CCC between the NIOX MINO(®) equipment and the NOA-280i(®) device was 0.8, with 95 % limits of agreement of -8.35 to 0.29 ppb. In adults living at 2240 m above sea level, FeNO measurements show minimal diurnal variation, and readings are reproducible (<15 %) over a period of at least five consecutive days; however, the FeNO measurements obtained with the NIOX MINO(®) and NOA 280i(®) devices are not interchangeable due to the wide limits of agreement recorded.
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Affiliation(s)
- Laura Gochicoa-Rangel
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, C.P. 14080, Mexico City, Distrito Federal, Mexico
| | - Fermín Rojas-Cisneros
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, C.P. 14080, Mexico City, Distrito Federal, Mexico
| | - José Luis Miguel-Reyes
- Clínica de Asma, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| | - Selene Guerrero-Zúñiga
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, C.P. 14080, Mexico City, Distrito Federal, Mexico
| | - Uri Mora-Romero
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, C.P. 14080, Mexico City, Distrito Federal, Mexico
| | - Ana Karen Maldonado-Mortera
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, C.P. 14080, Mexico City, Distrito Federal, Mexico
| | - Luis Torre-Bouscoulet
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, C.P. 14080, Mexico City, Distrito Federal, Mexico.
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Mirowsky J, Gordon T. Noninvasive effects measurements for air pollution human studies: methods, analysis, and implications. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2015; 25:354-80. [PMID: 25605444 PMCID: PMC6659729 DOI: 10.1038/jes.2014.93] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/26/2014] [Accepted: 11/05/2014] [Indexed: 05/09/2023]
Abstract
Human exposure studies, compared with cell and animal models, are heavily relied upon to study the associations between health effects in humans and air pollutant inhalation. Human studies vary in exposure methodology, with some work conducted in controlled settings, whereas other studies are conducted in ambient environments. Human studies can also vary in the health metrics explored, as there exists a myriad of health effect end points commonly measured. In this review, we compiled mini reviews of the most commonly used noninvasive health effect end points that are suitable for panel studies of air pollution, broken into cardiovascular end points, respiratory end points, and biomarkers of effect from biological specimens. Pertinent information regarding each health end point and the suggested methods for mobile collection in the field are assessed. In addition, the clinical implications for each health end point are summarized, along with the factors identified that can modify each measurement. Finally, the important research findings regarding each health end point and air pollutant exposures were reviewed. It appeared that most of the adverse health effects end points explored were found to positively correlate with pollutant levels, although differences in study design, pollutants measured, and study population were found to influence the magnitude of these effects. Thus, this review is intended to act as a guide for researchers interested in conducting human exposure studies of air pollutants while in the field, although there can be a wider application for using these end points in many epidemiological study designs.
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Affiliation(s)
- Jaime Mirowsky
- Department of Environmental Medicine, New York University School of Medicine, Nelson Institute of Environmental Medicine, Tuxedo, New York, USA
| | - Terry Gordon
- Department of Environmental Medicine, New York University School of Medicine, Nelson Institute of Environmental Medicine, Tuxedo, New York, USA
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Effect of a smoking ban on respiratory health in nonsmoking hospitality workers: a prospective cohort study. J Occup Environ Med 2015; 56:e86-91. [PMID: 25285840 DOI: 10.1097/jom.0000000000000262] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to examine the effect of a smoking ban on lung function, fractional exhaled nitric oxide, and respiratory symptoms in nonsmoking hospitality workers. METHODS Secondhand smoke exposure at the workplace, spirometry, and fractional exhaled nitric oxide were measured in 92 nonsmoking hospitality workers before as well as twice after a smoking ban. RESULTS At baseline, secondhand smoke-exposed hospitality workers had lung function values significantly below the population average. After the smoking ban, the covariate-adjusted odds ratio for cough was 0.59 (95% confidence interval, 0.36 to 0.93) and for chronic bronchitis 0.75 (95% confidence interval, 0.55 to 1.02) compared with the preban period. CONCLUSIONS The below-average lung function before the smoking ban indicates chronic damages from long-term exposure. Respiratory symptoms such as cough decreased within 12 months after the ban.
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Turner S. Exhaled nitric oxide and the management of childhood asthma--yet another promising biomarker "has been" or a misunderstood gem. Paediatr Respir Rev 2015; 16:88-96. [PMID: 25182668 DOI: 10.1016/j.prrv.2014.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 06/20/2014] [Accepted: 07/27/2014] [Indexed: 10/24/2022]
Abstract
Childhood asthma is a common chronic condition. Approximately five percent of all children in western countries are prescribed treatment with inhaled corticosteroids (ICS) to prevent asthma symptoms. Current guidelines advocate titrating ICS dose to symptoms but this approach is not without problem, e.g. how to discern asthmatic from non-asthmatic symptoms? And when to reduce ICS dose? This review describes the strengths and weaknesses of fractional exhaled nitric oxide (FENO) as an objective index for individualising asthma control in children. Epidemiological and mechanistic evidence suggest that FENO should be a promising biomarker for eosinophilic airway inflammation (a hall mark for asthma) but somewhat surprisingly, clinical trials in children have not consistently found benefit from adding FENO to a symptom-based approach to ICS treatment in children. There are a number of reasons why FENO has apparently failed to translate from promising biomarker to clinically useful tool, and one reason may be a lack of understanding of what merits a significant intrasubject change in FENO. This review describes the rise and apparent fall of FENO as biomarker for asthma and then focuses on more recent evidence which suggest that FENO may prove to have a role in the management of childhood asthma, and in particular preventing exacerbations.
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Affiliation(s)
- Steve Turner
- Child Health, University of Aberdeen, Aberdeen, UK.
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