scholarly journals Predictors of Loss of Asthma Control Induced by Corticosteroid Withdrawal

2006 ◽  
Vol 13 (3) ◽  
pp. 129-133 ◽  
Author(s):  
Jose Belda ◽  
Krishnan Parameswaran ◽  
Catherine Lemière ◽  
Dennis Kamada ◽  
Paul M O'Byrne ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Asthma Control ◽  
Eosinophil Count ◽  
Inhaled Corticosteroids ◽  
Forced Expiratory Volume ◽  
Exhaled Nitric Oxide ◽  
Baseline Risk ◽  
Blood Eosinophil ◽  
Inhaled Corticosteroid ◽  
Sputum Eosinophil

BACKGROUND: Asthma guidelines recommend reducing the dose of inhaled corticosteroids after establishing control.OBJECTIVE: To identify predictors of loss of control and the kinetics of symptoms, and inflammatory and physiological measurements when inhaled corticosteroids are reduced in patients with stable asthma.PATIENTS AND METHODS: In a single-blind study, the daily dose of inhaled corticosteroid was reduced by one-half at intervals of 20±2 days in 17 adults with controlled asthma until loss of asthma control occurred or until the corticosteroid was replaced with placebo for 20 days. The patients recorded symptoms and peak expiratory flow each day, and forced expiratory volume in 1 s (FEV1), the provocative concentration of methacholine causing a 20% fall in FEV1(PC20), exhaled nitric oxide, and eosinophils in sputum and blood were measured every 10 days. A loss of asthma control was defined as a worsening of the symptoms score of at least 20%, and either a decrease in FEV1of at least 15% or a decrease in PC20of at least fourfold.RESULTS: Two patients had a respiratory infection and were withdrawn from the study. In eight patients, asthma became uncontrolled after a mean of 33 days (range 13 to 48 days). This was accurately reflected by a worsening of all parameters. The first parameter to change was the sputum eosinophil percentage (20 days before the loss of asthma control). Significant changes in exhaled nitric oxide, FEV1and methacholine PC20were observed only when the symptoms became uncontrolled. A high blood eosinophil count at baseline (risk ratio of 2.5, 95% CI 1.0 to 6.5) and an increase in sputum eosinophil count after the reduction of corticosteroids were predictors of loss of asthma control.CONCLUSION: In patients whose asthma is controlled on inhaled corticosteroid, it is prudent not to reduce the dose further if the blood eosinophils are increased or if the sputum eosinophils increase by as little as 1% after the reduction of corticosteroids.

scholarly journals Study of the role of exhaled nitric oxide (NO) in predicting controlled or uncontrolled asthma in asthmatic children

2020 ◽  
Vol 15 ◽  
Author(s):  
Xuan Ngo-Minh ◽  
Tram Tang-Thi-Thao ◽  
Nhu Doan-Thi-Quynh ◽  
Timothy J. Craig ◽  
Sy Duong-Quy
Keyword(s):  
Nitric Oxide ◽  
Asthma Control ◽  
Exhaled Nitric Oxide ◽  
Blood Eosinophil ◽  
Inhaled Corticosteroid ◽  
Uncontrolled Asthma ◽  
Cross Sectional ◽  
Total Ige ◽  
Asthmatic Children ◽  
Exhaled No

Background: Exhaled nitric oxide (NO), especially fractional concentration of exhaled NO (FENO) has been used to predict the responsiveness of inhaled corticosteroid (ICS) in children with asthma. However, the use of exhaled NO for predicting asthma control in children is still controversial.Methods: This was a randomized and cross-sectional study. Asthmatic children who were naïve to inhaled corticosteroid (ICS) were included in the present study. The measurements of FENO and CANO (concentration of NO in the gas phase of the alveolar), spirometry, blood eosinophil counts (BEC), and total IgE levels were done for each asthmatic child.Results: Ninety three asthmatic children (9±3 years) with moderate (63.4%) to severe (36.6%) asthma were included and finished the 3 month study. The levels of FENO and CANO at inclusion were 37±11 ppb and 5.8±1.4 ppb, respectively; the mean of BEC was 617±258 cells/µL; the level of total IgE was 1563±576 UI/mL; 89% of subjects were positive for at least one respiratory allergen. The percentage of severe asthma was reduced significantly after 3 months (P<0.001). Well controlled asthma subjects at 3 months had higher levels of FENO and lower levels of CANO at inclusion (P<0.05 and P<0.05). FENO <20 ppb or CANO >5 ppb had a risk of uncontrolled asthma at 3 months (OR: 1.7, CI 95% [(0.8) – (3.3)], P<0.05; OR: 1.9, CI 95% [(0.9) – (2.7)], p<0.05; respectively). FENO >35 ppb at inclusion had a positive predictive value for asthma control at 3 months (OR: 3.5, CI 95% [2.2 – 5.9], P<0.01).Conclusions: Exhaled NO is a biomarker of asthma which may have a potential role to predict the control of asthma in short-term follow-up in asthmatic children.

scholarly journals Clinical and Economic Consequences of Switching From Omalizumab to Mepolizumab in Uncontrolled Severe Eosinophilic Asthma: an Observational Retrospective Study

2020 ◽  
Author(s):  
Giovanna Elisiana Carpagnano ◽  
Emanuela Resta ◽  
Massimiliano Povero ◽  
Corrado Pelaia ◽  
Mariella D'Amato ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Asthma Control ◽  
Exhaled Nitric Oxide ◽  
Blood Eosinophil ◽  
Fractional Exhaled Nitric Oxide ◽  
Eosinophilic Asthma ◽  
Exacerbation Rate ◽  
Serum Ige ◽  
Severe Eosinophilic Asthma ◽  
Oral Corticosteroids

Abstract Background: Severe asthma is burdened by frequent exacerbations and use of oral corticosteroids, which worsen patients’ health and increase healthcare spending. The aim of this study was to assess the clinical and economic impact of switching from omalizumab to mepolizumab in patients eligible for both biologics, but not optimally controlled by omalizumab.Methods: We retrospectively enrolled uncontrolled severe asthmatic patients, referred to seven asthma clinics in Italy, who switched from omalizumab to mepolizumab during the last two years. Clinical, functional, and laboratory information included blood eosinophil count, asthma control test, spirometry, serum IgE, fractional exhaled nitric oxide, oral corticosteroids intake, use of controller and rescue drugs, exacerbations/hospitalizations, visits and diagnostic exams. Within the perspective of Italian National Health System, a pre- and post-mepolizumab 12-month standardized total cost per patient was calculated.Results: 33 patients were enrolled: 5 males and 28 females, mean age 57 years, mean disease onset 24 years. At omalizumab discontinuation, 88% were oral corticosteroids-dependent with annual mean rate of 4.0 clinically significant exacerbations, 0.30 exacerbations needing emergency room visits or hospitalization; absenteeism due to disease was 10.4 days per patient. Switch to mepolizumab improved all clinical outcomes, reducing total exacerbation rate (RR = 0.06, 95% CI 0.03 to 0.14), oral corticosteroids -dependent patients (OR = 0.02, 95% CI 0.005 to 0.08), and the number of lost working days because of uncontrolled disease (Δ = -7.9, 95% CI -11.2 to -4.6). Pulmonary function improved, as well as serum IgE, fractional exhaled nitric oxide and eosinophils decreased. Mean annual costs were € 12,239 for omalizumab and € 12,639 for mepolizumab (Δ = € 400, 95% CI -1,588 to 2,389); the increment due to drug therapy (+ € 1,581) was almost offset by savings regarding all other cost items (- € 1,181). Conclusions: Patients with severe eosinophilic asthma, not controlled by omalizumab, experienced comprehensive benefits in asthma control by switching to mepolizumab. These relevant improvements were burdened by only very slight increases in economic costs.

scholarly journals Exhaled nitric oxide thresholds associated with a sputum eosinophil count >=3% in a cohort of unselected patients with asthma

Thorax ◽  
2010 ◽  
Vol 65 (12) ◽  
pp. 1039-1044 ◽  
Author(s):  
F. N. Schleich ◽  
L. Seidel ◽  
J. Sele ◽  
M. Manise ◽  
V. Quaedvlieg ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Eosinophil Count ◽  
Exhaled Nitric Oxide ◽  
Sputum Eosinophil

Pretreatment Alveolar Nitric Oxide Levels Predict Improvement of Pulmonary Function 1 Year Following Anti-Asthma Treatments in Patients with Inhaled Corticosteroid-Naïve Asthma

2022 ◽  
pp. 1-11
Author(s):  
Kensuke Fukumitsu ◽  
Hirono Nishiyama ◽  
Yoshihiro Kanemitsu ◽  
Norihisa Takeda ◽  
Ryota Kurokawa ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Pulmonary Function ◽  
Inhaled Corticosteroids ◽  
Forced Expiratory Volume ◽  
Poor Responders ◽  
Newly Diagnosed ◽  
Inhaled Corticosteroid ◽  
Factors Associated ◽  
Long Acting ◽  
Continuous Use

<b><i>Introduction:</i></b> Inhaled corticosteroids (ICS) are fundamental agents to subside airway inflammation and improve forced expiratory volume in 1 s (FEV<sub>1</sub>) among asthmatics. Alveolar concentrations of nitric oxide (CANO), as well as the classical fraction of exhaled nitric oxide (FeNO50), are associated with the pathophysiology of asthma. However, the association between pretreatment CANO levels and response to anti-asthma treatments, including ICS, remains unknown. <b><i>Methods:</i></b> We retrospectively analyzed 107 patients newly diagnosed with asthma. ICS in combination with long-acting β<sub>2</sub>-agonists (ICS/LABA) was initiated. FEV<sub>1</sub> and FeNO levels were evaluated at diagnosis and were followed up at 6 and 12 months after the treatment intervention. CANO levels were estimated using various expiratory flows of FeNO measurements. Factors associated with annual changes in FEV<sub>1</sub> (ΔFEV<sub>1</sub>) were analyzed. Patients with a ΔFEV<sub>1</sub> &#x3c;–20 mL were defined as “poor-responders.” <b><i>Results:</i></b> FEV<sub>1</sub>, FeNO50, and CANO levels significantly improved by anti-asthma treatments. The average ΔFEV<sub>1</sub> was 85 (176) mL. Eighty-two patients continuously took ICS/LABA treatment. Higher pretreatment CANO levels and continuous use of LABA were independent predictive factors for the improvement of FEV<sub>1</sub> on multivariate analysis. The decline in FeNO50 and CANO levels by the anti-asthma treatments was significantly greater in 81 responders than in 26 poor-responders. CANO, but not FeNO50, levels at 12 months were significantly higher in poor-responders than in responders (<i>p</i> = 0.009). <b><i>Conclusion:</i></b> Levels of CANO, but not FeNO50, predict changes in pulmonary function in ICS-naïve asthmatics. Meanwhile, persistently high levels of CANO may be related to poor responsiveness to treatments assessed by ΔFEV<sub>1</sub>.

scholarly journals Tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils): a systematic review and meta-analysis

Thorax ◽  
2018 ◽  
Vol 73 (12) ◽  
pp. 1110-1119 ◽  
Author(s):  
Helen L Petsky ◽  
Chris J Cates ◽  
Kayleigh M Kew ◽  
Anne B Chang
Keyword(s):  
Nitric Oxide ◽  
Lung Function ◽  
Asthma Control ◽  
Inhaled Corticosteroids ◽  
Clinical Symptoms ◽  
Meta Analysis ◽  
Exhaled Nitric Oxide ◽  
Significant Group ◽  
Cochrane Reviews ◽  
Sputum Eosinophils

BackgroundAsthma guidelines guide health practitioners to adjust treatments to the minimum level required for asthma control. As many people with asthma have an eosinophilic endotype, tailoring asthma medications based on airway eosinophilic levels (sputum eosinophils or exhaled nitric oxide, FeNO) may improve asthma outcomes.ObjectiveTo synthesise the evidence from our updated Cochrane systematic reviews, for tailoring asthma medication based on eosinophilic inflammatory markers (sputum analysis and FeNO) for improving asthma-related outcomes in children and adults.Data sourcesCochrane reviews with standardised searches up to February 2017.Study selectionThe Cochrane reviews included randomised controlled comparisons of tailoring asthma medications based on sputum analysis or FeNO compared with controls (primarily clinical symptoms and/or spirometry/peak flow).ResultsThe 16 included studies of FeNO-based management (seven in adults) and 6 of sputum-based management (five in adults) were clinically heterogeneous. On follow-up, participants randomised to the sputum eosinophils strategy (compared with controls) were significantly less likely to have exacerbations (62 vs 82/100 participants with ≥1 exacerbation; OR 0.36, 95% CI 0.21 to 0.62). For the FeNO strategy, the respective numbers were adults OR 0.60 (95% CI 0.43 to 0.84) and children 0.58 (95% CI 0.45 to 0.75). However, there were no significant group differences for either strategy on daily inhaled corticosteroids dose (at end of study), asthma control or lung function.ConclusionAdjusting treatment based on airway eosinophilic markers reduced the likelihood of asthma exacerbations but had no significant impact on asthma control or lung function.

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