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Pianigiani T, Luzzi S, Dilroba A, Meocci M, Salvadori E, Alderighi L, Bergantini L, d'Alessandro M, Sestini P, Bargagli E, Cameli P. Evaluation of multiple-flows exhaled nitric oxide and its clinical significance in severe asthmatic patients treated with biologics: a prospective real-life study. J Asthma 2024:1-10. [PMID: 38884564 DOI: 10.1080/02770903.2024.2370012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/16/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Specific biomarkers, such as eosinophilia in peripheral blood or fractional exhaled nitric oxide (FeNO), can guide us in the choice of biologic therapy, allowing a more personalized approach. Although there are multiple evidences in the literature about the role of FeNO as a predictor of response to different biologic treatments, there are no data on the relationship between FeNO changes and clinical response to the four biologic drugs currently in use. OBJECTIVE To evaluate and to compare the expression of multiple-flows FeNO parameters in a cohort of patients with severe asthma (SA) before and during the treatment with biologics to evaluate the performance of these biomarkers in predicting the achievement of clinical remission. METHODS We prospectively enrolled 50 patients with severe asthma eligible for biologic therapy. Patients underwent clinical and functional monitoring at baseline (T0) and after 1, 6, and 12 months of treatment (T1, T6, T12), including multiple flows FeNO assessment. RESULTS A statistically significant reduction of FeNO50 values and J'awNO was observed only in benralizumab and dupilumab subgroups. Among biomarkers, the reduction of FeNO 50 values at T1 was associated with a higher probability of achieving clinical remission at T12 (p = 0.003), which was also confirmed by ROC curve analysis (AUC 0.758, p = 0.002; sensitivity 60% and specificity 74% for a reduction of 16 ppb). CONCLUSION These data confirm the potential of this biomarker in predicting clinical response to biologic treatment in patients with severe asthma in order to guide clinical decisions and evaluate a shift to other biologic therapy.
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Affiliation(s)
- Tommaso Pianigiani
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Simona Luzzi
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Akter Dilroba
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Martina Meocci
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Elisa Salvadori
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Lorenzo Alderighi
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Laura Bergantini
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Miriana d'Alessandro
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Piersante Sestini
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Elena Bargagli
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Paolo Cameli
- Respiratory Diseases Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
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Mao H, Xie Z, Huang S, Shen X, Jin S, Lin T, Yang Z. Analysis of the correlation between serum Klotho and FeNO: a cross-sectional study from NHANES (2007-2012). BMC Pulm Med 2024; 24:61. [PMID: 38287280 PMCID: PMC10823643 DOI: 10.1186/s12890-024-02864-7] [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] [Received: 09/05/2023] [Accepted: 01/17/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Klotho is an anti-aging protein that has multiple functions and may play a key role in the pathogenesis and progression of chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD). Fractional Exhaled Nitric Oxide (FeNO) is a non-invasive and novel biomarker that has the advantages of being simple, fast and reproducible. It can effectively assess the degree of airway inflammation in diseases such as asthma and COPD. Despite these insights, the relationship between serum Klotho levels and FeNO has not been explored yet. METHODS Leveraging data from the National Health and Nutrition Examination Survey (NHANES) spanning 2007 to 2012, we investigated the correlation between FeNO and serum Klotho levels. This association was scrutinized both as continuous variables and within quartile distributions, utilizing the Kruskal-Wallis H test. The correlation between the two variables was assessed through Spearman rank analysis. Employing survey weight-adjusted linear regression models, we gauged the strength of these associations. RESULTS This study included 6,527 participants with a median FeNO level of 14.5 parts per billion (ppb). We found that FeNO levels varied significantly across different quartiles of Klotho protein (H = 7.985, P = 0.046). We also found a significant positive correlation between serum Klotho levels and FeNO levels in the whole population (Spearman's rho = 0.029, P = 0.019). This correlation remained significant after adjusting for covariates such as age, gender, lung function, smoking status, alcohol use, BMI, cardiovascular disease (including hypertension, heart failure, coronary heart disease, and myocardial infarction), diabetes, inflammatory markers, serum vitamin D level and BUN (P < 0.05 for all). Furthermore, this correlation was stronger at the high (K3) and super high (K4) levels of Klotho than at the low (K1) and medium (K2) levels (β = 1.979 ppb and β = 1.993 ppb for K3 and K4 vs. K1, respectively; 95% CI: 0.497 ~ 2.953 and 95% CI: 0.129 ~ 2.827, respectively; P = 0.007 and P = 0.032, respectively). The β coefficient for serum Klotho was 0.002 ppb/pg/ml. CONCLUSIONS Our study illuminates a positive correlation between serum Klotho levels and FeNO. Further study is needed to verify the causality of this association and elucidate the underlying mechanisms.
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Affiliation(s)
- Haiyan Mao
- Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, 315100, Ningbo, China
| | - Zhenye Xie
- Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, 315100, Ningbo, China
| | - Shanshan Huang
- Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, 315100, Ningbo, China
| | - Xingkai Shen
- Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, 315100, Ningbo, China
| | - Shaofeng Jin
- Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, 315100, Ningbo, China
| | - Tong Lin
- Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, 315100, Ningbo, China.
| | - Zhouxin Yang
- Zhejiang Provincial Key Lab of Geriatrics and Geriatrics Institute of Zhejiang Province, Department of Geriatrics, Zhejiang Hospital, 310030, Hangzhou, China.
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Ragnoli B, Radaeli A, Pochetti P, Kette S, Morjaria J, Malerba M. Fractional nitric oxide measurement in exhaled air (FeNO): perspectives in the management of respiratory diseases. Ther Adv Chronic Dis 2023; 14:20406223231190480. [PMID: 37538344 PMCID: PMC10395178 DOI: 10.1177/20406223231190480] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/03/2023] [Indexed: 08/05/2023] Open
Abstract
Exhaled nitric oxide (NO) production, upregulated by inflammatory cytokines and mediators in central and peripheral airways, can be easily and non-invasively detected in exhaled air in asthma and other respiratory conditions as a promising tool for disease monitoring. The American Thoracic Society and European Respiratory Society released recommendations that standardize the measurement of the fractional exhaled NO (FeNO). In asthma, increased FeNO reflects eosinophilic-mediated inflammatory pathways and, as a biomarker of T2 inflammation can be used to identify asthma T2 phenotype. In this setting its measurement has shown to be an important tool especially in the diagnostic process, in the assessment and evaluation of poor adherence or predicting positive response to inhaled corticosteroids treatment, in phenotyping severe asthma patients and as a biomarker to predict the response to biologic treatments. The discovery of the role of NO in the pathogenesis of different diseases affecting the airways and the possibility to estimate the predominant site of increased NO production has provided new insight on its regulatory role in the airways, making it suitable for a potential extended use in clinical practice for different pulmonary diseases, even though its role remains less clear than in asthma. Monitoring FeNO in pulmonary obstructive lung diseases including chronic bronchitis and emphysema, interstitial lung diseases, obstructive sleep apnea and other pulmonary diseases is still under debate but has opened up a window to the role NO may play in the management of these diseases. The use of FeNO is reliable, cost effective and recommendable in both adults and children, and should be implemented in the management of patients with asthma and other respiratory conditions.
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Affiliation(s)
| | | | | | - Stefano Kette
- Respiratory Unit, S. Andrea Hospital, Vercelli, Italy
| | - Jaymin Morjaria
- Department of Respiratory Medicine, Harefield Hospital, Guy’s & St Thomas’ NHS Foundation Trust, Harefield, UK
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Klyamer D, Shao W, Krasnov P, Sukhikh A, Dorovskikh S, Popovetskiy P, Li X, Basova T. Cobalt and Iron Phthalocyanine Derivatives: Effect of Substituents on the Structure of Thin Films and Their Sensor Response to Nitric Oxide. BIOSENSORS 2023; 13:bios13040484. [PMID: 37185559 PMCID: PMC10136685 DOI: 10.3390/bios13040484] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/07/2023] [Accepted: 04/16/2023] [Indexed: 05/17/2023]
Abstract
In this work, we study the effect of substituents in cobalt(II) and iron(II) phthalocyanines (CoPcR4 and FePcR4 with R = H, F, Cl, tBu) on the structural features of their films, and their chemi-resistive sensor response to a low concentration of nitric oxide. For the correct interpretation of diffractograms of phthalocyanine films, structures of CoPcCl4 and FePcCl4 single crystals were determined for the first time. Films were tested as active layers for the determination of low concentrations of NO (10-1000 ppb). It was found that the best sensor response to NO was observed for the films of chlorinated derivatives MPcCl4 (M = Co, Fe), while the lowest response was in the case of MPc(tBu)4 films. FePcCl4 films exhibited the maximal response to NO, with a calculated limit of detection (LOD) of 3 ppb; the response and recovery times determined at 30 ppb of NO were 30 s and 80 s, respectively. The LOD of a CoPcCl4 film was 7 ppb. However, iron phthalocyanine films had low stability and their sensitivity to NO decreased rapidly over time, while the response of cobalt phthalocyanine films remained stable for at least several months. In order to explain the obtained regularities, quantum chemical calculations of the binding parameters between NO and phthalocyanine molecules were carried out. It was shown that the binding of NO to the side atoms of phthalocyanines occurred through van der Waals forces, and the values of the binding energies were in direct correlation with the values of the sensor response to NO.
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Affiliation(s)
- Darya Klyamer
- Nikolaev Institute of Inorganic Chemistry SB RAS, Novosibirsk 630090, Russia
| | - Wenping Shao
- School of Chemical Engineering, University of Science and Technology Liaoning, Anshan 114051, China
| | - Pavel Krasnov
- International Research Center of Spectroscopy and Quantum Chemistry, Siberian Federal University, Krasnoyarsk 660074, Russia
| | - Aleksandr Sukhikh
- Nikolaev Institute of Inorganic Chemistry SB RAS, Novosibirsk 630090, Russia
| | - Svetlana Dorovskikh
- Nikolaev Institute of Inorganic Chemistry SB RAS, Novosibirsk 630090, Russia
| | - Pavel Popovetskiy
- Nikolaev Institute of Inorganic Chemistry SB RAS, Novosibirsk 630090, Russia
| | - Xianchun Li
- School of Chemical Engineering, University of Science and Technology Liaoning, Anshan 114051, China
| | - Tamara Basova
- Nikolaev Institute of Inorganic Chemistry SB RAS, Novosibirsk 630090, Russia
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Czubaj-Kowal M, Nowicki GJ, Kurzawa R, Polak M, Ślusarska B. Factors Influencing the Concentration of Exhaled Nitric Oxide (FeNO) in School Children Aged 8–9-Years-Old in Krakow, with High FeNO Values ≥ 20 ppb. Medicina (B Aires) 2022; 58:medicina58020146. [PMID: 35208470 PMCID: PMC8877257 DOI: 10.3390/medicina58020146] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 11/21/2022] Open
Abstract
Background and Objectives: Measurement of fractional exhaled nitric oxide (FeNO) concentration is currently used as a non-invasive biomarker to assess airway inflammation. Many factors can influence the FeNO level. However, there have been no reports concerning factors attributed to FeNO levels in different age groups of children, especially those with high FeNO values. Therefore, this study aimed to assess the influence of selected factors on nitric oxide concentration in exhaled air in children aged 8–9 attending class 3 of public primary schools in Krakow with high FeNO values ≥ 20 ppb. Materials and Methods: The population-based study covered all third-grade pupils attending primary schools in the city of Krakow. Five thousand, four hundred and sixty children participated in the first screening stage, conducted from October 2017 to January 2018. Then, 792 participants with an FeNO level ≥ 20 ppb were selected. Finally, those selected pupils were invited to participate in the second stage, diagnostic, in April 2018. Four hundred and fifty-four children completed the diagnostic stage of the study, and their data was included in the presented analysis. Results and Conclusions: Significantly higher FeNO levels were observed in children diagnosed with the following diseases: asthma, allergic rhinitis, atopic dermatitis, and allergy (p < 0.05). In addition, it was observed that a higher FeNO concentration characterised children taking antihistamines compared to children not taking those medications (p = 0.008). In multivariate models, we observed that regardless of sex, age, BMI value, home smoking, and whether they were taking medications, children who had allergic rhinitis, or atopic dermatitis, or allergies had significantly higher FeNO levels. The strongest relationship was noted with allergic diseases. The results of our study may be of importance to clinicians when interpreting FeNO results, for example, when making a therapeutic decision.
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Affiliation(s)
- Marta Czubaj-Kowal
- Department of Paediatrics, Stefan Zeromski Specialist Hospital in Krakow, Na Skarpie 66 Str., 31-913 Krakow, Poland
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzińskiego 1 Str., 30-705 Krakow, Poland
- Correspondence: ; Tel.: +48-604-433-42
| | - Grzegorz Józef Nowicki
- Department of Family and Geriatric Nursing, Medical University of Lublin, Staszica 6 Str., 20-081 Lublin, Poland; (G.J.N.); (B.Ś.)
| | - Ryszard Kurzawa
- Department of Alergology and Pneumonology, Institute of Tuberculosis and Lung Disorders, Prof. Jana Rudnika 3B Str., 34-700 Rabka-Zdrój, Poland;
| | - Maciej Polak
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Grzegórzecka 20 Str., 31-531 Krakow, Poland;
| | - Barbara Ślusarska
- Department of Family and Geriatric Nursing, Medical University of Lublin, Staszica 6 Str., 20-081 Lublin, Poland; (G.J.N.); (B.Ś.)
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Pham YL, Beauchamp J. Breath Biomarkers in Diagnostic Applications. Molecules 2021; 26:molecules26185514. [PMID: 34576985 PMCID: PMC8468811 DOI: 10.3390/molecules26185514] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
The detection of chemical compounds in exhaled human breath presents an opportunity to determine physiological state, diagnose disease or assess environmental exposure. Recent advancements in metabolomics research have led to improved capabilities to explore human metabolic profiles in breath. Despite some notable challenges in sampling and analysis, exhaled breath represents a desirable medium for metabolomics applications, foremost due to its non-invasive, convenient and practically limitless availability. Several breath-based tests that target either endogenous or exogenous gas-phase compounds are currently established and are in practical and/or clinical use. This review outlines the concept of breath analysis in the context of these unique tests and their applications. The respective breath biomarkers targeted in each test are discussed in relation to their physiological production in the human body and the development and implementation of the associated tests. The paper concludes with a brief insight into prospective tests and an outlook of the future direction of breath research.
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Affiliation(s)
- Y Lan Pham
- Department of Sensory Analytics and Technologies, Fraunhofer Institute for Process Engineering and Packaging IVV, Giggenhauser Straße 35, 85354 Freising, Germany;
- Department of Chemistry and Pharmacy, Chair of Aroma and Smell Research, Friedrich-Alexander-Universität Erlangen-Nürnberg, Henkestraße 9, 91054 Erlangen, Germany
| | - Jonathan Beauchamp
- Department of Sensory Analytics and Technologies, Fraunhofer Institute for Process Engineering and Packaging IVV, Giggenhauser Straße 35, 85354 Freising, Germany;
- Correspondence:
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Iavicoli I, Fontana L, Leso V, Macrini MC, Pelclova D. Fractional Exhaled Nitric Oxide and Nanomaterial Exposure in Workplaces. Curr Med Chem 2020; 27:7200-7212. [DOI: 10.2174/0929867327666200320154545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/07/2020] [Accepted: 02/26/2020] [Indexed: 12/20/2022]
Abstract
Background:
The widespread application of engineered nanomaterials (ENMs) and the
increasing likelihood of general and occupational exposure raised concerns on their possible human
health impact. ENMs, in fact, may induce alterations in different organ systems, and particularly in
the respiratory tract. This makes it important to identify possible biomarkers of early lung effect in
exposed workers. In this regard, the possibility to use the fractional exhaled levels of nitric oxide
(FENO) in biological monitoring has attracted considerable interest.
Objective:
To comprehensively assess the role of FENO as a possible biomarker of lung effect in
ENM exposed workers.
Methods:
A systematic search was performed on Pubmed, Scopus, and ISI Web of Knowledge
databases according to the PRISMA guidelines.
Results:
Seven studies investigated FENO in workers exposed to different kinds of metal-(i.e.
silver and gold), metal oxide- (titanium and silica dioxide), and carbon-based ENMs (carbon nanotubes).
In general, no significant alterations were detected between exposed workers and controls.
Conclusions:
Definite conclusion on the function of FENO in occupational biological monitoring
cannot be extrapolated due to the limited number of available studies and the small size of investigated
populations. Additionally, the lack of environmental monitoring data and the fragmented
knowledge on ENM modes of action prevent to establish dose-response relationships. Future research
appears necessary to deeply define the possibility to employ FENO as an early biomarker of
lung effects taking in consideration possible occupational exposure issues, i.e. differently characterized
ENMs and work tasks, as well as individual influencing factors, i.e. smoking and atopy.
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Affiliation(s)
- Ivo Iavicoli
- Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Luca Fontana
- Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Veruscka Leso
- Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Maria Carmela Macrini
- Department of Public Health, Section of Occupational Medicine, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy
| | - Daniela Pelclova
- Department of Occupational Medicine, First Faculty of Medicine, Charles University and General University Hospital, Na Bojisti 1, 120,00 Prague, Czech Republic
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Boer S, Honkoop PJ, Loijmans RJB, Snoeck-Stroband JB, Assendelft WJJ, Schermer TRJ, Sont JK. Personalised exhaled nitric oxygen fraction ( F ENO)-driven asthma management in primary care: a F ENO subgroup analysis of the ACCURATE trial. ERJ Open Res 2020; 6:00351-2019. [PMID: 32963989 PMCID: PMC7487343 DOI: 10.1183/23120541.00351-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/24/2020] [Indexed: 01/19/2023] Open
Abstract
Background The aim of this study was to identify patients who benefit most from exhaled nitric oxide fraction (FENO)-driven asthma management in primary care, based on prespecified subgroups with different levels of FENO. Methods We used data from 179 adults with asthma from a 12-month primary care randomised controlled trial with 3-monthly assessments of FENO, asthma control, medication usage, costs of medication, severe asthma exacerbations and quality of life. In the original study, patients were randomised to either a symptom-driven treatment strategy (controlled asthma (Ca) strategy) or a FENO+symptom-driven strategy (FCa). In both groups, patients were categorised by their baseline level of FENO as low (<25 ppb), intermediate (25–50 ppb) and high (>50 ppb). At 12 months, we compared, for each prespecified FENO subgroup, asthma control, asthma-related quality of life, medication usage, and costs of medication between the Ca and FCa strategy. Results We found a difference between the Ca and FCa strategy for the mean dosage of beclomethasone strategy of 223 µg (95% CI 6–439), p=0.04) and for the total costs of asthma medication a mean reduction of US$159 (95% CI US$33–285), p=0.03) in patients with a low baseline FENO level. No differences were found for asthma control, severe asthma exacerbations and asthma-related quality of life in patients with a low baseline FENO level. Furthermore, in patients with intermediate or high level of FENO, no differences were found. Conclusions In primary care, FENO-driven asthma management is effective in patients with a low FENO level, for whom it is possible to down-titrate medication, while preserving asthma control and quality of life. In primary care, FENO-driven asthma management is effective in patients with a low FENO, for whom it is possible to down-titrate medication while preserving asthma control and quality of lifehttps://bit.ly/2wC25N7d
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Affiliation(s)
- Suzanne Boer
- Dept of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands.,Dept of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Persijn J Honkoop
- Dept of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Rik J B Loijmans
- Dept of General Practice, Academic Medical Centre, Amsterdam, The Netherlands
| | - Jiska B Snoeck-Stroband
- Dept of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Willem J J Assendelft
- Dept of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tjard R J Schermer
- Dept of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jacob K Sont
- Dept of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
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Asthma rehabilitation at high vs. low altitude and its impact on exhaled nitric oxide and sensitization patterns: Randomized parallel-group trial. Respir Med 2020; 170:106040. [PMID: 32843171 DOI: 10.1016/j.rmed.2020.106040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Allergens and pollution are reduced at high altitude. We investigated the effect of asthma rehabilitation at high altitude (HA, 3100 m) compared to low altitude (LA, 760 m) on exhaled nitric oxide (FeNO) and on specific IgE levels for house dust mites (HDM,d1) and common pollen (sx1). METHODS For this randomized controlled trial adult asthmatics living <1000 m were randomly assigned to a 3-week in-hospital-rehabilitation (education, physical- and breathing-exercises) at either LA or HA. Changes in FeNO, d1 and sx1 from baseline to end-rehabilitation were measured. RESULTS 50 asthmatics (34 females) were randomized [mean ± standard deviation LA: n = 25, 44 ± 11 years, total IgE 267 ± 365kU/l; HA: n = 25, 43 ± 13 years, total IgE 350 ± 445kU/l]. FeNO significantly improved at HA from 69 ± 56 ppb at baseline to the first day at altitude 23 ± 19 ppb and remained decreased until end-rehabilitation with 37 ± 23 ppb, mean difference 95%CI -31(-50 to -13, p = 0.001) whereas at LA FeNO did not change. A significant decrease in d1 and sx1 at end-rehabilitation was observed in the LA-group [mean difference 95%CI -10.2 kUA/l (-18.9 to -1.4) for d1 and -4.95 kUA/l(-9.69 to -0.21) for sx1] but not in the HA-group. No significant difference between groups [d1 5.9 kUA/l(-4.2 to 16.2) and sx1 4.4 kUA/l(-3.5 to 12.4)] was found. CONCLUSION Rehabilitation at HA led to significant FeNO reduction starting from the first day until end-rehabilitation despite unchanged levels of specific IgE. The significant decrease in d1 and sx1 at end-rehabilitation in the LA group might be explained by less HDM in the hospital and/or reduced seasonal pollen, as this decrease was not observed at HA.
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Phenotypes and endotypes of adult asthma: Moving toward precision medicine. J Allergy Clin Immunol 2020; 144:1-12. [PMID: 31277742 DOI: 10.1016/j.jaci.2019.05.031] [Citation(s) in RCA: 245] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 05/30/2019] [Accepted: 05/30/2019] [Indexed: 02/07/2023]
Abstract
Asthma is a chronic inflammatory disease of the airways that is challenging to dissect into subgroups because of the heterogeneity present across the spectrum of the disease. Efforts to subclassify asthma using advanced computational methods have identified a number of different phenotypes that suggest that multiple pathobiologically driven clusters of disease exist. The main phenotypes that have been identified include (1) early-onset allergic asthma, (2) early-onset allergic moderate-to-severe remodeled asthma, (3) late-onset nonallergic eosinophilic asthma, and (4) late-onset nonallergic noneosinophilic asthma. Subgroups of these phenotypes also exist but have not been as consistently identified. Advances in our understanding of the diverse immunologic perturbations that drive airway inflammation are consistent with clinical traits associated with these phenotypes and their response to biologic therapies. This has improved the clinician's approach to characterizing asthmatic patients in the clinic. Being able to define asthma endotypes using clinical characteristics and biomarkers will move physicians toward even more personalized management of asthma and precision-based care in the future. Here we will review the most prominent phenotypes and immunologic advances that suggest these disease subtypes represent asthma endotypes.
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Nguyen VN, Chavannes NH. Correlation between fractional exhaled nitric oxide and Asthma Control Test score and spirometry parameters in on-treatment-asthmatics in Ho Chi Minh City. J Thorac Dis 2020; 12:2197-2209. [PMID: 32642125 PMCID: PMC7330382 DOI: 10.21037/jtd.2020.04.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Although fractional exhaled nitric oxide (FeNO) is a reliable and easily applied marker of airway inflammation in asthma, the relationship between FeNO and indicators of asthma control [Asthma Control Test (ACT) score] and/or severity (spirometry parameters) remains unclear. This study aims to determine possible correlations between FeNO and ACT score; and between FeNO and spirometry parameters. Methods A cross-sectional study with convenience sampling was conducted among ambulatory patients in the Asthma & COPD clinic at the University Medical Center, Ho Chi Minh City from March 2016 to March 2017. Using measurement of FeNO, the ACT questionnaire and a spirometry test, correlations were determined between FeNO and the ACT score and spirometry parameters. Results Four hundred and ten asthmatic patients (mean age 42 years; 65% female) were included and analyzed; their mean time since onset of asthma was 9.5 years. All patients were treated following step 2 to 4 of GINA guidelines. Mean (SD) FeNO was 29.5 (24.4) parts per billion (ppb) and mean (SD) ACT score was 20.5 (40). A significant difference in FeNO values was found among the three groups with different asthma control levels categorized according to the ACT score (P=0.001) but was not found among the three groups with different asthma treatment levels (P=0.425). FeNO was significantly inversely correlated with the ACT score (Spearman’s r =−0.224, P<0.001) and with spirometry parameters indicate airway obstruction such as predicted FEV1, FEV1/FVC, predicted PEF and predicted FEF25–75% with Spearman’s r were −0.187; −0.143; −0.091 and −0.195, respectively (all P<0.05), whereas no correlation between FeNO and FVC—an indicator of airway restriction—was found. Conclusions In these asthmatic patients in Vietnam, an inverse correlation was found between FeNO and the ACT score and between FeNO and spirometry indicators of airway obstruction. Therefore, FeNO may be a useful tool in asthma management.
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Affiliation(s)
- Vinh Nhu Nguyen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Department of Family Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,Department of Respiratory Functional Exploration, University Medical Center, Ho Chi Minh City, Vietnam
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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12
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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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13
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Tao W, Lin P, Liu S, Xie Q, Ke S, Zeng X. 1-Butyl-3-Methylimidazolium Tetrafluoroborate Film as a Highly Selective Sensing Material for Non-Invasive Detection of Acetone Using a Quartz Crystal Microbalance. SENSORS 2017; 17:s17010194. [PMID: 28117697 PMCID: PMC5298767 DOI: 10.3390/s17010194] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 01/08/2017] [Accepted: 01/13/2017] [Indexed: 01/12/2023]
Abstract
Breath acetone serves as a biomarker for diabetes. This article reports 1-butyl-3-methylimidazolium tetrafluoroborate ([bmim][BF₄]), a type of room temperature ionic liquid (RTIL), as a selective sensing material for acetone. The RTIL sensing layer was coated on a quartz crystal microbalance (QCM) for detection. The sensing mechanism is based on a decrease in viscosity and density of the [bmim][BF₄] film due to the solubilization of acetone leading to a positive frequency shift in the QCM. Acetone was detected with a linear range from 7.05 to 750 ppmv. Sensitivity and limit of detection were found to be 3.49 Hz/ppmv and 5.0 ppmv, respectively. The [bmim][BF₄]-modified QCM sensor demonstrated anti-interference ability to commonly found volatile organic compounds in breath, e.g., isoprene, 1,2-pentadiene, d-limonene, and dl-limonene. This technology is useful for applications in non-invasive early diabetic diagnosis.
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Affiliation(s)
- Wenyan Tao
- Shenzhen Key Laboratory of Special Functional Materials & Shenzhen Engineering Laboratory for Advance Technology of Ceramics, College of Materials Science and Engineering, Shenzhen University, Shenzhen 510081, China.
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, China.
| | - Peng Lin
- Shenzhen Key Laboratory of Special Functional Materials & Shenzhen Engineering Laboratory for Advance Technology of Ceramics, College of Materials Science and Engineering, Shenzhen University, Shenzhen 510081, China.
| | - Sili Liu
- Department of Biomedical Engineering, the Chinese University of Hong Kong, Shatin, Hong Kong 999077, China.
| | - Qingji Xie
- College of Chemistry and Chemical Engineering, Hunan Normal University, Changsha 410082, China.
| | - Shanming Ke
- Shenzhen Key Laboratory of Special Functional Materials & Shenzhen Engineering Laboratory for Advance Technology of Ceramics, College of Materials Science and Engineering, Shenzhen University, Shenzhen 510081, China.
| | - Xierong Zeng
- Shenzhen Key Laboratory of Special Functional Materials & Shenzhen Engineering Laboratory for Advance Technology of Ceramics, College of Materials Science and Engineering, Shenzhen University, Shenzhen 510081, China.
- Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, China.
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14
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Tao W, Lin P, Ai Y, Wang H, Ke S, Zeng X. Multichannel quartz crystal microbalance array: Fabrication, evaluation, application in biomarker detection. Anal Biochem 2015; 494:85-92. [PMID: 26582433 DOI: 10.1016/j.ab.2015.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 10/30/2015] [Accepted: 11/02/2015] [Indexed: 11/16/2022]
Abstract
A multichannel quartz crystal microbalance array (MQCM) with three pairs of gold electrodes was fabricated for detection of two biomarkers: acetone and nitric oxide (NO). The gold electrodes were deposited symmetrically on an AT-cut 10 MHz circular quartz plate using photolithography, sputtering, and lift-off technologies. The effect of gold layer thickness on MQCM performance was investigated and the optimized thickness was 101 nm. The simulation values of the electric parameters C0, Cq, Lq, and Rq in the Butterworth-Van Dike equivalent circuit for the MQCM device were 97 pF, 1.3 pF, 1.05 mH, and 9.8 Ω, respectively. Simulation values were in the theoretical range, which indicated that the fabricated MQCM device had good resonance performance. Two types of nanocomposites, titanium dioxide-multiwalled carbon nanotubes and cobalt (II)phthalocyanine-silica, were synthesized as sensing materials. The sensing mechanism is based on coordination adsorption of target molecules onto the sensing material, resulting in a resonant frequency shift of modified QCM sensor. A linear range from 4.33 to 129.75 ppmv for acetone was obtained and one from 5.75 to 103.45 ppbv for NO.
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Affiliation(s)
- Wenyan Tao
- Shenzhen Key Laboratory of Special Functional Materials & Shenzhen Engineering Laboratory for Advance Technology of Ceramics, College of Materials Science and Engineering, Shenzhen University, Shenzhen, China; Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Optoelectronic Engineering, Shenzhen University, Shenzhen, China
| | - Peng Lin
- Shenzhen Key Laboratory of Special Functional Materials & Shenzhen Engineering Laboratory for Advance Technology of Ceramics, College of Materials Science and Engineering, Shenzhen University, Shenzhen, China.
| | - Yanqing Ai
- Software College, Shenzhen Institute of Information Technology, Shenzhen, China
| | - Hairui Wang
- Shenzhen Key Laboratory of Special Functional Materials & Shenzhen Engineering Laboratory for Advance Technology of Ceramics, College of Materials Science and Engineering, Shenzhen University, Shenzhen, China; Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Optoelectronic Engineering, Shenzhen University, Shenzhen, China
| | - Shanming Ke
- Shenzhen Key Laboratory of Special Functional Materials & Shenzhen Engineering Laboratory for Advance Technology of Ceramics, College of Materials Science and Engineering, Shenzhen University, Shenzhen, China
| | - Xierong Zeng
- Shenzhen Key Laboratory of Special Functional Materials & Shenzhen Engineering Laboratory for Advance Technology of Ceramics, College of Materials Science and Engineering, Shenzhen University, Shenzhen, China; Key Laboratory of Optoelectronic Devices and Systems of Ministry of Education and Guangdong Province, College of Optoelectronic Engineering, Shenzhen University, Shenzhen, China.
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15
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Wang Y, Nikodem M, Zhang E, Cikach F, Barnes J, Comhair S, Dweik RA, Kao C, Wysocki G. Shot-noise limited Faraday rotation spectroscopy for detection of nitric oxide isotopes in breath, urine, and blood. Sci Rep 2015; 5:9096. [PMID: 25767064 PMCID: PMC4357895 DOI: 10.1038/srep09096] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 02/19/2015] [Indexed: 11/24/2022] Open
Abstract
Measurement of NO and/or its metabolites in the various body compartments has transformed our understanding of biology. The inability of the current NO measurement methods to account for naturally occurring and experimental NO isotopes, however, has prevented the scientific community from fully understating NO metabolism in vivo. Here we present a mid-IR Faraday rotation spectrometer (FRS) for detection of NO isotopes. The instrument utilizes a novel dual modulation/demodulation (DM) FRS method which exhibits noise performance at only 2 times the fundamental quantum shot-noise level and provides the record sensitivity in its class. This is achieved with a system that is fully autonomous, robust, transportable, and does not require cryogenic cooling. The DM-FRS enables continuous monitoring of nitric oxide isotopes with the detection limits of 3.72 ppbv/Hz1/2 to14NO and 0.53 ppbv/Hz1/2 to15NO using only 45 cm active optical path. This DM-FRS measurement method can be used to improve the performance of conventional FRS sensors targeting other radical species. The feasibility of the instrument to perform measurements relevant to studies of NO metabolism in humans is demonstrated.
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Affiliation(s)
- Yin Wang
- Electrical Engineering Department, Princeton University, Princeton, NJ 08540, USA
| | - Michal Nikodem
- Electrical Engineering Department, Princeton University, Princeton, NJ 08540, USA
| | - Eric Zhang
- Electrical Engineering Department, Princeton University, Princeton, NJ 08540, USA
| | - Frank Cikach
- Department of Pathobiology/Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Jarrod Barnes
- Department of Pathobiology/Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Suzy Comhair
- Department of Pathobiology/Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Raed A Dweik
- 1] Department of Pathobiology/Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA [2] Pulmonary and Critical Care Medicine/Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Christina Kao
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Gerard Wysocki
- Electrical Engineering Department, Princeton University, Princeton, NJ 08540, USA
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16
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Song WJ, Kwon JW, Kim EJ, Lee SM, Kim SH, Lee SY, Kim SH, Park HW, Chang YS, Kim WK, Shim JY, Seo JH, Kim BJ, Kim HB, Song DJ, Jang GC, Jang AS, Park JW, Yoon HJ, Lee JS, Cho SH, Hong SJ. Clinical application of exhaled nitric oxide measurements in a korean population. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2014; 7:3-13. [PMID: 25553257 PMCID: PMC4274466 DOI: 10.4168/aair.2015.7.1.3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 10/25/2013] [Indexed: 12/31/2022]
Abstract
Nitric oxide (NO) is a biologic mediator of various physiologic functions. Recent evidence suggests the clinical utility of fractional exhaled NO (FeNO) as a biomarker for assessing asthma and other respiratory diseases. FeNO methodologies have been recently standardized by international research groups and subsequently validated in several Korean population studies. Normal ranges for FeNO have been reported for various ethnic groups, and the clinical utility has been widely evaluated in asthma and various respiratory diseases. Based on current evidence including most of Korean population data, this position paper aims to introduce the methodological considerations, and provide the guidance for the proper clinical application of FeNO measurements in Korean populations.
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Affiliation(s)
- Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Won Kwon
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun-Jin Kim
- Allergy TF, Department of Immunology and Pathology, Korea National Institute of Health, Cheongwon, Korea
| | - Sang-Min Lee
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - So-Yeon Lee
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Suwon, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Heung-Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woo Kyung Kim
- Department of Pediatrics, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jung Yeon Shim
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ju-Hee Seo
- Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byoung-Ju Kim
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
| | - Hyo Bin Kim
- Department of Pediatrics, Hae-undae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dae Jin Song
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - An-Soo Jang
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jung-Won Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ho-Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Joo-Shil Lee
- Allergy TF, Department of Immunology and Pathology, Korea National Institute of Health, Cheongwon, Korea
| | - Sang-Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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17
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Cikach FS, Tonelli AR, Barnes J, Paschke K, Newman J, Grove D, Dababneh L, Wang S, Dweik RA. Breath analysis in pulmonary arterial hypertension. Chest 2014; 145:551-558. [PMID: 24091389 DOI: 10.1378/chest.13-1363] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is a progressive and devastating condition characterized by vascular cell proliferation and is associated with several metabolic derangements. We hypothesized that metabolic derangements in PAH can be detected by measuring metabolic by-products in exhaled breath. METHODS We collected breath and blood samples from patients with PAH at the time of right-sided heart catheterization (n=31) and from healthy control subjects (n=34). Breath was analyzed by selected ion flow tube-mass spectrometry in predetermined training and validation cohorts. RESULTS Patients with PAH were 51.5±14 years old, and 27 were women (85%). Control subjects were 38±13 years old, and 22 were women (65%). Discriminant analysis in the training set identified three ion peaks (H3O+29+, NO+56+, and O2+98+) and the variable age that correctly classified 88.9% of the individuals. In an independent validation cohort, 82.8% of the individuals were classified correctly. The concentrations of the volatile organic compounds 2-propanol, acetaldehyde, ammonia, ethanol, pentane, 1-decene, 1-octene, and 2-nonene were different in patients with PAH compared with control subjects. Exhaled ammonia was higher in patients with PAH (median [interquartile range]: 94.7 parts per billion (ppb) [70-129 ppb] vs 60.9 ppb [46-77 ppb], P<.001) and was associated with right atrial pressure (ρ=0.57, P<.001), mean pulmonary artery pressure (ρ=0.43, P=.015), cardiac index by thermodilution (ρ=-0.39, P=.03), pulmonary vascular resistance (ρ=0.40, P=.04), mixed venous oxygen (ρ=-0.59, P<.001), and right ventricular dilation (ρ=0.42, P=.03). CONCLUSIONS Breathprint is different between patients with PAH and healthy control subjects. Several specific compounds, including ammonia, were elevated in the breath of patients with PAH. Exhaled ammonia levels correlated with severity of disease.
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Affiliation(s)
- Frank S Cikach
- Pathobiology Department, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Adriano R Tonelli
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Jarrod Barnes
- Pathobiology Department, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Kelly Paschke
- Pathobiology Department, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Jennie Newman
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - David Grove
- Pathobiology Department, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Luma Dababneh
- Pathobiology Department, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Sihe Wang
- Department of Clinical Pathology, Cleveland Clinic, Cleveland, OH
| | - Raed A Dweik
- Pathobiology Department, Lerner Research Institute, Cleveland Clinic, Cleveland, OH.
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18
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Manna A, Caffarelli C, Varini M, Dascola CP, Montella S, Maglione M, Sperlì F, Santamaria F. Clinical application of exhaled nitric oxide measurement in pediatric lung diseases. Ital J Pediatr 2012; 38:74. [PMID: 23273317 PMCID: PMC3545741 DOI: 10.1186/1824-7288-38-74] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 12/19/2012] [Indexed: 12/18/2022] Open
Abstract
Fractional exhaled nitric oxide (FeNO) is a non invasive method for assessing the inflammatory status of children with airway disease. Different ways to measure FeNO levels are currently available. The possibility of measuring FeNO levels in an office setting even in young children, and the commercial availability of portable devices, support the routine use of FeNO determination in the daily pediatric practice. Although many confounding factors may affect its measurement, FeNO is now widely used in the management of children with asthma, and seems to provide significantly higher diagnostic accuracy than lung function or bronchial challenge tests. The role of FeNO in airway infection (e.g. viral bronchiolitis and common acquired pneumonia), in bronchiectasis, or in cases with diffuse lung disease is less clear. This review focuses on the most recent advances and the current clinical applications of FeNO measurement in pediatric lung disease.
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Affiliation(s)
- Angelo Manna
- Department of Pediatrics, Federico II University, Via Sergio Pansini, 5 80131, Naples, Italy
| | - Carlo Caffarelli
- Department of Pediatrics, University Hospital of Parma, Parma, Italy
| | - Margherita Varini
- Department of Pediatrics, University Hospital of Parma, Parma, Italy
| | | | - Silvia Montella
- Department of Pediatrics, Federico II University, Via Sergio Pansini, 5 80131, Naples, Italy
| | - Marco Maglione
- Department of Pediatrics, Federico II University, Via Sergio Pansini, 5 80131, Naples, Italy
| | - Francesco Sperlì
- Department of Pediatrics, Federico II University, Via Sergio Pansini, 5 80131, Naples, Italy
| | - Francesca Santamaria
- Department of Pediatrics, Federico II University, Via Sergio Pansini, 5 80131, Naples, Italy
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19
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Caspersen C, Stang J, Thorsen E, Stensrud T. Exhaled nitric oxide concentration upon acute exposure to moderate altitude. Scand J Med Sci Sports 2012; 23:e102-7. [PMID: 23157566 DOI: 10.1111/sms.12018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2012] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to assess immediate changes in the partial pressure of nitric oxide (NO) in exhaled gas (PE NO ) in healthy trained subjects who were acutely exposed to moderate altitude. One group of nine and another group of 20 healthy subjects were exposed to an ambient pressure of 728 hPa (546 mmHg) corresponding to an altitude of 2800 m for 5 and 90 min, respectively, in an altitude chamber. PE NO was measured offline by sampling exhaled gas in tight metal foil bags at 5, 30, 60, and 90 min. A correction for increased expiratory flow rate due to gas density effects at altitude was performed (PE NO corr). PE NO was significantly decreased by 13-16%, while the fraction of NO in exhaled gas (FE NO) was increased by 16-19% compared to sea level. There was no significant change in PE NO corr after exposure to altitude for 5, 30, 60, and 90 min. We conclude that there was no change in PENO upon arrival at altitude after correcting for gas density effects on expiratory flow rate. Corrections for altitude effects must be done before comparing measurements performed at different altitudes when using measurements of FENO to monitor athletes who have asthma during training at altitude.
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Affiliation(s)
- C Caspersen
- Institute of Medicine, University of Bergen, Bergen, Norway
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20
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Abstract
With each breath that we exhale, thousands of molecules are expelled in our breath, giving individuals a "breath-print" that can tell a lot about them and their state of health. Breath analysis is rapidly evolving as the new frontier in medical testing. The end of the 20th century and the beginning of the 21st century have arguably witnessed a revolution in our understanding of the constituents of exhaled breath and the development of the field of breath analysis and testing. Thanks to major breakthroughs in new technologies (infrared, electrochemical, chemiluminescence, and others) and the availability of mass spectrometers, the field of breath analysis has made considerable advances in the 21st century. Several methods are now in clinical use or nearly ready to enter that arena. Breath analysis has the potential to offer relatively inexpensive, rapid, noninvasive methods for detecting and/or monitoring a variety of diseases. Breath analysis also has applications in fields beyond medicine, including environmental monitoring, security, and others. This review will focus on exhaled breath as a potential source of biomarkers for medical applications with specific attention to applications (and potential applications) in cardiovascular disease.
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Affiliation(s)
- Frank S Cikach
- Department of Pathobiology/Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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21
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Grob NM, Laskowski D, Dweik RA. A technical report on exhaled nitric oxide measurement: asthma monitoring in athletes. J Breath Res 2012; 2:37027. [PMID: 20622980 DOI: 10.1088/1752-7155/2/3/037027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Exhaled NO (FE(NO)) measurements have been utilized as a marker to diagnose asthma as well as a non-invasive tool for monitoring airway inflammation and the response to anti-inflammatory medications. One area where this non-invasive monitoring may be helpful is for asthmatic athletes as they train for competitive events. We hypothesized that in the course of training an asthmatic individual may experience worsening of lung inflammation reflected in FE(NO) levels that may be too subtle to detect by conventional methods like spirometry. Data were collected from an asthmatic patient (n = 1) over the course of endurance training using both the desktop (NIOX) and the portable NO (MINO) analyzers daily for eight weeks. We found that average NO levels measured in the desktop system correlated well with the two portable analyzers (r(2) =0.73, r(2) = 0.74 p < 0.0001); additionally, there was a strong correlation between the two MINO devices (r(2) = 0.88; p < 0.0001). A strong negative relationship existed between the number of miles run and NO, regardless of the device used. FEV(1) and PEF, however, did not change significantly as the miles run increased. Exercise training in asthmatics was associated with a decrease (improvement) in NO levels but no significant change in FEV(1) and PEF. This suggests that exhaled NO levels may be more sensitive to changes in the airway as a result of exercise than traditional pulmonary function testing.
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Affiliation(s)
- Natalia M Grob
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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Grob NM, Dweik RA. Exhaled nitric oxide in asthma: progress since the introduction of standardized methodology. J Breath Res 2012; 2:37002. [PMID: 20664809 DOI: 10.1088/1752-7155/2/3/037002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The measurement of nitric oxide (NO) in exhaled breath has given us the ability to learn about and monitor the inflammatory status of the airway through a non-invasive method that is easy to perform and repeat. This has been most useful in the diagnosis and management of asthma and has promised a seemingly unlimited potential for evaluating the airways and how clinical decisions are made (Grob N M and Dweik R A 2008 Chest133 837-9). The exhaled NO field was initially limited, however, due to the absence of standardized methodology. The ATS and ERS jointly released recommendations for standardized methods of measuring and reporting exhaled NO in 1999 that were revised in 2005 (1999 Am. J. Respir. Crit. Care. Med. 160 2104-17; 2005 Am. J. Respir. Crit. Care. Med. 171 912-30). In this paper, we summarize the literature that followed this standardization. We searched the literature for all papers that included the term 'exhaled nitric oxide' and selected those that followed ATS guidelines for online measurement for further review. We also reviewed cut-off values suggested by groups studying exhaled nitric oxide. We found a wide range of NO values reported for normal and asthma populations. The geometric mean for FE(NO) ranged from 10 ppb to 33 ppb in healthy adult control populations. For asthma, the FE(NO) geometric mean ranged from 6 ppb to 98 ppb. This considerable variation likely reflects the different clinical settings and purposes of measurement. Exhaled NO has been used for a multitude of reasons that range from screening, to diagnosis, to monitoring the effect of therapy. The field of exhaled NO has made undeniable progress since the standardization of the measurement methods. Our challenge now is to have guidelines to interpret exhaled NO levels in the appropriate context. As the utility of exhaled NO continues to evolve, it can serve as a good example of the crucial role of the standardization of collection and measurement methods to propel any new test in the right direction as it makes its way from a research tool to a clinically useful test.
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Affiliation(s)
- Natalia M Grob
- Department of Pulmonary, Allergy and Critical Care Medicine/Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
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Hunter GW, Dweik RA. Applied breath analysis: an overview of the challenges and opportunities in developing and testing sensor technology for human health monitoring in aerospace and clinical applications. J Breath Res 2012; 2:037020. [PMID: 20622933 DOI: 10.1088/1752-7155/2/3/037020] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aerospace industry requires the development of a range of chemical sensor technologies for such applications as leak detection, emission monitoring, fuel leak detection, environmental monitoring, and fire detection. A family of chemical sensors are being developed based on micromachining and microfabrication technology to fabricate microsensors with minimal size, weight, and power consumption, and the use of nanomaterials and structures to develop sensors with improved stability combined with higher sensitivity. However, individual sensors are limited in the amount of information that they can provide in environments that contain multiple chemical species. Thus, sensor arrays are being developed to address detection needs in such multi-species environments. These technologies and technical approaches have direct relevance to breath monitoring for clinical applications. This paper gives an overview of developing cutting-edge sensor technology and possible barriers to new technology implementation. This includes lessons learned from previous microsensor development, recent work in development of a breath monitoring system, and future directions in the implementation of cutting edge sensor technology. Clinical applications and the potential impact to the biomedical field of miniaturized smart gas sensor technology are discussed.
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Should exhaled nitric oxide measurement be part of routine asthma management? Ann Allergy Asthma Immunol 2012; 109:289-91. [PMID: 23062380 DOI: 10.1016/j.anai.2012.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 08/20/2012] [Indexed: 11/20/2022]
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Aytekin M, Dweik RA. Nitric oxide and asthma severity: towards a better understanding of asthma phenotypes. Clin Exp Allergy 2012; 42:614-6. [PMID: 22515385 DOI: 10.1111/j.1365-2222.2012.03976.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
With each breath that we exhale, thousands of molecules are expelled in our breath, giving individuals a "breath-print" that can tell a lot about them and their state of health. Breath analysis is rapidly evolving as the new frontier in medical testing. The end of the 20th century and the beginning of the 21st century have arguably witnessed a revolution in our understanding of the constituents of exhaled breath and the development of the field of breath analysis and testing. Thanks to major breakthroughs in new technologies (infrared, electrochemical, chemiluminescence, and others) and the availability of mass spectrometers, the field of breath analysis has made considerable advances in the 21st century. Several methods are now in clinical use or nearly ready to enter that arena. Breath analysis has the potential to offer relatively inexpensive, rapid, noninvasive methods for detecting and/or monitoring a variety of diseases. Breath analysis also has applications in fields beyond medicine, including environmental monitoring, security, and others. This review will focus on exhaled breath as a potential source of biomarkers for medical applications with specific attention to applications (and potential applications) in cardiovascular disease.
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Affiliation(s)
- Frank S. Cikach
- Department of Pathobiology / Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, 44195
| | - Raed A. Dweik
- Department of Pathobiology / Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, 44195
- Department of Pulmonary and Critical Care Medicine / Respiratory Institute Cleveland Clinic, Cleveland, Ohio, 44195
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Dweik RA, Boggs PB, Erzurum SC, Irvin CG, Leigh MW, Lundberg JO, Olin AC, Plummer AL, Taylor DR. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med 2011; 184:602-15. [PMID: 21885636 DOI: 10.1164/rccm.9120-11st] [Citation(s) in RCA: 1742] [Impact Index Per Article: 134.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Measurement of fractional nitric oxide (NO) concentration in exhaled breath (Fe(NO)) is a quantitative, noninvasive, simple, and safe method of measuring airway inflammation that provides a complementary tool to other ways of assessing airways disease, including asthma. While Fe(NO) measurement has been standardized, there is currently no reference guideline for practicing health care providers to guide them in the appropriate use and interpretation of Fe(NO) in clinical practice. PURPOSE To develop evidence-based guidelines for the interpretation of Fe(NO) measurements that incorporate evidence that has accumulated over the past decade. METHODS We created a multidisciplinary committee with expertise in the clinical care, clinical science, or basic science of airway disease and/or NO. The committee identified important clinical questions, synthesized the evidence, and formulated recommendations. Recommendations were developed using pragmatic systematic reviews of the literature and the GRADE approach. RESULTS The evidence related to the use of Fe(NO) measurements is reviewed and clinical practice recommendations are provided. CONCLUSIONS In the setting of chronic inflammatory airway disease including asthma, conventional tests such as FEV(1) reversibility or provocation tests are only indirectly associated with airway inflammation. Fe(NO) offers added advantages for patient care including, but not limited to (1) detecting of eosinophilic airway inflammation, (2) determining the likelihood of corticosteroid responsiveness, (3) monitoring of airway inflammation to determine the potential need for corticosteroid, and (4) unmasking of otherwise unsuspected nonadherence to corticosteroid therapy.
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Dweik RA. The great challenge for exhaled breath analysis: embracing complexity, delivering simplicity. J Breath Res 2011; 5:030201. [PMID: 21900732 DOI: 10.1088/1752-7155/5/3/030201] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Hunter GW, Xu JC, Biaggi-Labiosa AM, Laskowski D, Dutta PK, Mondal SP, Ward BJ, Makel DB, Liu CC, Chang CW, Dweik RA. Smart sensor systems for human health breath monitoring applications. J Breath Res 2011; 5:037111. [PMID: 21896970 DOI: 10.1088/1752-7155/5/3/037111] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Breath analysis techniques offer a potential revolution in health care diagnostics, especially if these techniques can be brought into standard use in the clinic and at home. The advent of microsensors combined with smart sensor system technology enables a new generation of sensor systems with significantly enhanced capabilities and minimal size, weight and power consumption. This paper discusses the microsensor/smart sensor system approach and provides a summary of efforts to migrate this technology into human health breath monitoring applications. First, the basic capability of this approach to measure exhaled breath associated with exercise physiology is demonstrated. Building from this foundation, the development of a system for a portable asthma home health care system is described. A solid-state nitric oxide (NO) sensor for asthma monitoring has been identified, and efforts are underway to miniaturize this NO sensor technology and integrate it into a smart sensor system. It is concluded that base platform microsensor technology combined with smart sensor systems can address the needs of a range of breath monitoring applications and enable new capabilities for healthcare.
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Affiliation(s)
- G W Hunter
- NASA Glenn Research Center, Cleveland, OH, USA.
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Millward D, Paul S, Brown M, Porter D, Stilson M, Cohen R, Olvey E, Hagan J. The diagnosis of asthma and exercise-induced bronchospasm in division I athletes. Clin J Sport Med 2009; 19:482-6. [PMID: 19898076 DOI: 10.1097/jsm.0b013e3181bcde2c] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the accuracy of clinically diagnosed exercise-induced bronchospasm (EIB) and asthma among National Collegiate Athletic Association Division I student athletes. DESIGN Cohort study. SETTING Division I university athletic department and primary care sports medicine clinic/athletic training room. PATIENTS All varsity athletes were eligible for the study. Seventy-five participants entered the study; 74 completed all the study protocols. INTERVENTIONS Study participants underwent measurement of exhaled nitric oxide (eNO), followed by baseline spirometry. Eucapnic voluntary hyperventilation (EVH) was then performed, followed by spirometry every 3 minutes for a total of 21 minutes to measure change in forced expiratory volume in 1 second. MAIN OUTCOME MEASURES Exhaled nitric oxide levels, baseline spirometry, and response of forced expiratory volume in 1 second to EVH. RESULTS There were a total of 16 subjects with a positive EVH test. There were 16 (80%) individuals using a bronchodilator who had a negative EVH test versus 4 (20%) who had a positive test. Mean eNO values were different across subject groups defined by treatment status, although not statistically significant. The highest mean eNO value of 24.32 ppb was found in subjects only taking bronchodilators compared with the lowest mean value of 16.75 ppb in athletes who were not taking any medications. CONCLUSIONS The results from this study provide further evidence to support the need for objective testing to correctly diagnose EIB. These data suggest that measuring eNO may help to distinguish truly isolated EIB from asthma in athletes, but a larger study is needed to confirm these initial observations.
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Affiliation(s)
- David Millward
- University of Arizona Sports Medicine, Tucson, Arizona 85721-0095, USA.
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Hemmingsson T, Linnarsson D. Lower exhaled nitric oxide in hypobaric than in normobaric acute hypoxia. Respir Physiol Neurobiol 2009; 169:74-7. [DOI: 10.1016/j.resp.2009.08.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Revised: 08/01/2009] [Accepted: 08/10/2009] [Indexed: 11/29/2022]
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Mashir A, Dweik RA. Exhaled breath analysis: The new interface between medicine and engineering. ADV POWDER TECHNOL 2009; 20:420-425. [PMID: 20948990 PMCID: PMC2952965 DOI: 10.1016/j.apt.2009.05.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Exhaled breath testing is becoming an increasingly important non-invasive diagnostic method that can be used in the evaluation of health and disease states in the lung and beyond. Potential advantages of breath tests over other conventional medical tests include their non-invasive nature, low cost, and safety. To advance in this area further, however, there has to be a close collaboration between technical experts and engineers who have devices looking for clinical application(s), the medical experts who have the clinical problems looking for a test/biomarker that can be helpful in diagnosis or monitoring, and industry/commercial experts who can build and commercialize the final product.
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Affiliation(s)
- Alquam Mashir
- Department of Pathobiology/Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Raed A. Dweik
- Department of Pathobiology/Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, United States
- Department of Pulmonary and Critical Care Medicine/Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195, United States
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Abstract
Exhaled nitric oxide can now be measured in a clinical setting as a noninvasive, reproducible, facile, point-of-service test to measure airway inflammation, a central component of asthma that had not been assessed previously. An excellent surrogate marker of steroid-responsive eosinophilic airway inflammation, it serves to identify steroid-sensitive asthmatic patients and enables clinical monitoring of the response to steroid therapy and titration of the dose. Standardization of methodology and technological advances, such as the recent availability of handheld analyzers, individualized patient cards to store serial test measurements, and the assignment of coding procedural terminology, make this a necessary adjunct to clinical and functional assessment of airway obstruction and hyperresponsiveness in ambulatory pediatric and adult asthma practices.
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Affiliation(s)
- Chitra Dinakar
- Section of Allergy, Asthma, and Immunology, Children's Mercy Hospital and Clinics, Kansas City, MO 64108, USA.
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Hemmingsson T, Horn A, Linnarsson D. Measuring exhaled nitric oxide at high altitude. Respir Physiol Neurobiol 2009; 167:292-8. [DOI: 10.1016/j.resp.2009.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Revised: 06/03/2009] [Accepted: 06/04/2009] [Indexed: 11/25/2022]
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35
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Affiliation(s)
- Raed A Dweik
- Departments of Pulmonary and Critical Care Medicine/Respiratory Institute, and Pathobiology/Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Anton Amann
- Department of Operative Medicine, Innsbruck Medical University, A-6020 Innsbruck, Austria and Breath Research Unit of the Austrian Academy of Sciences, Dammstrasse 22, A-6850 Dornbirn, Austria
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36
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Grob NM, Aytekin M, Dweik RA. Biomarkers in exhaled breath condensate: a review of collection, processing and analysis. J Breath Res 2008; 2:037004. [PMID: 21386165 DOI: 10.1088/1752-7155/2/3/037004] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Exhaled breath condensate (EBC) is a potential rich source for countless biomarkers that can provide valuable information about respiratory as well as systemic diseases. EBC has been studied in a variety of diseases including allergic rhinitis, asthma, chronic obstructive lung disease, cystic fibrosis, lung cancer, and obstructive sleep apnea syndrome. Although numerous biomarkers have been discovered and studied in EBC, the methods of collection and biomarker detection have not been fully standardized. While leaving standardization methods up to individual labs for the present time is optimal for the continued discovery of new biomarkers in EBC, this decreases the reproducibility and generalizability of the findings. In this review we will discuss specific biomarkers studied in specific diseases as well as some of the related technical issues including collection, processing and analysis.
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Affiliation(s)
- N M Grob
- Department of Pulmonary, Allergy, and Critical Care Medicine/Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195, USA. Pathobiology/Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA. Case Western Reserve University, School of Medicine, Cleveland, OH, USA
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