Association among Fraction of Exhaled Nitrous Oxide, Bronchodilator Response and Inhaled Corticosteroid Type

BACKGROUND: Fraction of exhaled nitrous oxide (FeNO) is a known marker of airway inflammation and a topic of recent investigation for asthma control in children.OBJECTIVE: To investigate the relationship among FeNO and bronchodilator response measured by spirometry and types of inhaled corticosteroids (ICS).METHODS: A one-year review of children tested with spirometry and FeNO in a regional pediatric asthma centre was conducted.RESULTS: A total of 183 children were included (mean [± SD] age 12.8±2.8 years). Fluticasone was used most commonly (n=66 [36.1%]), followed by ciclesonide (n=50 [27.3%]). Most children (n=73 [39.9%]) had moderate persistent asthma. Increased FeNO was associated with percent change in forced expiratory volume in 1 s (FEV1) after bronchodilator adjusted for allergic rhinitis, parental smoking and ICS type (B=0.08 [95% CI 0.04 to 0.12]; P<0.001). Similarly, FeNO was associated with percent change in forced expiratory flow at 25% to 75% of the pulmonary volume (FEF25–75) after bronchodilator adjusted for parental smoking and ICS type (B=0.13 [95% CI 0.01 to 0.24]; P=0.03). FeNO accounted for only 16% and 9% of the variability in FEV1and FEF25–75, respectively. Mean-adjusted FeNO was lowest in fluticasone users compared with no ICS (mean difference 18.6 parts per billion [ppb] [95% CI 1.0 to 36.2]) and there was no difference in adjusted FeNO level between ciclesonide and no ICS (5.9 ppb [95% CI −9.0 to 20.8]).CONCLUSION: FeNO levels correlated with bronchodilator response in a regional pediatric asthma centre. However, FeNO accounted for only 16% and 9% of the variability in FEV1and FEF25–75, respectively. Mean adjusted FeNO varied according to ICS type, suggesting a difference in relative efficacy between ICS beyond their dose equivalents.

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Inhaled Budesonide vis-à-vis Inhaled Mometasone in Chinese Children with Mild Persistent Asthma: A Single-Center, Retrospective Study

Pharmacology ◽

10.1159/000518733 ◽

2021 ◽

pp. 1-7

Author(s):

Pei Gao ◽

Ying Ding ◽

Bingru Yin ◽

Haoxiang Gu

Keyword(s):

Retrospective Study ◽

Asthma Exacerbation ◽

Inhaled Corticosteroids ◽

Persistent Asthma ◽

Forced Expiratory Volume ◽

Single Center ◽

Level Of Evidence ◽

Asthmatic Children ◽

Technical Efficacy ◽

Mild Persistent Asthma

Introduction: A very limited option of inhaled corticosteroids (ICSs) is approved for pediatric use in China because in children the use of ICSs for long periods is associated with dose-dependent growth reduction. Due to the lack of consensus on which is the best ICS-based treatment option to manage mild persistent asthma in children, the present study was performed to evaluate the efficacy and safety of budesonide (BUD)-based therapy vis-à-vis mometasone-based therapy in children with mild persistent asthma. Methods: A single-center, retrospective study was conducted in asthmatic children aged between 6 and 11 years. BUD and mometasone furoate (MF) were administered as per the approved dosing regimen using pressurized metered-dose inhalers via oral inhalation route for a period of 12 weeks. The study outcome was assessed in terms of the forced expiratory volume in 1 s (FEV1), symptom scores, and nonoccurrence of side effects. Results: Among the 77 asthmatic children, 71 completed the study treatment and were used in carrying out the analysis. The improvement of spirometric parameters like FEV1, Tiffeneau-Pinelli index (FEV1/forced vital capacity [FVC]), and peak expiratory flow (PEF) values observed in the MF cohort was significantly greater than those of the BUD cohort (p < 0.05 for all). An increase of approximately 12%/child was observed for FEV1/FVC ratios for the BUD cohort and MF cohorts. After the 12-week study, the PEFm and PEFe values increased to about 50 L/min/child for the BUD cohort and about 98 L/min/child for the MF cohort. During the study, no asthma exacerbation event was observed in the MF cohort, whereas 1 child in the BUD cohort had asthma exacerbation in week 4. The use of rescue medication during the study was required for 16.2 and 6% of children, respectively, for BUD and MF cohorts. Owing to low dosing frequency, MF could provide a better treatment approach than BUD due to improved patient compliance. Conclusions: Although both drugs showed improvement in the quality of life of asthmatic children with manageable treatment-emergent adverse effects, the improvement was augmented in MF-treated children. Level of Evidence: The level of evidence was III. Technical Efficacy Stage: The technical efficacy stage was 4.

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Oscillometric and Spirometric Bronchodilator Response in Preschool Children with and without Asthma

Canadian Respiratory Journal ◽

10.1155/2012/560323 ◽

2012 ◽

Vol 19 (4) ◽

pp. 273-277 ◽

Cited By ~ 16

Author(s):

Youn Ho Shin ◽

Sun Jung Jang ◽

Jung Won Yoon ◽

Hye Mi Jee ◽

Sun Hee Choi ◽

...

Keyword(s):

Preschool Children ◽

Forced Vital Capacity ◽

Vital Capacity ◽

Forced Expiratory Volume ◽

Bronchodilator Response ◽

Asthmatic Children ◽

Before And After ◽

Forced Expiratory Flow ◽

Quality Control Criteria ◽

Control Criteria

BACKGROUND: Bronchodilator responses (BDR) are routinely used in the diagnosis and management of asthma; however, their acceptability and repeatability have not been evaluated using quality control criteria for preschool children.OBJECTIVES: To compare conventional spirometry with an impulse oscillometry system (IOS) in healthy and asthmatic preschool children.METHODS: Data from 30 asthmatic children and 29 controls (two to six years of age) who underwent IOS and spirometry before and after salbutamol administration were analyzed.RESULTS: Stable asthmatic subjects significantly differed versus controls in their spirometry-assessed BDR (forced expiratory volume in 1 s [FEV1], forced vital capacity and forced expiratory flow at 25% to 75% of forced vital capacity) as well as their IOS-assessed BDR (respiratory resistance at 5 Hz [Rrs5], respiratory reactance at 5 Hz and area under the reactance curve). However, comparisons based on the area under the ROC curve for ΔFEV1% initial versus ΔRrs5% initial were 0.82 (95% CI 0.71 to 0.93) and 0.75 (95% CI 0.62 to 0.87), respectively. Moreover, the sensitivity and specificity for ΔFEV1≥9% were 0.53 and 0.93, respectively. Importantly, sensitivity increased to 0.63 when either ΔFEV1≥9% or ΔRrs5≥29% was considered as an additional criterion for the diagnosis of asthma.CONCLUSION: The accuracy of asthma diagnosis in preschool children may be increased by combining spirometry with IOS when measuring BDR.

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Fluticasone versus Salmeterol/Low-Dose Fluticasone for Long-Term Asthma Control

Annals of Pharmacotherapy ◽

10.1345/aph.1a311 ◽

2002 ◽

Vol 36 (12) ◽

pp. 1944-1949 ◽

Cited By ~ 9

Author(s):

Catherine A Heyneman ◽

Rachel Crafts ◽

Jerry Holland ◽

Aaron D Arnold

Keyword(s):

Fluticasone Propionate ◽

Asthma Control ◽

Low Dose ◽

Inhaled Corticosteroids ◽

Symptom Control ◽

Persistent Asthma ◽

Forced Expiratory Volume ◽

Combination Drug ◽

Medium Dose

OBJECTIVE: To evaluate the relative clinical superiority of increasing the dose of fluticasone propionate versus the addition of salmeterol to low-dose fluticasone propionate for long-term asthma control. DATA SOURCES: Literature was identified by a MEDLINE search (1966–October 2002). Key search terms included asthma, inhalation, corticosteroid, β-adrenergic agonist, and combination drug therapy. DATA SYNTHESIS: Current guidelines for long-term control of asthma include treatment with either inhaled corticosteroids (medium dose) or inhaled corticosteroids (low to medium dose) in combination with a long-acting bronchodilator. Previous studies evaluating salmeterol or formoterol combination therapy with beclomethasone or budesonide have generally produced superior results compared with increasing the dose of the inhaled corticosteroid. Four recent controlled clinical trials have compared the clinical utility of fluticasone propionate monotherapy versus salmeterol/low-dose fluticasone propionate for long-term asthma control in patients with moderate to severe persistent asthma. Based on spirometry data, rescue albuterol use, and symptom scores, the addition of salmeterol to low-dose fluticasone propionate was superior to increasing the dose of fluticasone propionate. CONCLUSIONS: Based on improvements in forced expiratory volume in 1 second, peak expiratory flow, and symptom control, the addition of salmeterol to low-dose fluticasone propionate provides better control of asthma than increasing the dose of fluticasone propionate.

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Spirometric changes in children with asthma exposed to environmental tobacco smoke and treated with inhaled corticosteroids

Vojnosanitetski pregled ◽

10.2298/vsp170306115r ◽

2019 ◽

Vol 76 (3) ◽

pp. 321-330

Author(s):

Snezana Radic ◽

Branislava Milenkovic ◽

Branislav Gvozdenovic ◽

Biljana Medjo ◽

Sanja Dimic-Janjic

Keyword(s):

Lung Function ◽

Fluticasone Propionate ◽

Environmental Tobacco Smoke ◽

Tobacco Smoke ◽

Inhaled Corticosteroids ◽

Persistent Asthma ◽

Forced Expiratory Volume ◽

The Family ◽

Lower Lung ◽

Children With Asthma

Background/Aim. Corticosteroids are the most frequently prescribed anti-inflammatory treatment in asthma. A purpose of this study was to compare the spirometric parameters as a response to inhaled fluticasone propionate (FP) treatment in children with asthma, exposed and nonexposed to environmental tobacco smoke (ETS). Methods. The study included 527 children aged between 1 and 16 years with persistent asthma divided into the groups of ETS exposed (ETSE, n = 337) and ETS free (ETSF, n = 190) children. Spirometry was performed before (1st set of results) and after 6 months of FP treatment (2nd set of results). Good lung function (GLF) was defined as forced expiratory volume in one second (FEV1) ? 85%, and ?poor lung function? (PLF) as FEV1 < 85%. Results. Among the ETSE children, 208 had one smoking parent, 129 had two, 228 had smoking mothers and 238 smoking fathers. The ETSE children received a higher FP dose (p < 0.0001) which was increased with the increase of the number of smokers in the family. The ETSE children had significantly lower lung function both in the 1st and 2nd sets of tests compared to the ETSF children (p < 0.05). After the FP treatment, both groups improved all spirometric parameters (p < 0.001). In the 2nd set of the spirometric tests, the children of smoking mothers had lower spirometry values compared to the children of smoking fathers (p < 0.05). The proportion of the children improving from the PLF to GLF after 6 months of FP was much higher among the ETSF than the ETSE children (p < 0.05). Conclusions. The ETSE children had lower spirometric values before FP. After 6-months of the FP treatment children in both groups improved the spirometric values, but the improvement was higher in the ETSF children.

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Swimming and Persons with Mild Persistant Asthma

The Scientific World JOURNAL ◽

10.1100/tsw.2007.221 ◽

2007 ◽

Vol 7 ◽

pp. 1182-1188 ◽

Cited By ~ 29

Author(s):

Mirjana Arandelovic ◽

Ivana Stankovic ◽

Maja Nikolic

Keyword(s):

Lung Function ◽

Inhaled Corticosteroids ◽

Bronchial Hyperresponsiveness ◽

Persistent Asthma ◽

Forced Expiratory Volume ◽

Control Group ◽

Significant Difference ◽

Group A ◽

Mild Persistent Asthma ◽

Group B

The aim of our study was to analyze the effect of recreational swimming on lung function and bronchial hyperresponsiveness (BHR) in patients with mild persistent asthma. This study included 65 patients with mild persistent asthma, who were divided into two groups: experimental group A (n = 45) and control group B (n = 20). Patients from both groups were treated with low doses of inhaled corticosteroids (ICS) and short-acting β2 agonists salbutamol as needed. Our program for patients in group A was combined asthma education with swimming (twice a week on a 1-h basis for the following 6 months). At the end of the study, in Group A, we found a statistically significant increase of lung function parameters FEV1 (forced expiratory volume in 1 sec) (3.55 vs. 3.65) (p < 0.01), FVC (forced vital capacity) (4.27 vs. 4.37) (p < 0.05), PEF (peak expiratory flow) (7.08 vs. 7.46) (p < 0.01), and statistically significant decrease of BHR (PD200.58 vs. 2.01) (p < 0.001). In Group B, there was a statistically significant improvement of FEV1 3.29 vs. 3.33 (p < 0.05) and although FVC, FEV1/FVC, and PEF were improved, it was not significant. When Groups A and B were compared at the end of the study, there was a statistically significant difference of FVC (4.01 vs. 4.37), FEV1 (3.33 vs. 3.55), PEF (6.79 vs.7.46), and variability (p <0.001), and statistically significantly decreased BHR in Group A (2.01 vs. 1.75) (p < 0.001). Engagement of patients with mild persistent asthma in recreational swimming in nonchlorinated pools, combined with regular medical treatment and education, leads to better improvement of their parameters of lung function and also to more significant decrease of their airway hyperresponsiveness compared to patients treated with traditional medicine

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CQ4　Is the addition of leukotriene receptor antagonist to inhaled corticosteroids in children with persistent asthma effective?

Nihon Shoni Arerugi Gakkaishi The Japanese Journal of Pediatric Allergy and Clinical Immunology ◽

10.3388/jspaci.31.224 ◽

2017 ◽

Vol 31 (2) ◽

pp. 224-230 ◽

Cited By ~ 1

Author(s):

Tetsuharu Manabe ◽

Hiroki Murai ◽

Yuri Takaoka ◽

Hirokazu Arakawa

Keyword(s):

Receptor Antagonist ◽

Inhaled Corticosteroids ◽

Persistent Asthma ◽

Leukotriene Receptor Antagonist ◽

Leukotriene Receptor

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CLINICAL AND SPIROGRAPHIC FEATURES OF BRONCHIAL ASTHMA IN SCHOOLCHILDREN DEPENDING ON THE DIFFERENT REGIMENS OF BASIC ANTI-INFLAMMATORY THERAPY

Wiadomości Lekarskie ◽

10.36740/wlek202001105 ◽

2020 ◽

Vol 73 (1) ◽

Cited By ~ 1

Author(s):

Olena Koloskova ◽

Tetiana Bilous ◽

Galyna Bilyk ◽

Kristina Buryniuk-Glovyak ◽

Olena Korotun ◽

...

Keyword(s):

Bronchial Asthma ◽

Inhaled Corticosteroids ◽

Persistent Asthma ◽

High Specificity ◽

Clinical Feature ◽

Clinical Group ◽

Comparison Groups ◽

Anti Inflammatory ◽

High Doses ◽

Persistent Bronchial Asthma

The aim: To study the clinical and spirographic features persistence of the bronchial asthma in schoolchildren against the background of the alternative daily doses of inhaled corticosteroids to increase the effectiveness of anti-inflammatory therapy for this disease. Materials and methods: A complete comprehensive clinical-paraclinical examination of 65 schoolchildren with persistent asthma was conducted. According to the average daily dose of inhaled corticosteroids (ICS) the patients were divided into two clinical groups. The first (I) group consisted of 46 children who received ICS in the regimen of low-to-medium equipotent doses (253.95±9.98 μg per day), and the second (II) comparison group was formed of 19 patients who controlled the pBA using high doses of ICS (494.74±5.56 μg per day). Results: The patients of the І clinical group compared to patients of the ІІ group have a higher risk of the mild bronchial obstructive syndrome during asthma attacks. In assessing the level of control of persistent bronchial asthma using the CIA-scale, it was found that in II group cases of the controlled course of the disease were observed almost two times less than in children of the I group of comparison. In conducting spirography in children of comparison groups, it was shown that the ratio of indices of bronchospasm (FEV1/ FVC) was worse in patients receiving high doses of ICS. Conclusions: So, сharacteristic clinical feature of asthma controlled by high doses of ICS is more severe nature of bronchial obstructive syndrome during the period of exacerbation (OR=1.9-3.0). In the management of persistent bronchial asthma, the Gensler index which has high specificity (94.4%) and accuracy (92.2%) should be used for disease control verification.

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