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Yun HJ, Eom SY, Hahn YS. Assessing Asthma Control by Impulse Oscillometry and Fractional Expiratory Nitric Oxide in Children With Normal Spirometry. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2822-2829.e1. [PMID: 37178768 DOI: 10.1016/j.jaip.2023.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 04/03/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Because spirometric parameters fail to address current status of asthma in some patients, additional tests are required for better evaluation of asthma. OBJECTIVE We aimed to test the ability of impulse oscillometry (IOS) and fractional expiratory nitric oxide (FeNO) in identifying inadequately controlled asthma (ICA) that was not uncovered by spirometry. METHODS Recruited asthmatic children between ages of 8 and 16 years underwent spirometry, IOS, and FeNO measurements on the same day. Only subjects who had spirometric indices within normal range were included. Asthma Control Questionnaire-6 scores of 0.75 or lower and greater than 0.75 indicated well-controlled asthma (WCA) and ICA. Percent predicted values of IOS parameters and IOS reference values for upper and lower limits of normal (>95th and <5th percentiles, respectively) were calculated on the basis of previously published equations. RESULTS There were no significant differences in all spirometric indices between the WCA (n = 59) and the ICA (n = 101) groups. The % predicted values of IOS parameters except resistance at 20 Hz (R20) were significantly different between the 2 groups. Receiver operating characteristic analysis showed that the highest and lowest areas under the curve were 0.81 and 0.67 for the difference between the resistances at 5 Hz and 20 Hz (R5-R20) and R20 in discrimination of ICA versus WCA. The areas under the curve for IOS parameters were improved by combination with FeNO. The better discriminative ability of IOS was also supported by the higher values of the concordance index for the resistance at 5 Hz (R5), R5-R20, the reactance at 5 Hz (X5), and the resonant frequency of reactance than those for spirometric parameters. Compared with those with normal values, subjects with abnormal IOS parameters or high FeNO had significantly higher odds of having ICA. CONCLUSIONS The IOS parameters and FeNO were shown to be useful in identifying children with ICA when spirometry was normal.
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Affiliation(s)
- Hee-Jeong Yun
- Department of Pediatrics, College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Korea
| | - Sang-Yong Eom
- Department of Preventive Medicine, College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Korea
| | - Youn-Soo Hahn
- Department of Pediatrics, College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Korea.
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Collaro AJ, Chang AB, Marchant JM, Vicendese D, Chatfield MD, Cole JF, Blake TL, McElrea MS. Developing Fractional Exhaled Nitric Oxide Predicted and Upper Limit of Normal Values for a Disadvantaged Population. Chest 2023; 163:624-633. [PMID: 36279906 DOI: 10.1016/j.chest.2022.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Fractional exhaled nitric oxide (Feno), used as a biomarker, is influenced by several factors including ethnicity. Normative data are essential for interpretation, and currently single cutoff values are used in children and adults. RESEARCH QUESTION Accounting for factors that influence Feno, (1) what are appropriate predicted and upper limit of normal (ULN) Feno values in an underserved population (First Nations Australians), (2) how do these values compare with age-based interpretive guidelines, and (3) what factors influence Feno and what is the size of the effect? STUDY DESIGN AND METHODS Feno data of First Nations Australians (age < 16 years, n = 862; age ≥ 16 years, n = 348) were obtained. Medical history using participant questionnaires and medical records were used to define healthy participants. Flexible regression using spline functions, as used by the Global Lung Function Initiative, were used to generate predicted and ULN values. RESULTS Look-up tables for predicted and ULN values using age (4-76 years) and height (100-200 cm) were generated and are supplied with a calculator for clinician use. In healthy First Nations children (age < 18 years), ULN values ranged between 25 and 60 parts per billion (ppb) when considering only biologically plausible age and height combinations. For healthy adults, ULN values ranged between 39 and 88 ppb. Neither the current Feno interpretation guidelines, nor the currently recommended cutoff of 50 ppb for First Nations children 16 years of age or younger were appropriate for use in this cohort. Our modelling revealed that predicted and ULN values of healthy participants varied nonlinearly with age and height. INTERPRETATION Because single pediatric, adult, or all-age Feno cutoff values used by current interpretive guidelines to define abnormality fail to account for factors that modify Feno values, we propose predicted and ULN values for First Nations Australians 4 to 76 years of age. Creating age- and height-adjusted predicted and ULN values could be considered for other ethnicities.
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Affiliation(s)
- Andrew J Collaro
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Child Health Division, Menzies School of Health Research, Casuarina, NT, Australia
| | - Julie M Marchant
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Don Vicendese
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; School of Engineering and Mathematical Sciences, La Trobe University, Bundoora, VIC, Australia
| | - Mark D Chatfield
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Child Health Division, Menzies School of Health Research, Casuarina, NT, Australia
| | - Johanna F Cole
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Tamara L Blake
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Margaret S McElrea
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
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Chen L, Agalliu I, Roth A, Rastogi D. Association of fractional exhaled nitric oxide with asthma morbidity in urban minority children. J Asthma 2023; 60:553-564. [PMID: 35499408 PMCID: PMC10170416 DOI: 10.1080/02770903.2022.2073549] [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: 11/23/2021] [Revised: 04/01/2022] [Accepted: 04/30/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Fractional exhaled nitric oxide (FeNO) is a well-established measure of allergic airway inflammation and possible useful adjunct disease management tool. We investigated the association of baseline and follow-up FeNO measurements with disease burden in minority children with persistent asthma. METHODS A retrospective chart review was conducted on 352 African American and Hispanic children seen at an urban Asthma Center in Bronx, NY. Demographic, clinical characteristics, and pulmonary function tests (PFTs) were compared between children with low, intermediate, and high baseline FeNO levels. Among 95 children with subsequent follow up visits, associations of change in FeNO with demographics, clinical characteristics, and PFTs were examined using mixed effects linear regression models. RESULTS A higher proportion of children with intermediate (54%) and high FeNO (58%) levels had lower airways obstruction compared to those with low FeNO levels (33%). Children with intermediate FeNO levels had more annual hospitalizations (2.8 ± 6.2) compared to those with low and high FeNO levels (1.3 ± 2.8 and 1.3 ± 2.5). These associations did not differ between ethnicities. An increase in FeNO over time was associated with higher BMI z-scores (β = 6.2, 95% CI: 1.0 to 11.4) and two or more hospitalizations in the past year (β = 16.1, 95% CI: 1.5 to 30.8). CONCLUSIONS Intermediate and high FeNO levels are associated with lower airways obstruction and hospitalizations. Initial and serial FeNO measurements can be a useful adjunctive tool in identifying asthma-related morbidity in urban African American and Hispanic children.
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Affiliation(s)
- Laura Chen
- Department of Pediatrics, Section of Respiratory, Allergy-Immunology, and Sleep Medicine, Yale School of Medicine, 789 Howard Ave, New Haven, CT, 06520, USA
| | - Ilir Agalliu
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Avenue, Bronx, NY, 10461, USA
| | - Adam Roth
- Department of Pediatrics, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Parkway, Bronx, NY, 10461, USA
| | - Deepa Rastogi
- Division of Pulmonary and Sleep Medicine, Children’s National Health System, George Washington University School of Medicine and Health Sciences, 111 Michigan Avenue, Washington, DC, 20010, USA
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Velusamy P, Su CH, Ramasamy P, Arun V, Rajnish N, Raman P, Baskaralingam V, Senthil Kumar SM, Gopinath SCB. Volatile Organic Compounds as Potential Biomarkers for Noninvasive Disease Detection by Nanosensors: A Comprehensive Review. Crit Rev Anal Chem 2022; 53:1828-1839. [PMID: 35201946 DOI: 10.1080/10408347.2022.2043145] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Biomarkers are biological molecules associated with physiological changes of the body and aids in the detecting the onset of disease in patients. There is an urgent need for self-monitoring and early detection of cardiovascular and other health complications. Several blood-based biomarkers have been well established in diagnosis and monitoring the onset of diseases. However, the detection level of biomarkers in bed-side analysis is difficult and complications arise due to the endothelial dysfunction. Currently single volatile organic compounds (VOCs) based sensors are available for the detection of human diseases and no dedicated nanosensor is available for the elderly. Moreover, accuracy of the sensors based on a single analyte is limited. Hence, breath analysis has received enormous attention in healthcare due to its relatively inexpensive, rapid, and noninvasive methods for detecting diseases. This review gives a detailed analysis of how biomarker imprinted nanosensor can be used as a noninvasive method for detecting VOC to health issues early using exhaled breath analysis.
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Affiliation(s)
- Palaniyandi Velusamy
- Research and Development Wing, Sree Balaji Medical College and Hospital (SBMCH), Bharath Institute of Higher Education and Research (BIHER), Chennai, Tamil Nadu, India
| | - Chia-Hung Su
- Department of Chemical Engineering, Ming Chi University of Technology, Taishan, Taipei, Taiwan
| | - Palaniappan Ramasamy
- Research and Development Wing, Sree Balaji Medical College and Hospital (SBMCH), Bharath Institute of Higher Education and Research (BIHER), Chennai, Tamil Nadu, India
| | - Viswanathan Arun
- Department of Biotechnology SRFBMST, Sri Ramachandra Institute of Higher Education & Research, Chennai, Tamil Nadu, India
| | - Narayanan Rajnish
- Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | - Pachaiappan Raman
- Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, India
| | - Vaseeharan Baskaralingam
- Nanobiosciences and Nanopharmacology Division, Biomaterials and Biotechnology in Animal Health Lab, Department of Animal Health and Management, Alagappa University, Karaikudi, Tamil Nadu, India
| | - Sakkarapalayam Murugesan Senthil Kumar
- Electroorganic and Materials Electrochemistry Division, CSIR-Central Electrochemical Research Institute, Karaikudi, Tamil Nadu, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Subash C B Gopinath
- Faculty of Chemical Engineering Technology and Institute of Nano Electronic Engineering, Universiti Malaysia Perlis, Arau, Perlis, Malaysia
- Centre of Excellence for Nanobiotechnology and Nanomedicine (CoExNano), Faculty of Applied Sciences, AIMST University, Semeling, Kedah, Malaysia
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Akan A, Dibek Mısırlıoğlu E, Civelek E, Kocabaş CN. Determining the Best Tool Comparable with Global Initiative for Asthma Criteria for Assessing Pediatric Asthma Control. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2021; 34:89-96. [PMID: 34432544 DOI: 10.1089/ped.2020.1334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Guidelines such as Global Initiative for Asthma (GINA) recommend disease control as the mainstay of asthma management. Objective: To investigate which measure of asthma control best correlates with the GINA criteria for determining asthma control in children. Methods: Child asthma-patients at a tertiary hospital were enrolled in the study after evaluation of response to treatment. Asthma control test (ACT)/pediatric asthma control test (PACT), Pediatric Asthma Quality of Life Questionnaire (PAQLQ), fractional exhaled nitric oxide (FeNO), and lung function parameters were evaluated. Patients were examined by asthma specialists and control status was evaluated based on GINA. Results: The median age (interquartile range) of patients was 10.7 (8.4-12.9) years, 57.9% of patients were boys. Of 228 children, 84.2%, 9.6%, and 6.1% displayed "well-controlled", "partially controlled", and "uncontrolled" asthma, respectively, according to GINA. The patients with "partially controlled" and "uncontrolled" asthma were grouped as "not well-controlled." The cutoff levels were 22, 21, and 5.9 for PACT, ACT, and PAQLQ, respectively, for determining "well-controlled" asthma (P < 0.001). With these cutoff values, ACT exhibited higher comparability with GINA than PACT and PAQLQ (κ = 0.473, 0.221, and 0.150, respectively, P < 0.001). PAQLQ had higher agreement with GINA criteria in children ≥12 years old (κ = 0.326, P < 0.001 and κ = 0.151, P = 0.014, respectively). Correctly classified patients with PACT, ACT, and PALQLQ based on GINA with these cutoff levels were 93 (64.1%), 63 (75.9%), and 139 (62.9%), respectively. FeNO and lung function parameters were unsuccessful at revealing control status according to GINA. Conclusion: ACT is better than PACT for comparability with GINA. Better correlation of PAQLQ and ACT and better comparability of PAQLQ and GINA were evident in older children.
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Affiliation(s)
- Ayşegül Akan
- Department of Pediatric Allergy and Immunology, Trabzon Kanuni Research and Training Hospital, Health Sciences University, Trabzon, Turkey
| | - Emine Dibek Mısırlıoğlu
- Department of Pediatric Allergy and Immunology, Ankara City Research and Training Hospital, Health Sciences University, Ankara, Turkey
| | - Ersoy Civelek
- Department of Pediatric Allergy and Immunology, Ankara City Research and Training Hospital, Health Sciences University, Ankara, Turkey
| | - Can Naci Kocabaş
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
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Jang YY, Ahn JY. Evaluation of Fractional Exhaled Nitric Oxide in Pediatric Asthma and Allergic Rhinitis. CHILDREN-BASEL 2020; 8:children8010003. [PMID: 33374635 PMCID: PMC7822451 DOI: 10.3390/children8010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/09/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022]
Abstract
Fractional exhaled nitric oxide (FeNO) is a non-invasive test for evaluating the degree of airway inflammation and for the diagnosis, evaluation, and treatment of asthma. We attempted to measure FeNO levels in Korean children with asthma and determine its cutoff value for diagnosing asthma. We enrolled 176 children and adolescents between the ages of 5 and 18 years, who visited for the evaluation of chronic cough, shortness of breath, and wheezing. Among them, 138 patients who underwent skin prick tests or inhalation Immuno CAP (UniCAP; Pharmacia, Uppsala, Sweden) tests for allergy testing together with a pulmonary function test were included. FeNO was measured using a NIOX MINO (Aerocrine AB, Solna, Sweden) instrument according to the American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines. There were 29 patients with asthma, 43 with rhinitis, and 38 with asthma and allergic rhinitis. In the asthma group, FeNO levels significantly correlated with total immunoglobulin E (r = 0.572, p < 0.001), but did not show significant correlation with pulmonary function test parameters (forced vital capacity—FVC, forced expiratory volume in one second—FEV1, FEV1/FVC) or PC20 (provocative concentration of methacholine causing a 20% fall in FEV1). The FeNO cutoff values obtained in the asthma and asthma rhinitis groups were 16.5 ppb and 18.5 ppb, respectively. Hence, we provide a FeNO cutoff value according to the presence or absence of rhinitis in pediatric patients with asthma.
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Affiliation(s)
- Yoon Young Jang
- Department of Pediatrics, School of Medicine, Daegu Catholic University Medical Center, Daegu 42472, Korea;
| | - Ji Young Ahn
- Department of Pediatrics, College of Medicine, Yeungnam University, Daegu 38541, Korea
- Correspondence: ; Tel.: +82-53-620-3536; Fax: +82-53-620-4459
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Blake TL, Chang AB, Chatfield MD, Marchant JM, Petsky HL, McElrea MS. Fractional Exhaled Nitric Oxide Values in Indigenous Australians 3 to 16 Years of Age. Chest 2019; 156:239-246. [PMID: 30910638 DOI: 10.1016/j.chest.2019.02.401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/12/2019] [Accepted: 02/22/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Fractional exhaled nitric oxide (Feno) levels can identify eosinophilic asthma phenotypes. We aimed to determine Feno values of healthy Aboriginal and/or Torres Strait Islander (Indigenous) Australians, differences between these Indigenous ethnic groups, and appropriateness of published cutoff values. METHODS We measured Feno levels in 1,036 Indigenous Australians (3-16 years of age). Participants were classified into healthy (ie, no asthma or atopy history) or asthmatic and/or atopic groups. RESULTS Median Feno values and distribution did not differ between Indigenous ethnicities. For healthy participants < 12 years of age (n = 390), 7.2% of our cohort fell into the inflammatory zone of the American Thoracic Society (ATS), National Institute for Health and Care Excellence (NICE), and British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN) guidelines (cutoff 35 parts per billion [ppb]), but only 3.8% fell into this category when using the Global Initiative for Asthma (GINA) guidelines (50 ppb). Similarly, when using the NICE and BTS/SIGN guidelines (40 ppb) for participants 12 to 16 years of age (n = 213), more healthy participants fell into the inflammatory zone compared with the ATS and GINA guidelines (50 ppb) (9.9% vs 4.7%, respectively). CONCLUSIONS Feno values for healthy Indigenous Australians children (3-16 years of age) are likely higher than published white-based values. The GINA recommended cutoff value (> 50 ppb) appears the most appropriate for identifying healthy Indigenous children but requires confirmation from a larger study.
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Affiliation(s)
- Tamara L Blake
- Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD; Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Brisbane, QLD.
| | - Anne B Chang
- Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD; Child Health Division, Menzies School of Health Research, Darwin, NT
| | - Mark D Chatfield
- Child Health Division, Menzies School of Health Research, Darwin, NT; The University of Queensland, Brisbane, QLD
| | - Julie M Marchant
- Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD
| | - Helen L Petsky
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
| | - Margaret S McElrea
- Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD; Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Brisbane, QLD; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD
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张 惠, 张 静, 刘 雨, 邓 跃, 罗 建, 牛 焕, 孙 新. [Application of pulmonary function and fractional exhaled nitric oxide tests in the standardized management of bronchial asthma in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:419-424. [PMID: 28407829 PMCID: PMC7389675 DOI: 10.7499/j.issn.1008-8830.2017.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/30/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the changes of pulmonary function and fractional exhaled nitric oxide (FeNO) in the standardized treatment of bronchial asthma in children. METHODS A total of 254 children who were newly diagnosed with acute exacerbation of bronchial asthma were selected as asthma group, and they were divided into two subgroups: asthma with concurrent rhinitis and asthma without concurrent rhinitis. All patients received the standardized management and treatment for one year. The pulmonary function parameters included forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), maximal mid-expiratory flow (MMEF), and mid-expiratory flow at 25%, 50%, and 75% of vital capacity (MEF25, MEF50, and MEF75). The FeNO levels were measured before treatment and at 3, 6, 9, and 12 months after treatment. Another 62 healthy children were selected as the control group, and the pulmonary function and FeNO levels were measured only once. RESULTS During one year of standardized treatment, FEV1, PEF, MMEF, MEF25, MEF50, and MEF75 gradually increased, and FeNO levels gradually decreased (P<0.05). Indicators of large airway function, such as FEV1 and PEF, almost returned to normal after 6 months of treatment; indicators of small airway function, such as MMEF, MEF25, MEF50, and MEF75 almost returned to normal after 9 months of treatment; there were no significant differences in the above indices between the asthma group and the control group after one year of treatment (P>0.05). However, the asthma group had a significantly higher FeNO levels than the control group after one year of treatment (P<0.05). The asthmatic patients with concurrent rhinitis had significantly higher FeNO levels than those without concurrent rhinitis before treatment and 3 months after treatment (P<0.05). Before treatment, there was a significant negative correlation between FeNO levels and pulmonary function parameters (P<0.05). CONCLUSIONS With the standardized treatment of bronchial asthma in children, pulmonary function parameters gradually increase and FeNO levels gradually decrease. The recovery of large airway function occurs earlier than the recovery of small airway function. Furthermore, the effect of rhinitis on airway responsiveness should be noted.
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Affiliation(s)
- 惠琴 张
- />第四军医大学西京医院儿科, 陕西 西安 710032Department of Pediatrics, Xijing Hospital of Fourth Military Medical University, Xi'an 710032, China
| | - 静静 张
- />第四军医大学西京医院儿科, 陕西 西安 710032Department of Pediatrics, Xijing Hospital of Fourth Military Medical University, Xi'an 710032, China
| | - 雨东 刘
- />第四军医大学西京医院儿科, 陕西 西安 710032Department of Pediatrics, Xijing Hospital of Fourth Military Medical University, Xi'an 710032, China
| | - 跃林 邓
- />第四军医大学西京医院儿科, 陕西 西安 710032Department of Pediatrics, Xijing Hospital of Fourth Military Medical University, Xi'an 710032, China
| | - 建峰 罗
- />第四军医大学西京医院儿科, 陕西 西安 710032Department of Pediatrics, Xijing Hospital of Fourth Military Medical University, Xi'an 710032, China
| | - 焕红 牛
- />第四军医大学西京医院儿科, 陕西 西安 710032Department of Pediatrics, Xijing Hospital of Fourth Military Medical University, Xi'an 710032, China
| | - 新 孙
- />第四军医大学西京医院儿科, 陕西 西安 710032Department of Pediatrics, Xijing Hospital of Fourth Military Medical University, Xi'an 710032, China
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张 惠, 张 静, 刘 雨, 邓 跃, 罗 建, 牛 焕, 孙 新. [Application of pulmonary function and fractional exhaled nitric oxide tests in the standardized management of bronchial asthma in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:419-424. [PMID: 28407829 PMCID: PMC7389675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/30/2016] [Indexed: 03/30/2024]
Abstract
OBJECTIVE To investigate the changes of pulmonary function and fractional exhaled nitric oxide (FeNO) in the standardized treatment of bronchial asthma in children. METHODS A total of 254 children who were newly diagnosed with acute exacerbation of bronchial asthma were selected as asthma group, and they were divided into two subgroups: asthma with concurrent rhinitis and asthma without concurrent rhinitis. All patients received the standardized management and treatment for one year. The pulmonary function parameters included forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), maximal mid-expiratory flow (MMEF), and mid-expiratory flow at 25%, 50%, and 75% of vital capacity (MEF25, MEF50, and MEF75). The FeNO levels were measured before treatment and at 3, 6, 9, and 12 months after treatment. Another 62 healthy children were selected as the control group, and the pulmonary function and FeNO levels were measured only once. RESULTS During one year of standardized treatment, FEV1, PEF, MMEF, MEF25, MEF50, and MEF75 gradually increased, and FeNO levels gradually decreased (P<0.05). Indicators of large airway function, such as FEV1 and PEF, almost returned to normal after 6 months of treatment; indicators of small airway function, such as MMEF, MEF25, MEF50, and MEF75 almost returned to normal after 9 months of treatment; there were no significant differences in the above indices between the asthma group and the control group after one year of treatment (P>0.05). However, the asthma group had a significantly higher FeNO levels than the control group after one year of treatment (P<0.05). The asthmatic patients with concurrent rhinitis had significantly higher FeNO levels than those without concurrent rhinitis before treatment and 3 months after treatment (P<0.05). Before treatment, there was a significant negative correlation between FeNO levels and pulmonary function parameters (P<0.05). CONCLUSIONS With the standardized treatment of bronchial asthma in children, pulmonary function parameters gradually increase and FeNO levels gradually decrease. The recovery of large airway function occurs earlier than the recovery of small airway function. Furthermore, the effect of rhinitis on airway responsiveness should be noted.
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Affiliation(s)
- 惠琴 张
- />第四军医大学西京医院儿科, 陕西 西安 710032Department of Pediatrics, Xijing Hospital of Fourth Military Medical University, Xi'an 710032, China
| | - 静静 张
- />第四军医大学西京医院儿科, 陕西 西安 710032Department of Pediatrics, Xijing Hospital of Fourth Military Medical University, Xi'an 710032, China
| | - 雨东 刘
- />第四军医大学西京医院儿科, 陕西 西安 710032Department of Pediatrics, Xijing Hospital of Fourth Military Medical University, Xi'an 710032, China
| | - 跃林 邓
- />第四军医大学西京医院儿科, 陕西 西安 710032Department of Pediatrics, Xijing Hospital of Fourth Military Medical University, Xi'an 710032, China
| | - 建峰 罗
- />第四军医大学西京医院儿科, 陕西 西安 710032Department of Pediatrics, Xijing Hospital of Fourth Military Medical University, Xi'an 710032, China
| | - 焕红 牛
- />第四军医大学西京医院儿科, 陕西 西安 710032Department of Pediatrics, Xijing Hospital of Fourth Military Medical University, Xi'an 710032, China
| | - 新 孙
- />第四军医大学西京医院儿科, 陕西 西安 710032Department of Pediatrics, Xijing Hospital of Fourth Military Medical University, Xi'an 710032, China
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Blake TL, Chang AB, Chatfield MD, Petsky HL, Rodwell LT, Brown MG, Hill DC, McElrea MS. Does Ethnicity Influence Fractional Exhaled Nitric Oxide in Healthy Individuals?: A Systematic Review. Chest 2017; 152:40-50. [PMID: 28215791 DOI: 10.1016/j.chest.2017.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/21/2016] [Accepted: 02/01/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Fractional exhaled nitric oxide (Feno) is used clinically as a biomarker of eosinophilic airway inflammation. Awareness of the factors influencing Feno values is important for valid clinical interpretation. METHODS We undertook a systematic review of PubMed, Cochrane Library, Scopus, and Web of Science databases and reference lists of included articles to evaluate whether ethnicity influences Feno values, and to determine if this influence affects clinical interpretation according to current guidelines. We included all studies that performed online Feno measurements on at least 25 healthy, non-Caucasian individuals, and examined the effect of ethnicity on Feno. RESULTS From 62 potential studies, 12 studies were included. One study recruited only children (< 12 years of age), six studies recruited children and/or adolescents, four studies recruited adults only, and a single study involved children, adolescents, and adults. In total, 16 different ethnic populations representing 11 ethnicities were studied. Ethnicity was considered a significant influencing factor in 10 of the included studies. We found the geometric mean Feno to be above the normal healthy range in two studies. We also identified five studies in which at least 5% of participants had Feno results above the age-specific inflammatory ranges. CONCLUSIONS Ethnicity influences Feno values, and for some ethnic groups this influence likely affects clinical interpretation according to current guidelines. There is a need to establish healthy Feno reference ranges for specific ethnic groups to improve clinical application.
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Affiliation(s)
- Tamara L Blake
- Queensland University of Technology, Centre for Children's Health Research, South Brisbane, QLD, Australia; Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Chermside, QLD, Australia; Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia.
| | - Anne B Chang
- Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Chermside, QLD, Australia; Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia; Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Mark D Chatfield
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Helen L Petsky
- Queensland University of Technology, Centre for Children's Health Research, South Brisbane, QLD, Australia
| | - Leanne T Rodwell
- Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia
| | - Michael G Brown
- Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Deb C Hill
- Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Chermside, QLD, Australia
| | - Margaret S McElrea
- Queensland University of Technology, Centre for Children's Health Research, South Brisbane, QLD, Australia; Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Chermside, QLD, Australia; Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia
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11
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Yoon J, Park JS, Cho HJ, Lee E, Yang SI, Hong SJ, Yu J. Comparison between exhaled nitric oxide and bronchial challenge with methacholine or adenosine-5'-monophosphate in the diagnosis of childhood asthma. ALLERGY ASTHMA & RESPIRATORY DISEASE 2016. [DOI: 10.4168/aard.2016.4.2.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jisun Yoon
- Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun-Sung Park
- Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Ju Cho
- Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Lee
- Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Song-I Yang
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jinho Yu
- Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Shim JY. Association of wheezing phenotypes with fractional exhaled nitric oxide in children. KOREAN JOURNAL OF PEDIATRICS 2014; 57:211-6. [PMID: 25045362 PMCID: PMC4102682 DOI: 10.3345/kjp.2014.57.5.211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 03/19/2014] [Indexed: 02/01/2023]
Abstract
Asthma comprises a heterogeneous group of disorders characterized by airway inflammation, airway obstruction, and airway hyperresponsiveness (AHR). Airway inflammation, which induces AHR and recurrence of asthma, is the main pathophysiology of asthma. The fractional exhaled nitric oxide (FeNO) level is a noninvasive, reproducible measurement of eosinophilic airway inflammation that is easy to perform in young children. As airway inflammation precedes asthma attacks and airway obstruction, elevated FeNO levels may be useful as predictive markers for risk of recurrence of asthma. This review discusses FeNO measurements among early-childhood wheezing phenotypes that have been identified in large-scale longitudinal studies. These wheezing phenotypes are classified into three to six categories based on the onset and persistence of wheezing from birth to later childhood. Each phenotype has characteristic findings for atopic sensitization, lung function, AHR, or FeNO. For example, in one birth cohort study, children with asthma and persistent wheezing at 7 years had higher FeNO levels at 4 years compared to children without wheezing, which suggested that FeNO could be a predictive marker for later development of asthma. Preschool-aged children with recurrent wheezing and stringent asthma predictive indices also had higher FeNO levels in the first 4 years of life compared to children with wheezing and loose indices or children with no wheeze, suggesting that FeNO measurements may provide an additional parameter for predicting persistent wheezing in preschool children. Additional large-scale longitudinal studies are required to establish cutoff levels for FeNO as a risk factor for persistent asthma.
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Affiliation(s)
- Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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