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Lee JH, Lee JH, Park SY, Koskela HO, Song WJ. Is fractional exhaled nitric oxide a treatable trait in chronic cough: a narrative review. J Thorac Dis 2023; 15:5844-5855. [PMID: 37969307 PMCID: PMC10636432 DOI: 10.21037/jtd-23-135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 09/24/2023] [Indexed: 11/17/2023]
Abstract
Background and Objective Current management of chronic cough is largely based on sequential therapeutic trials. The concept of treatable traits was first introduced for individualized treatment of chronic airway diseases; however, it has emerged as a potentially useful strategy in revising the management of chronic cough. This narrative review aimed to analyze the literature to determine if fractional exhaled nitric oxide (FeNO) is a treatable trait in chronic cough, compared to other type 2 biomarkers, and to summarize current knowledge and gaps in the clinical application. Methods An online electronic search was performed on PubMed, Web of Science, and Scopus of English-language literature with following keywords: cough, nitric oxide (NO), eosinophils, biomarker, and treatable trait. Relevance and eligibility of each article were assessed by one or more of the authors and a narrative review was composed. Key Content and Findings Eosinophilic or type 2 airway inflammation is a major treatable trait in patients with chronic cough. Induced sputum tests are regarded as the gold standard for defining inflammatory phenotype, however, technically demanding and cannot be widely applied in clinical practice. FeNO, a practical biomarker, has emerged as an alternative to induced sputum analyses. Mechanistic and clinical evidence indicated that FeNO had a potential for diagnostic utility and treatment response predictability. Conclusions FeNO measurement may help to identify patients with chronic cough that will benefit from corticosteroid treatment. Further studies are warranted to determine the diagnostic roles of FeNO in the management of patients with chronic cough.
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Affiliation(s)
- Ji-Ho Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Airway Sensation and Cough Research Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - So-Young Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Heikki Olavi Koskela
- Unit for Medicine and Clinical Research, Pulmonary Division, Kuopio University Hospital, Kuopio, Finland
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Airway Sensation and Cough Research Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Kang SY, Lee SM, Lee SP. Measurement of Fractional Exhaled Nitric Oxide in Adults: Comparison of Two Different Analyzers (NIOX VERO and NObreath). Tuberc Respir Dis (Seoul) 2021; 84:182-187. [PMID: 33691356 PMCID: PMC8273020 DOI: 10.4046/trd.2020.0137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/10/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Fractional exhaled nitric oxide (FeNO) is a non-invasive marker for eosinophilic airway inflammation and a good predictor of response to corticosteroids. There is a need for a reliable and accurate measurement method, as FeNO measurements have been widely used in clinical practice. Our study aimed to compare two FeNO analyzers and derive a conversion equation for FeNO measurements in adults. METHODS We included 99 participants who had chief complaints of chronic cough and difficulty in breathing. The participants underwent concurrent FeNO measurement using NIOX VERO (Circassia AB) and NObreath (Bedfont). We compared the values of the two devices and analyzed their correlation and agreement. We then formulated an equation to convert FeNO values measured by NObreath into those obtained by NIOX VERO. RESULTS The mean age of the participants was 51.2±17.1 years, with a female predominance (58.6%). Approximately 60% of the participants had asthma. The FeNO level measured by NIOX VERO (median, 27; interquartile range [IQR], 15-45) was significantly lower than that measured by NObreath (median, 38; IQR, 22-58; p<0.001). There was a strong positive correlation between the two devices (r=0.779, p<0.001). Additionally, Bland-Altman plots and intraclass correlation coefficient demonstrated a good agreement. Using linear regression, we derived the following conversion equation: natural log (Ln) (NObreath)=0.728×Ln (NIOX VERO)+1.244. CONCLUSION The FeNO values of NIOX VERO and NObreath were in good agreement and had positive correlations. Our proposed conversion equation could help assess the accuracy of the two analyzers.
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Affiliation(s)
- Sung-Yoon Kang
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Sang Min Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Sang Pyo Lee
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
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Exhaled Nitric Oxide (FeNO) in Patients Hospitalized for an Exacerbation of Bronchiectasis and/or COPD. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1337:323-330. [DOI: 10.1007/978-3-030-78771-4_36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Abstract
Chronic cough is a common condition, and generally affects about 3% of Korean adults with a significant influence on quality of life (QoL). Despite continued clinical and academic efforts, there are unmet needs for chronic cough prevention and management in Korea. Epidemiologically, there are two major challenges: an aging population and air pollution. Korea is one of the most rapidly aging countries, and the relative proportion of elderly to younger people is expected to double within the next two decades. Air pollution is a major concern, but there is very limited evidence on the effects of air pollutant on cough in Korean patients. Clinically, upper and lower airway diseases, such as rhinitis/rhinosinusitis and cough variant asthma/eosinophilic bronchitis, are reported to account for about 75% of chronic cough in Korean adults, which formed the basis in formulating clinical practice guidelines. However, further studies are warranted to resolve clinical uncertainty, particularly for the evaluation and treatment of upper airway conditions in chronic cough. The prevalence of gastroesophageal reflux disease (GERD) is increasing, thus its relevance to cough among Koreans may warrant re-evaluation. Infection-associated chronic cough, such as tuberculosis, is another continuing concern. The proportion of chronic refractory or unexplained cough is assumed to be 10–20% among patients visiting referral clinics for chronic cough. This review presents our perspectives on current epidemiological and clinical issues of chronic cough in Korea, and addresses major knowledge gaps and future research priorities.
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Affiliation(s)
- Ji-Hyang Lee
- Department of Allergy and Clinical Immunology, Airway Sensation and Cough Research Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Airway Sensation and Cough Research Laboratory, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ahn S, Kim TO, Chang J, Shin HJ, Kwon YS, Lim SC, Kim YI. Clinical Features of Chronic Obstructive Pulmonary Disease with High Fractional Exhaled Nitric Oxide. Tuberc Respir Dis (Seoul) 2020; 83:234-241. [PMID: 32610837 PMCID: PMC7362749 DOI: 10.4046/trd.2019.0086] [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] [Received: 12/20/2019] [Accepted: 05/11/2020] [Indexed: 01/15/2023] Open
Abstract
Background The fractional exhaled nitric oxide (FENO) test is useful in asthma patients. However, a few studies on its usefulness in chronic obstructive pulmonary disease (COPD) patients have been reported. We analyzed the FENO level distribution and clinical characteristics according to the FENO level in COPD patients. Methods From December 2014 to June 2019, COPD patients who underwent pulmonary function and FENO tests at Chonnam National University Hospital were retrospectively evaluated for FENO, comorbidities, asthma history, blood eosinophil, and pulmonary function test. The high FENO group was defined as those with FENO level>25 parts per billion (ppb). Results A total of 849 COPD patients (mean age, 70.3±9.4 years) were included. The mean forced expiratory volume at 1 second was 66.5±21.7% and the mean FENO level was 24.3±20.5 ppb. Patients with FENO ≤25 ppb were 572 (67.4%) and those with FENO >25 ppb were 277 (32.6%). Blood eosinophil percentage was significantly higher (4.2±4.8 vs. 2.7±2.5, p<0.001) in patients with the high FENO group than the low FENO group. The high FENO group revealed a significantly higher frequency of patients with blood eosinophil percentage >3% (46.9% vs. 34.8%, p=0.001) and asthma history (25.6% vs. 8.6%, p<0.001) than the lower FENO group. Asthma history, blood eosinophil percentage >3%, and positive bronchodilator response (BDR) were independent risk factors for the high FENO level (adjusted odds ratio [aOR], 3.85; p<0.001; aOR, 1.46; p=0.017; and aOR, 1.57, p=0.034, respectively) in the multivariable analysis. Conclusion The FENO level distribution varied in COPD patients and the mean FENO value was slightly elevated. Asthma history, eosinophil percent, and positive BDR were independent risk factors for the high FENO level.
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Affiliation(s)
- Seong Ahn
- Division of Pulmonology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Tae-Ok Kim
- Division of Pulmonology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jinsun Chang
- Division of Pulmonology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hong-Joon Shin
- Division of Pulmonology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yong-Soo Kwon
- Division of Pulmonology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung-Chul Lim
- Division of Pulmonology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yu-Il Kim
- Division of Pulmonology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Lee YJ, Fujisawa T, Kim CK. Biomarkers for Recurrent Wheezing and Asthma in Preschool Children. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:16-28. [PMID: 30479074 PMCID: PMC6267183 DOI: 10.4168/aair.2019.11.1.16] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/08/2018] [Accepted: 09/10/2018] [Indexed: 01/21/2023]
Abstract
Wheezing is one of the characteristic symptoms of asthma, but all preschool children with wheezing are not diagnosed with asthma. Preschool children are not cooperative enough to participate in spirometry and invasive tests. Thus, there is no conventional method to diagnose asthma in preschool children. We reviewed studies on non-invasive biomarkers for assessing asthma in preschool children. Specimens that can be easily obtained by non-invasive methods are blood, exhaled breath and urine. Eosinophils, eosinophil cationic protein and eosinophil-derived neurotoxin (EDN) in blood are helpful in evaluating eosinophilic inflammation of the airways. Exhaled breath contains nitric oxide, volatile organic compounds, various cytokines and mediators as analytical components. Fraction of exhaled nitric oxide has been used to assess the degree of eosinophil inflammation and has been standardized in school-age children and adults, but not yet in preschool children. Exhaled breath condensate (EBC) pH and various cytokines/mediators that are detected in EBC seem to be promising biomarkers for assessing asthma, but need more standardization and validation. There are several biomarkers useful for assessing asthma, but none are ideal. Some biomarkers need standardized methods of obtaining samples from uncooperative preschool children for clinical use and require sufficient validation. Recently, another activated eosinophil marker, serum EDN, has shown promising results as a biomarker for recurrent wheezing and asthma in preschool children.
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Affiliation(s)
- Yong Ju Lee
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | | | - Chang Keun Kim
- Asthma and Allergy Center, Inje University Sanggye Paik Hospital, Seoul, Korea.,SKIMS-BIO Co., Ltd. Seoul, Korea.
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Ren L, Zhang W, Zhang Y, Zhang L. Nasal Nitric Oxide Is Correlated With Nasal Patency and Nasal Symptoms. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:367-380. [PMID: 30912326 PMCID: PMC6439193 DOI: 10.4168/aair.2019.11.3.367] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/27/2018] [Accepted: 12/18/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Nitric oxide (NO) is an important endogenous mediator in both upper and lower respiratory systems. The purpose of the present study was to extract nasal NO (nNO) normal range of Chinese adults and the internal influencing factors. The differences in nNO levels between rhinitis and asymptomatic atopic subjects, and the diagnostic value of nNO in allergic rhinitis (AR) were further investigated. METHODS One thousand adults were recruited from the general public. Participants were divided into different subgroups according to the questionnaires and skin prick tests. In all of these subjects, nNO, fractional exhaled NO (FeNO) and nasal airflow resistance were measured. The normal ranges of nNO and FeNO, the differences between subgroups, and the correlations between NO (nNO and FeNO) and other internal factors were analyzed. RESULTS Both nNO and FeNO levels were significantly higher in AR patients than in healthy and asymptomatic atopic subjects. The nNO levels were significantly lower in asymptomatic atopic subjects than in normal adults. FeNO levels were significantly higher in non-AR patients than in the healthy and asymptomatic atopic adults. The cutoff value of nNO for the diagnosis of AR was 117.5 ppb (sensitivity, 50.9%; specificity, 63.9%). The nNO levels were correlated with FeNO levels, total nasal resistance measured at 75Pa, nasal volume within 0-7 cm from the anterior nares (V0-7cm) and nasal symptom visual analogue scale (VAS) scores, while the FeNO levels were correlated with age, height, weight, body surface area, nasal volume of V0-7cm and the nasal symptom VAS score. CONCLUSIONS The nNO level can be significantly different between healthy and AR patients and may be significantly correlated with nasal symptoms and nasal patency of rhinitis patients. However, the clinical value of nNO is still in the exploration stage.
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Affiliation(s)
- Lei Ren
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Zhang
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Yuan Zhang
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Luo Zhang
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China.,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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9
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Chang YS. In this July. Asia Pac Allergy 2018; 8:e32. [PMID: 30079310 PMCID: PMC6073177 DOI: 10.5415/apallergy.2018.8.e32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea
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Liu PF, Yan P, Zhao DH, Shi WF, Meng S, Liu Y, Liu B, Li GF, Xie LX. The effect of environmental factors on the differential expression of miRNAs in patients with chronic obstructive pulmonary disease: a pilot clinical study. Int J Chron Obstruct Pulmon Dis 2018. [PMID: 29535514 PMCID: PMC5836692 DOI: 10.2147/copd.s156865] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective The objective of the study was to analyze the effect of environmental factors on the differential expression of microRNAs in the peripheral blood of migratory and local patients in northern People’s Republic of China and on clinical symptoms of local patients in northern People’s Republic of China with COPD. Methods A total of 118 patients in the northern region and 8 migratory patients were enrolled in this prospective study. We collected general information. Blood samples were collected from 9 patients in the Beijing group, from 8 patients in the migratory group and from 9 healthy control subjects. After extracting the total RNA from these 3 groups, serum miRNA was identified by Solexa sequencing. We collected COPD assessment test (CAT) and Modified British Medical Research Council (mMRC) scores at different levels of air pollution and also collected the number of exacerbations over the year prior to the baseline and in the year preceding the follow-up. Results In total 9 miRNAs were differentially expressed. When air quality index (AQI) >100, the CAT and mMRC scores at baseline were significantly higher than those when the AQI ≤100 (P<0.001). When AQI >100, the follow-up CAT and mMRC scores were significantly higher than those when AQI ≤100 (P<0.001). Follow-up mMRC scores were significantly higher than baseline scores (P=0.04). When AQI ≤100, the baseline CAT score of the group with fewer symptoms was 6.50 (4.00–8.75). However, when AQI >100, the baseline CAT score of this fewer symptoms group was 10.00 (6.25–12.00). The median CAT score was close to 10. When AQI ≤100, the follow-up CAT score of the fewer symptoms group was 8.00 (4.25–12.00). However, when AQI >100, the follow-up CAT score of the fewer symptoms group was 9.50 (6.00–16.75). The median CAT score was close to 10. Conclusion Environmental factors may cause differential expression of miRNAs in the peripheral blood of migratory and local patients in northern People’s Republic of China. Air pollution may aggravate clinical symptoms of patients with COPD.
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Affiliation(s)
- Peng-Fei Liu
- Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing
| | - Peng Yan
- Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing
| | - Da-Hui Zhao
- Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing
| | - Wen-Fang Shi
- Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing
| | - Song Meng
- Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing
| | - Yang Liu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Logistic University of Chinese People's Armed Police Force, Tianjin, People's Republic of China
| | - Bin Liu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Logistic University of Chinese People's Armed Police Force, Tianjin, People's Republic of China
| | - Guo-Feng Li
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Logistic University of Chinese People's Armed Police Force, Tianjin, People's Republic of China
| | - Li-Xin Xie
- Department of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing
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Song DJ, Song WJ, Kwon JW, Kim GW, Kim MA, Kim MY, Kim MH, Kim SH, Kim SH, Kim SH, Kim ST, Kim SH, Kim JK, Kim JH, Kim HJ, Kim HB, Park KH, Yoon JK, Lee BJ, Lee SE, Lee YM, Lee YJ, Lim KH, Jeon YH, Jo EJ, Jee YK, Jin HJ, Choi SH, Hur GY, Cho SH, Kim SH, Lim DH. KAAACI Evidence-Based Clinical Practice Guidelines for Chronic Cough in Adults and Children in Korea. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:591-613. [PMID: 30306744 PMCID: PMC6182199 DOI: 10.4168/aair.2018.10.6.591] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 05/24/2018] [Indexed: 12/13/2022]
Abstract
Chronic cough is common in the community and causes significant morbidity. Several factors may underlie this problem, but comorbid conditions located at sensory nerve endings that regulate the cough reflex, including rhinitis, rhinosinusitis, asthma, eosinophilic bronchitis, and gastroesophageal reflux disease, are considered important. However, chronic cough is frequently non-specific and accompanied by not easily identifiable causes during the initial evaluation. Therefore, there are unmet needs for developing empirical treatment and practical diagnostic approaches that can be applied in primary clinics. Meanwhile, in referral clinics, a considerable proportion of adult patients with chronic cough are unexplained or refractory to conventional treatment. The present clinical practice guidelines aim to address major clinical questions regarding empirical treatment, practical diagnostic tools for non-specific chronic cough, and available therapeutic options for chronic wet cough in children and unexplained chronic cough in adults in Korea.
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Affiliation(s)
- Dae Jin Song
- Department of Pediatrics, Korea University College of Medicine and Environmental Health Center for Childhood Asthma, Korea University Anam Hospital, Seoul, Korea
| | - Woo Jung Song
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Woo Kwon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Gun Woo Kim
- Department of Internal Medicine, St. Carollo General Hospital, Suncheon, Korea
| | - Mi Ae Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Mi Yeong Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Min Hye Kim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Sang Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sang Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang Hyuck Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sun Tae Kim
- Department of Otorhinolaryngology, Gachon University, Gil Medical center, Incheon, Korea
| | - Sae Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Bundang, Korea
| | - Ja Kyoung Kim
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Joo Hee Kim
- Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hyun Jung Kim
- Institute for Evidence-based Medicine Cochrane Korea, Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyo Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Kyung Hee Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | | | - Byung Jae Lee
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Eun Lee
- Respiratory and Allergy Clinic, Pusan National University Yangsan Hospital, Yangsan, Korea
| | | | - Yong Ju Lee
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Kyung Hwan Lim
- Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - You Hoon Jeon
- Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Dongtan, Korea
| | - Eun Jung Jo
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Young Koo Jee
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Hyun Jung Jin
- Department of Internal medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Sun Hee Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Gyu Young Hur
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Sang Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Hoon Kim
- Department of Internal Medicine, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea.
| | - Dae Hyun Lim
- Department of Pediatrics, Inha University School of Medicine and Environmental Health Center for Allergic Disease, Inha University Hospital, Incheon, Korea.
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Kim YH, Sol IS, Yoon SH, Kim MJ, Kim KW, Sohn MH, Kim KE. Association of extended nitric oxide parameters with bronchial hyperresponsiveness and bronchodilator response in children with asthma. J Breath Res 2017; 11:046003. [PMID: 28656903 DOI: 10.1088/1752-7163/aa7c1f] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Theoretical non-linear modeling of exhaled nitric oxide has revealed extended flow-independent parameters that could explain where or how nitric oxide is produced in the lung and transferred to the airway gas stream. We aimed to evaluate the associations of bronchial hyperresponsiveness and bronchodilator response with extended flow-independent nitric oxide parameters. Nitric oxide (30, 50, 100, 200 ml s-1) was measured in 432 children with asthma on the same day with either a methacholine challenge test (n = 156) or spirometry with bronchodilator (n = 276; 96 previously diagnosed with asthma and treated with inhaled corticosteroid, 37 with acute exacerbation treated with systemic corticosteroid). We additionally included 107 healthy controls for evaluation of the suitability of the non-linear model of exhaled nitric oxide. In asthmatic children, the response-dose ratio of the methacholine challenge test was correlated positively with bronchial nitric oxide (JawNO) and airway tissue nitric oxide (CawNO) (r = 0.367 and r = 0.299, respectively; both p < 0.001), while the change in forced expiratory volume in 1 s, representing bronchodilator response, was associated positively with only JawNO (r = 0. 216, p < 0.001). On multiple regression, JawNO, CawNO, and the diffusing capacity of NO (DawNO) were significantly associated with the response-dose ratio. JawNO was significantly associated with change in forced expiratory volume in children with stable asthma but not those with acute exacerbation. Our findings suggest that bronchial hyperresponsiveness is associated with CawNO while factors other than airway tissue inflammation could affect bronchodilator response in children with mild asthma. Systemic corticosteroid use during asthma exacerbation could affect the association of bronchodilator response with extended nitric oxide parameters.
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Affiliation(s)
- Yoon Hee Kim
- Department of Pediatrics, Gangnam Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Kwon JW, Song WJ, Kim MH, Lim KH, Yang MS, Jung JW, Lee J, Suh DI, Shin YS, Kim SH, Kim SH, Lee BJ, Cho SH. The KAAACI Standardization Committee Report on the procedure and application of fractional exhaled nitric oxide measurement. ALLERGY ASTHMA & RESPIRATORY DISEASE 2017. [DOI: 10.4168/aard.2017.5.4.185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jae-Woo Kwon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Hye Kim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kyung-Hwan Lim
- Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Min-Suk Yang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jae-Woo Jung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeongmin Lee
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Yoo Seob Shin
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Suh DI, Yang HJ, Kim BS, Shin YH, Lee SY, Park G, Kim WK, Kim HB, Baek H, Kim JK, Kim JT, Lim DH. Asthma Severity and the Controller Prescription in Children at 12 Tertiary Hospitals. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:52-60. [PMID: 27826962 PMCID: PMC5102836 DOI: 10.4168/aair.2017.9.1.52] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 07/09/2016] [Accepted: 08/09/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE Guidelines need to be tailored to where they are applied. We aimed to describe the distinctive asthma severity profile and the pattern of controller prescription in Korean children. METHODS Twelve pediatric allergists from tertiary medical centers reviewed medical records of all asthmatic children who visited their clinics between September 1 and November 30 of 2013. Controller prescriptions were re-classified into 4 categories, then the prevalence of each asthma severity category and the controller prescription patterns according to asthma severity assessed by a Western (Global Initiative for Asthma, GINA) and an Asia-Pacific (Japanese Pediatric GuideLine, JPGL) guideline were evaluated. RESULTS A total of 840 cases were reviewed. Both GINA and JPGL revealed that 328 (39.0%) and 249 (29.6%) subjects had intermittent asthma whereas 24 (2.9%) and 21 (2.5%) subjects had severe persistent asthma, respectively. Although higher category controllers tended to be prescribed to those who had more severe asthma, there was much overlap in categories of prescribed controllers between groups with regard to asthma severities. Leukotriene receptor antagonists (LTRA) was the most frequently prescribed as a single controller (40%) or as an add-on medication (19%) in the group of asthmatic children <6 years. CONCLUSIONS Korean children have distinctive patterns of asthma severity and management strategies with a lower prevalence of severe asthma and a preference toward LTRA rather than low dose inhaled corticosteroids (ICS) alone or add-on long-acting beta-agonist (LABA) in the group of <6 year-old asthmatics that has not been predicted in Western countries. Thus, strategies tailored to regional situations need to be developed and recommended.
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Affiliation(s)
- Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Jong Yang
- Department of Pediatrics, Soonchunhyang University Hospital, Seoul, Korea
| | - Bong Seong Kim
- Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Youn Ho Shin
- Department of Pediatrics, Gangnam CHA Hospital, Seoul, Korea
| | - So Yeon Lee
- Department of Pediatrics, Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Geunhwa Park
- Department of Pediatrics, Gwanghye General Hospital, Busan, Korea
| | - Woo Kyung Kim
- Department of Pediatrics, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hyo Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Heysung Baek
- Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Ja Kyoung Kim
- Department of Pediatrics, Kangwon National University Hospital, Chuncheon, Korea
| | - Jin Tack Kim
- Department of Pediatrics, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Uijeongbu, Korea.
| | - Dae Hyun Lim
- Department of Pediatrics, Inha University Hospital, Incheon, Korea.,Environmental Health Center for Allergic Rhinitis, Ministry of Environment, Korea.
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15
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Song WJ, Morice AH. Cough Hypersensitivity Syndrome: A Few More Steps Forward. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:394-402. [PMID: 28677352 PMCID: PMC5500693 DOI: 10.4168/aair.2017.9.5.394] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/07/2017] [Accepted: 03/09/2017] [Indexed: 01/17/2023]
Abstract
Cough reflex is a vital protective mechanism against aspiration, but when dysregulated, it can become hypersensitive. In fact, chronic cough is a significant medical problem with a high degree of morbidity. Recently, a unifying paradigm of cough hypersensitivity syndrome has been proposed. It represents a clinical entity in which chronic cough is a major presenting problem, regardless of the underlying condition. Although it remains a theoretical construct, emerging evidence suggests that aberrant neurophysiology is the common etiology of this syndrome. Recent success in randomized clinical trials using a P2X3 receptor antagonist is the first major advance in the therapeutics of cough in the past 30 years; it at last provides a strategy for treating intractable cough as well as an invaluable tool for dissecting the mechanism underpinning cough hypersensitivity. Additionally, several cough measurement tools have been validated for use and will help assess the clinical relevance of cough in various underlying conditions. Along with this paradigm shift, our understanding of cough mechanisms has improved during the past decades, allowing us to continue to take more steps forward in the future.
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Affiliation(s)
- Woo Jung Song
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Alyn H Morice
- Centre for Cardiovascular and Metabolic Research, University of Hull, Hull York Medical School, Castle Hill Hospital, Cottingham, East Yorkshire, United Kingdom.
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Thorhallsdottir AK, Gislason D, Malinovschi A, Clausen M, Gislason T, Janson C, Benediktsdottir B. Exhaled nitric oxide in a middle-aged Icelandic population cohort. J Breath Res 2016; 10:046015. [PMID: 27902492 DOI: 10.1088/1752-7155/10/4/046015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The prevalence of atopy and asthma is relatively low in Iceland. The purpose of this study was to describe exhaled nitric oxide (FeNO) levels in the general population in correlation with demographic characteristics, smoking status, asthma, rhinitis, atopic status and lung function tests. Altogether 403 subjects, from the European Community Respiratory Health Survey (ECRHS) III who answered the main questionnaire and were checked by FeNO measurements, lung function testing, skin prick testing and measurement of total IgE and specific IgE were included. The geometric mean (95% CI) of FeNO was 16.2 ppb (15.2-17.1) and the prevalence of higher FeNO (⩾25 ppb) was 19.5% in the random sample. Subjects with higher FeNO levels were less likely to be current smokers and more likely to have asthma and rhinitis. Having higher FeNO values was also associated with higher total IgE, having specific IgE to at least one allergen and being skin prick test positive. Current smokers had significantly lower levels of FeNO, geometric mean (95% CI) 9.6 ppb (8.4-11.0), than ex-smokers 18.2 ppb (16.6-20.0) and never smokers 17.3 ppb (16.1-18.5). In multivariable models, having asthma (OR (95% CI) 2.10 (1.20-3.67)), having a specific IgE (OR 2.30 (1.25-4.23)) and being skin prick test positive (OR 2.06 (1.18-3.60)) were independently positively associated with a higher FeNO (⩾25) whereas current smoking was independently negatively associated with a higher FeNO (OR 0.19 (0.06-0.63)). Higher levels of FeNO (⩾25 ppb) were found in one out of five Icelanders; FeNO was positively associated with asthma and allergy and negatively with smoking.
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Affiliation(s)
- Anna Kristin Thorhallsdottir
- Primary Health Care Centre, Gardabaer, Iceland. Department of Respiratory Medicine and Sleep, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland. Author to whom any correspondence should be addressed. Primary Health Care Centre, Gardabaer, Iceland
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Kang SY, Kim GW, Song WJ, Chang YS, Cho SH. Chronic cough in Korean adults: a literature review on common comorbidity. Asia Pac Allergy 2016; 6:198-206. [PMID: 27803879 PMCID: PMC5088255 DOI: 10.5415/apallergy.2016.6.4.198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/20/2016] [Indexed: 01/15/2023] Open
Abstract
Chronic cough is a significant medical condition with high prevalence and a strong negative impact on the quality of life. Cough hypersensitivity is thought to underlie chronic cough, with several environmental and host factors interacting to cause neuronal sensitization and chronicity. Comorbid conditions affecting cough reflex pathways, such as upper airway diseases, asthma, and gastroesophageal reflux, play important roles in chronic cough. However, their prevalence may vary in patients living in different geographical regions or with different ethnicities. We conducted a literature review to examine common comorbidities in Korean adult patients with chronic cough, their clinical implications, and the issues that still need to be addressed in the development of clinical evidence of chronic cough in Korean adult patients.
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Affiliation(s)
- Sung-Yoon Kang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
| | - Gun-Woo Kim
- Department of Internal Medicine, Kwangju Christian Hospital, Gwangju 61661, Korea
| | - Woo-Jung Song
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Sang-Heon Cho
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
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18
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Could Fractional Exhaled Nitric Oxide Test be Useful in Predicting Inhaled Corticosteroid Responsiveness in Chronic Cough? A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 5:135-143.e1. [PMID: 27707661 DOI: 10.1016/j.jaip.2016.07.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 07/16/2016] [Accepted: 07/18/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Fractional exhaled nitric oxide (Feno) is a safe and convenient test for assessing TH2 airway inflammation, which is potentially useful in the management of patients with chronic cough. OBJECTIVE To summarize the current evidence on the diagnostic usefulness of Feno for predicting inhaled corticosteroid (ICS) responsiveness in patients with chronic cough. METHODS A systematic literature review was conducted to identify articles published in peer-reviewed journals up to February 2015, without language restriction. We included studies that reported the usefulness of Feno (index test) for predicting ICS responsiveness (reference standard) in patients with chronic cough (target condition). The data were extracted to construct a 2 × 2 accuracy table. Study quality was assessed with Quality Assessment of Diagnostic Accuracy Studies 2. RESULTS We identified 5 original studies (2 prospective and 3 retrospective studies). We identified considerable heterogeneities in study design and outcome definitions, and thus were unable to perform a meta-analysis. The proportion of ICS responders ranged from 44% to 59%. Sensitivity and specificity ranged from 53% to 90%, and from 63% to 97%, respectively. The reported area under the curve ranged from about 0.60 to 0.87; however, studies with a prospective design and a lower prevalence of asthma had lower area under the curve values. None measured placebo effects or objective cough frequency. CONCLUSIONS We did not find strong evidence to support the use of Feno tests for predicting ICS responsiveness in chronic cough. Further studies need to have a randomized, placebo-controlled design, and should use validated measurement tools for cough. Standardization would facilitate the development of clinical evidence.
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Jung CG, Park HS. Factors Predicting Recovery From Asthma Exacerbations. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2016; 8:479-80. [PMID: 27582397 PMCID: PMC5011046 DOI: 10.4168/aair.2016.8.6.479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 01/05/2023]
Affiliation(s)
- Chang Gyu Jung
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.
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Liu PF, Zhao DH, Qi Y, Wang JG, Zhao M, Xiao K, Xie LX. The clinical value of exhaled nitric oxide in patients with lung cancer. CLINICAL RESPIRATORY JOURNAL 2016; 12:23-30. [PMID: 26934059 DOI: 10.1111/crj.12471] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 12/16/2015] [Accepted: 02/23/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Peng-Fei Liu
- Department of Pulmonary & Critical Care Medicine; Chinese PLA General Hospital; Beijing 100853 China
| | - Da-Hui Zhao
- Department of Pulmonary & Critical Care Medicine; Chinese PLA General Hospital; Beijing 100853 China
| | - Yan Qi
- Department of Nephrology; Chinese PLA General Hospital; Beijing 100853 China
| | - Jian-Guo Wang
- Department of Pulmonary & Critical Care Medicine; Chinese PLA General Hospital; Beijing 100853 China
| | - Ming Zhao
- Department of Pulmonary & Critical Care Medicine; Chinese PLA General Hospital; Beijing 100853 China
| | - Kun Xiao
- Department of Pulmonary & Critical Care Medicine; Chinese PLA General Hospital; Beijing 100853 China
| | - Li-Xin Xie
- Department of Pulmonary & Critical Care Medicine; Chinese PLA General Hospital; Beijing 100853 China
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Online Measurement of Exhaled NO Concentration and Its Production Sites by Fast Non-equilibrium Dilution Ion Mobility Spectrometry. Sci Rep 2016; 6:23095. [PMID: 26975333 PMCID: PMC4791560 DOI: 10.1038/srep23095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/01/2016] [Indexed: 01/08/2023] Open
Abstract
Exhaled nitric oxide (NO) is one of the most promising breath markers for respiratory diseases. Its profile for exhalation and the respiratory NO production sites can provide useful information for medical disease diagnosis and therapeutic procedures. However, the high-level moisture in exhaled gas always leads to the poor selectivity and sensitivity for ion spectrometric techniques. Herein, a method based on fast non-equilibrium dilution ion mobility spectrometry (NED-IMS) was firstly proposed to directly monitor the exhaled NO profile on line. The moisture interference was eliminated by turbulently diluting the original moisture to 21% of the original with the drift gas and dilution gas. Weak enhancement was observed for humid NO response and its limit of detection at 100% relative humidity was down to 0.58 ppb. The NO concentrations at multiple exhalation flow rates were measured, while its respiratory production sites were determined by using two-compartment model (2CM) and Högman and Meriläinen algorithm (HMA). Last but not the least, the NO production sites were analyzed hourly to tentatively investigate the daily physiological process of NO. The results demonstrated the capacity of NED-IMS in the real-time analysis of exhaled NO and its production sites for clinical diagnosis and assessment.
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Yune S, Lee JY, Choi DC, Lee BJ. Fractional exhaled nitric oxide: comparison between portable devices and correlation with sputum eosinophils. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2015; 7:404-8. [PMID: 25749783 PMCID: PMC4446639 DOI: 10.4168/aair.2015.7.4.404] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/08/2014] [Accepted: 12/11/2014] [Indexed: 11/20/2022]
Abstract
This study was performed to compare the 2 different portable devices measuring fractional exhaled nitric oxide (FeNO) and to see the correlation between FeNO and induced sputum eosinophil count (ISE). Forty consecutive subjects clinically suspected to have asthma underwent FeNO measurement by NIOX-MINO® and NObreath® concurrently. All also had induced sputum analysis, methacholine provocation test or bronchodilator response test, and spin prick test. Agreement between the 2 devices was evaluated. The correlation between FeNO and ISE was assessed, as well as the cut-off level of FeNO to identify ISE ≥3%. The intraclass correlation coefficient (ICC) between FeNO levels measured by NIOX-MINO® (FeNONIOX-MINO) and NObreath® (FeNONObreath) was 0.972 with 95% confidence interval of 0.948-0.985. The 95% limits of agreement were -28.9 to 19.9 ppb. The correlation coefficient between ISE and FeNONIOX-MINO was 0.733 (P<0.001), and 0.751 between ISE and FeNONObreath (P<0.001). The ROC curve found that the FeNONIOXMINO of 37.5 ppb and the FeNONObreath of 36.5 ppb identified ISE ≥3% with 90% sensitivity and 81% specificity. Age, sex, body mass index, smoking history, atopy, and the presence of asthma did not affect the FeNO level and its correlation with ISE. The NIOX-MINO ® and NObreath® agree with each other to a high degree. Both devices showed close correlation with ISE with similar cut-off value in identifying ISE ≥3%.
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Affiliation(s)
- Sehyo Yune
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Young Lee
- Center for Health Promotion, Samsung Medical Center, Seoul, Korea
| | - Dong Chull Choi
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Jae Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Kim MY, Jo EJ, Lee SE, Lee SY, Song WJ, Kim TW, Hur GY, Lee JH, Kim TB, Park HW, Chang YS, Park HS, Min KU, Cho SH. Reference ranges for induced sputum eosinophil counts in Korean adult population. Asia Pac Allergy 2014; 4:149-55. [PMID: 25097850 PMCID: PMC4116041 DOI: 10.5415/apallergy.2014.4.3.149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 07/08/2014] [Indexed: 12/19/2022] Open
Abstract
Background Induced sputum analyses are widely utilized to evaluate airway inflammation in asthmatics. However, the values have not been examined in Korean adults. Objective The purpose of this study is to determine reference ranges for induced sputum eosinophils and their influencing factors in Korean adults. Methods A total of 208 healthy nonasthmatic adults were recruited. Sputum induction and processing followed the international standard protocols. Results Adequate sputum samples were successfully collected from 81 subjects (38.9%). The upper 90 percentile for sputum eosinophil was calculated as 3.5%. The median value of eosinophil count percentage was significantly higher in subjects with atopy than those without atopy (median, 1.6%; range, 0-11.0% vs. median, 0%; range 0-3.6%, p=0.030). However, no significant correlations were found with age, gender, body mass index, smoking status, blood eosinophil, or fractional exhaled nitric oxide levels. Conclusion Current study was the first attempt to determine the reference ranges of induced sputum eosinophils in Korean adults. The cutoff value for sputum eosinophilia was 3.5%, and was significantly associated with atopy.
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Affiliation(s)
- Mi-Yeong Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan 614-735, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 110-799, Korea
| | - Eun-Jung Jo
- Department of Internal Medicine, Pusan National University College of Medicine, Busan 626-870, Korea
| | - Seung-Eun Lee
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan 626-700, Korea
| | - Suh-Young Lee
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 110-799, Korea. ; Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea. ; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - Woo-Jung Song
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 110-799, Korea. ; Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Tae-Wan Kim
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 110-799, Korea. ; Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Gyu-Young Hur
- Department of Internal Medicine, Korea University College of Medicine, Seoul 136-705, Korea
| | - Jae-Hyung Lee
- Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul 139-711, Korea
| | - Tae-Bum Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Heung-Woo Park
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 110-799, Korea. ; Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Yoon-Seok Chang
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 110-799, Korea. ; Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea. ; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 463-707, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon 443-721, Korea
| | - Kyung-Up Min
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 110-799, Korea. ; Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
| | - Sang-Heon Cho
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 110-799, Korea. ; Department of Internal Medicine, Seoul National University College of Medicine, Seoul 110-799, Korea
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