Elevated exhaled nitric oxide is a clinical indicator of future uncontrolled asthma in asthmatic patients on inhaled corticosteroids

BACKGROUND: Monitoring noninvasive biomarkers of inflammation is an important adjunct in asthma therapy.OBJECTIVE: The goal of the present study was to identify airway and alveolar site(s) of inflammation using exhaled nitric oxide (NO) as a marker in asthmatic patients, and to evaluate the NO response to maintenance fluticasone 250 μg/salmeterol 50 μg (F/S) and add-on montelukast 10 mg (M).METHODS: Thirty (24 women) nonsmoking, mild to moderate asthmatic patients were studied, mean age (± SD) 43±9 years, treated with F/S for more than one year. All were clinically stable for longer than eight weeks and had not taken oral corticosteroids and/or leukotriene antagonists for eight weeks before the present study. Spirometry, Juniper asthma symptom score, fractional exhaled NO (FENO) 100 mL/s, bronchial NO and alveolar NO concentration (CANO) were measured in a single-blind, nonrandomized crossover study.PROTOCOL: Visit 1: baseline F/S; visit 2: after four weeks of F/S plus M; visit 3: after four weeks of S plus M; and visit 4: after four weeks of S only. Values in asthmatic patients were also compared with 34 nonsmoking age-matched healthy controls with normal lung function.RESULTS: After 180 μg aerosolized metered dose inhaler albuterol, the forced expiratory volume in 1 s at baseline was 2.6±0.8 L (86%±16% of the predicted value) and the forced expiratory volume in 1 s over the forced vital capacity was 77%±9% (mean ± SD), and was similar at visits 2 to 4. Juniper scores were mildly abnormal at visits 1 to 3, but significantly worse (P=0.03) at visit 4 versus visits 1 to 3. FENO values at visits 1 to 3 were similar but significantly increased (P=0.007) at visit 4. Bronchial NO was higher (P=0.03) at visit 4, versus visits 1 and 2, and was no different at visit 3. Compared with the healthy subjects, FENO and bronchial NO values were abnormal (greater than the normal mean plus 2 SD) in 33% of asthmatic patients at visits 1 to 3. CANO was similar for visits 1 to 4. CANO was abnormal (greater than the normal mean + 2 SD) in 20% of asthmatic patients.CONCLUSION: In clinically stable asthmatic patients, despite controller treatment including moderate-dose inhaled corticosteroids and add-on M, 33% of mild to moderate asthmatic patients have ongoing nonsuppressed bronchial sites of increased NO production, compared with healthy control subjects. These controllers have no effect on CANO, which was abnormal in 20% of the asthmatic patients studied. The addition of add-on M to baseline moderate-dose inhaled corticosteroid did not further reduce total exhaled, bronchial and/or alveolar NO production.

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Benefit of inhaled corticosteroids (ICS) in asthmatic patients with bronchial hyperresponsiveness (BHR) to mannitol and low fractional exhaled nitric oxide (FeNO) levels

10.1183/1393003.congress-2017.pa4757 ◽

2017 ◽

Author(s):

Clair Lake ◽

Keith K.H. Wong ◽

John D. Brannan

Keyword(s):

Nitric Oxide ◽

Inhaled Corticosteroids ◽

Bronchial Hyperresponsiveness ◽

Exhaled Nitric Oxide ◽

Fractional Exhaled Nitric Oxide ◽

Asthmatic Patients

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Monitoring the Fractional Concentration of Exhaled Nitric Oxide (FENO) in Uncontrolled Asthma Before and After Steroid Therapy Using a New Portable Monitor

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2006.11.374 ◽

2007 ◽

Vol 119 (1) ◽

pp. S89

Author(s):

W.E. Berger

Keyword(s):

Nitric Oxide ◽

Steroid Therapy ◽

Exhaled Nitric Oxide ◽

Uncontrolled Asthma ◽

Portable Monitor ◽

Fractional Concentration ◽

Before And After

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The effect of omalizumab on small airway inflammation as measured by exhaled nitric oxide in moderate-to-severe asthmatic patients

Allergy and Asthma Proceedings ◽

10.2500/aap.2014.35.3741 ◽

2014 ◽

Vol 35 (3) ◽

pp. 241-249 ◽

Cited By ~ 8

Author(s):

M. Asghar Pasha ◽

David Jourd'heuil ◽

Francis Jourd'heuil ◽

Lori Mahon ◽

Francisco Romero ◽

...

Keyword(s):

Nitric Oxide ◽

Airway Inflammation ◽

Exhaled Nitric Oxide ◽

Small Airway ◽

Asthmatic Patients ◽

Severe Asthmatic

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The Utility of Serum IL-1β and CRP Together with Fractional Exhaled Nitric Oxide in the Diagnosis of Asthma in Adults

NeuroQuantology ◽

10.14704/nq.2021.19.8.nq21122 ◽

2021 ◽

Vol 19 (8) ◽

pp. 119-124

Author(s):

Hayder Abdul-Amir Makki Al-Hindy ◽

Ali Jihad Hemid Al-Athari ◽

Mazin J. Mousa ◽

Safa Jihad Hameed ◽

Suhad Hafidh Obeed

Keyword(s):

Nitric Oxide ◽

Sensitivity And Specificity ◽

Bronchial Asthma ◽

High Sensitivity ◽

Exhaled Nitric Oxide ◽

Fractional Exhaled Nitric Oxide ◽

Asthmatic Patients ◽

Significant Difference ◽

Asthma Patients ◽

Hs Crp

Background: Bronchial asthma (BrA), recognized lately as an umbrella, covers various subtypes rather than only one disease. Asthma is a chronic inflammation of the airways, in which cytokines could play a crucial role in its pathogenesis. Hence, labors to progress noninvasive markers for asthma had centered through this era. Presently, the fractional exhaled nitric oxide (FeNO), serum C-reactive protein (CRP), and interleukin levels are emerging analytical biomarkers in this field. FeNO is a noninvasive and practical tool even in mild asthma. This study aimed to evaluate the utility of serum IL-1β and CRP together with fractional exhaled nitric oxide in the diagnosis of adult bronchial asthma. Method: The study was a case control, including 150-patients and 100-healthy controls. FeNO tests, measurements of plasma levels IL-1β and HS-CRP had undertaken for all the participants. The statistical data had examined by SPSS (V/27) for Windows. Descriptive data of the variables had compatibly used. A significance lower than or identical to 0.05 had intended. ROC curve examination of FeNO tests, IL-1β, and HS-CRP, to predict asthma from healthy control had applied. Results: there was a significant difference in the FeNo test, HS-CRP levels, and BMI, while no significant difference in all other variables between the groups. The FeNo results correlate positively, though not significantly, with the levels of IL-1β in asthmatic patients (> 0.05). There was a nonsignificant negative correlation between the FeNo results with the level of HSCRP. The accuracy, sensitivity, and specificity of the IL-1β to distinguish asthma were 68.6% and 58% at 95% CI [0.41-0.745], respectively, which was not significant (p>0.05). However, ROC analysis of HS-CRP revealed predictability for asthma patients (p-0.000), with higher accuracy, sensitivity, and specificity: 89.9%, and 68.1% at 95% CI [0.820-0.979], respectively. The FeNo tests revealed highly significant (0.000), high sensitivity, and specific (91% for both) with high 95% CI [0.938-1.000] predictability for asthma. Conclusion: The utility of circulating HS-CRP is more valuable than IL-1β when combined with fractional exhaled nitric oxide in the diagnosis of asthma. Novel biomarkers could improve the precision of this field.

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