Combination of Fractional Exhaled Nitric Oxide (FeNO) Level and Asthma Control Test (ACT) in Detecting GINA-Defined Asthma Control in Treated Asthmatic Patients in Vietnam

Background. FeNO has been used as a marker for Th2-mediated airway inflammation in asthma. There is evidence which recommends the use of this biomarker in asthma management. Little is known about whether the FeNO test alone or in combination with the ACT score can reflect asthma control in Vietnamese patients. Materials and Methods. A cross-sectional study was conducted in asthmatic patients (≥18 years old) recruited at the University Medical Center, Ho Chi Minh City, Vietnam from March 2016 to March 2017. Asthma control levels were assessed following the GINA 2017 guidelines, and FeNO was measured by a Niox Mino device. FeNO cut-offs predicting asthma control status were determined using the ROC curve analysis. The combination of FeNO and ACT was investigated in detecting well-controlled and uncontrolled asthma. The results of the study are as follows: 278 patients with 68% females, mean age of 44 years, and mean asthma duration of 10 years were analyzed. All patients were treated following step 2 to 4 of GINA guidelines. Mean (SD) FeNO was 30.6 (24) ppb. Patients with uncontrolled (16%), partly controlled (29%), and well-controlled asthma (55%) had a median (IQR) FeNO of 50.0 (74), 25.0 (23), and 21.0 (22.3) ppb, respectively, and the mean of FeNO in the uncontrolled group was significantly higher than that in other groups (p<0.001). The area under the ROC curve (AUC) for FeNO detecting uncontrolled asthma was 0.730 with an optimal cut-off point of FeNO > 50 ppb, and this AUC increased to 0.89 when combining FeNO and ACT. The AUC for FeNO detecting well-controlled asthma was 0.601 with an optimal cut-off point of FeNO <25 ppb and this AUC increased to 0.78 if combining FeNO and ACT. Conclusions. FeNO can predict asthma control status with an estimated cut-off point of <25 ppb for well-controlled and >50 ppb for uncontrolled asthma. The combination of FeNO and ACT provides better information regarding asthma control than FeNO alone, and this combination is useful to predict asthma control statuses in asthmatic patients in Viet Nam.

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Asthma control and management among schoolchildren in urban Uganda: results from a cross-sectional study

Wellcome Open Research ◽

10.12688/wellcomeopenres.15460.1 ◽

2019 ◽

Vol 4 ◽

pp. 168 ◽

Cited By ~ 5

Author(s):

Harriet Mpairwe ◽

Pius Tumwesige ◽

Milly Namutebi ◽

Marble Nnaluwooza ◽

Tonny Katongole ◽

...

Keyword(s):

Asthma Control ◽

Asthma Management ◽

Cross Sectional Study ◽

P Value ◽

Asthma Diagnosis ◽

Sectional Study ◽

Asthma Control Test ◽

Cross Sectional ◽

Children With Asthma ◽

Control And Management

Background: Children from low- and middle-income countries have poor asthma control, mainly because of poor management. The extent of this problem in Uganda is not well known, but such information would be useful to guide policy and practice. We therefore conducted a cross-sectional study among schoolchildren with asthma in urban Uganda, to assess the level of asthma control and management. Methods: Schoolchildren aged 5-17 years were enrolled, asthma was diagnosed by the study medical team. Asthma control was assessed using the Asthma Control Test and the childhood Asthma Control Test. Data on previous asthma management was obtained using interviewer-led questionnaires. Data were analysed using multiple linear and multiple logistic regression. Results: We enrolled 561 children with asthma, of whom only 56% had ever had an asthma diagnosis. We categorised asthma as well-controlled (55.5%), partly-controlled (29.5%) and poorly-controlled (15.0%). Poor asthma control was associated with increasing age (adjusted regression coefficient [95% confidence interval], p-value: -1.07 [-1.20, -0.94], p<0.0001), concurrent allergic rhinitis (-1.33 [-2.28, -0.38], p=0.006), and city residence in early life (-1.99 [-3.69, -0.29], p=0.06). Regular use of inhaled asthma medication in the last 12 months was very low; 18.1% for salbutamol and 6.7% for inhaled corticosteroids. The main barriers to inhaled asthma medication use were lack of prescription (47.6%) and inaccurate diagnosis (38.8%). Increased inhaler use was associated with tertiary education of the fathers (adjusted odds ratio [95% confidence interval], p-value: 5.19 [2.39-11.28], p<0.0001), city residence in early life (4.66 [1.79-12.43], 0.002) and an asthma diagnosis prior to enrolment (11.39 [6.35-20.43], p<0.0001). Conclusions: This study confirms that children with asthma in Uganda generally have inadequate asthma control, which is attributable to poor asthma management. This could be improved through re-training of medical workers and patient education, and by increasing availability and affordability of essential asthma medications.

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Disease control in patients with asthma and respiratory symptoms (wheezing, cough) during sleep

Asthma Research and Practice ◽

10.1186/s40733-020-00062-w ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Jonathan Doenges ◽

Elisabeth Kuckuck ◽

Werner Cassel ◽

Olaf Hildebrandt ◽

Andreas Weissflog ◽

...

Keyword(s):

Asthma Control ◽

Respiratory Symptoms ◽

Asthma Management ◽

Objective Evaluation ◽

Uncontrolled Asthma ◽

Asthma Control Test ◽

Asthmatic Patients ◽

Significant Difference ◽

Asthma Patients ◽

Act Score

Abstract Introduction The Global Initiative for Asthma (GINA)-defined criteria for asthma control include questions about daytime symptoms, limitation of activity, nocturnal symptoms, need for reliever treatment and patients’ satisfaction. Patients with nocturnal symptoms like wheezing and cough often suffer from lower sleep quality and impaired daytime performance. The lack of an appropriate method for standardized and objective monitoring of respiratory symptoms leads to difficulties in asthma management. The aim of this study is to present a new method for automated wheeze and cough detection during sleep and to assess the actual level of asthma control by the Asthma Control Test (ACT). Methods Respiratory symptoms like wheezing and cough were recorded with the LEOSound-Monitor for one night in 55 asthmatic patients in their individual domestic setting. Patients were asked to assess their level of asthma subjectively with the ACT. The study consisted of 37 women and 18 men, with a mean age of 41 years, and a mean BMI of 27 kg/m2. Most of the patients had been taking an ICS/LABA combination and would resort to a SABA as their rescue medication. Results 60% of the participants were classed as having controlled, and 40% were classed as having partially- or uncontrolled asthma. During sleep wheezing was found in 8 of the 55 asthma patients (14.5%) and coughing was found in 30 patients (54.5%). The median ACT score in wheezing-patients was 14, while in non-wheezing patients it was 21. Uncontrolled asthma was found in 6 of the 8 wheezing-patients. Coughing versus non-coughing patients did not show a significant difference in the ACT-score (20, 22 respectively). Conclusion Wheezing is a sign of uncontrolled asthma. The ACT-score in wheezing patients is worse compared to patients without wheezing. LEOSound proofed to be a useful tool in providing an objective evaluation of respiratory symptoms, like coughing and wheezing. In clinical practice, this may allow an improvement in asthma therapy.

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The Role of FENO in Comparison to Spirometry and ACT in Control of Children Asthma Symptoms

Iranian Journal of Allergy Asthma and Immunology ◽

10.18502/ijaai.v18i5.1898 ◽

2019 ◽

Author(s):

Abbas Dabbaghzadeh ◽

Marzieh Tavakol ◽

Mohammad Gharagozlou

Keyword(s):

Asthma Control ◽

Medical Center ◽

Lung Function Test ◽

Cross Sectional Study ◽

Forced Expiratory Volume ◽

Asthma Control Test ◽

Cross Sectional ◽

Before And After ◽

The Mean ◽

Act Score

Fractional exhaled nitric oxide (FeNO) is a noninvasive marker of inflammation, used for monitoring asthma. The aim of this study was to compare FeNO, asthma control test (ACT), and lung function test (spirometry) in children aged 8-15 years. This observational, cross-sectional study was performed on76 asthmatic children (age, 8-15 years), who were referred to the Department of Immunology and Allergy, Children's Medical Center, Tehran, Iran during 2012-2013. Patients were matched for sex and age. The recruited patients were selected via consecutive sampling. FeNO was measured with a portable electrochemical analyzer and forced spirometry was performed according to the American Thoracic Society (ATS) guidelines. The ACT questionnaire was used and completed for all the patients. The mean FeNO was 28.5±29.1 ppb, and the mean ACT score was 19.8±3.6. FeNO was significantly correlated with forced expiratory volume (FEV1) (r, 0.232; p=0.049) or 25-75% maximum expiratory flow (MEF 25-75) (r, -0.304; p=0.009). FeNO showed no significant correlation with ACT score or FEV1/forced vital capacity (FVC) (p>0.05). Additionally, there was no significant correlation between FeNO and changes in FEV1 and MEF 25-75% before and after the administration of bronchodilators (p>0.05). To improve asthma control, childhood ACT, FeNO, and spirometric tests can be used as complementary tools in clinical practice to detect children with poorly controlled asthma.

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The Fraction Exhaled Nitric Oxide as a Biomarker of Asthma Control

Biomarker Insights ◽

10.1177/1177271919826550 ◽

2019 ◽

Vol 14 ◽

pp. 117727191982655 ◽

Cited By ~ 5

Author(s):

Fernanda Cruvinel de Abreu ◽

Jose Laerte Rodrigues da Silva Júnior ◽

Marcelo Fouad Rabahi

Keyword(s):

Nitric Oxide ◽

Asthma Control ◽

Characteristic Curve ◽

Clinical History ◽

Cross Sectional Study ◽

Uncontrolled Asthma ◽

Cross Sectional ◽

Asthmatic Patients ◽

Helper Cell Type ◽

Feno Level

Introduction and Objective: The main goal of asthma treatment is to achieve and maintain clinical control of the disease. The exhaled fraction nitric oxide (FeNO) level is a biomarker of T-helper cell type 2 (Th2) inflammation of the airways. Our objective was to determine whether the FeNO level can be used to discriminate between patients with controlled, partially controlled, and uncontrolled asthma. Materials and Methods: The FeNO level and asthma control were evaluated in a retrospective and analytic cross-sectional study through data collected from asthmatic patients who were assessed by clinical history, asthma control, physical examination, spirometry, and FeNO level. Asthma control was determined by the criteria of the Global Initiative for Asthma and classified as controlled asthma, partially controlled asthma, and uncontrolled asthma. The FeNO values were classified as low (<25 ppb) or intermediate/high (⩾25 ppb) based on the American Thoracic Society recommendations. Results: The symptoms of 81 asthmatic patients were classified as controlled (34 [42%] patients), partially controlled (27 [33.3%] patients), and uncontrolled (20 [24.7%] patients). The FeNO level discriminated between the uncontrolled and controlled groups ( P = .01) and between the uncontrolled and partially controlled groups ( P = .01), but not between the controlled and partially controlled groups ( P = .98). An FeNO level >30 ppb was associated with uncontrolled asthma ( P = .0001) with an area under the receiver operating characteristic curve of 0.78 (95% confidence interval = 0.65-0.89). Conclusions: FeNO level could be helpful in determining asthma control as >30 ppb was associated with uncontrolled asthma.

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Asthma control level in Finland among asthmatics with smoking history: a cross-sectional study

10.21203/rs.3.rs-15879/v1 ◽

2020 ◽

Author(s):

Timo Helin

Keyword(s):

Primary Care ◽

Asthma Control ◽

Smoking Status ◽

Control Level ◽

Cross Sectional Study ◽

Smoking History ◽

Uncontrolled Asthma ◽

Cross Sectional ◽

Asthmatic Patients ◽

Gina Guidelines

Abstract Surprisingly little is known about asthma control level of smoking asthmatics. The aim of this study was to investigate asthma control level, according to GINA guidelines, among asthmatics with smoking history.One hundred and ninety asthmatics from primary care were investigated. The patients were current or ex-smokers with history of 10 or more pack-years. They completed a questionnaire, with questions set according to the GINA guidelines, so that their asthma control level (well controlled, partly controlled, uncontrolled) according to GINA could be determined.According to GINA guidelines, 66 (34.7%) patients had their asthma well controlled, 81 (42.6%) had their asthma partly controlled, and 43 (22.6%) were uncontrolled. Current smokers had more often uncontrolled asthma than ex-smokers OR 2.54 (95%CI 1.25-5.14, p=0.01). Patients with asthma exacerbation during the previous year had uncontrolled asthma more often than the patients without exacerbation OR 2.17 (95%CI 1.06-4.47, p=0.04), and patients with FEV1 < 80% of predicted had their asthma more often uncontrolled than patients with FEV1 > 80% of predicted OR 2.04 (95%CI 1.02-4.08, p=0.04).Primary care asthmatic patients who are either current or ex-smokers, are often not well controlled. The asthma control level was associated with current smoking status. Therefore, every attempt should be made to get smoking asthmatics to quit smoking.

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Hubungan Keteraturan Penggunaan Kortikosteroid Inhalasi dengan Tingkat Kontrol Asma Pasien Berdasarkan ACT di Poliklinik Paru RSUP Dr. M. Djamil Padang

Jurnal Kesehatan Andalas ◽

10.25077/jka.v5i1.447 ◽

2016 ◽

Vol 5 (1) ◽

Author(s):

Wulan Prisilla Prisilla ◽

Irvan Medison ◽

Selfi Renita Rusjdi

Keyword(s):

Asthma Control ◽

Inhaled Corticosteroids ◽

Asthma Management ◽

The Elderly ◽

Control Test ◽

Uncontrolled Asthma ◽

Asthma Control Test ◽

Cross Sectional ◽

Kolmogorov Smirnov ◽

Smirnov Test

AbstrakAsma merupakan penyakit yang didasari oleh reaksi inflamasi pada saluran napas yang dapat dicegah dengan kortikosteroid inhalasi. Asma sukar disembuhkan, sehingga tujuan penatalaksanaan asma adalah asma terkontrol. Penilaian tingkat kontrol asma dapat dilakukan dengan menggunakan kuesioner Asthma Control Test (ACT) yang bersifat subjektif tetapi validitasnya telah diuji. Tujuan penelitian ini adalah menentukan hubungan keteraturan penggunaan kortikosteroid inhalasi dengan tingkat kontrol asma pasien berdasarkan ACT di Poliklinik Paru RSUP Dr. M. Djamil Padang. Penelitian cross sectional analytic ini telah dilakukan dari September hingga Desember 2013. Populasi adalah pasien berusia ≥14 tahun yang didiagnosis asma oleh dokter. Jumlah subjek penelitian sebanyak 96 orang. Data yang diperoleh diolah dan dianalisis menggunakan uji Kolmogorov-Smirnov. Insiden terbanyak asma berada pada kelompok usia lanjut (60,4%). Sebagian besar pasien tidak teratur menggunakan kortikosteroid inhalasi (63,5%) dan pasien dengan asma tidak terkontrol memiliki proporsi tertinggi (59,4%) . Analisis statistik menunjukkan bahwa terdapat hubungan yang bermakna antara keteraturan penggunaan kortikosteroid inhalasi dengan tingkat kontrol asma pasien berdasarkan ACT di Poliklinik Paru RSUP Dr. M. Djamil (p=0,002).Kata kunci: kortikosteroid inhalasi, ACT, tingkat control asma AbstractAsthma is a disease caused by an inflammatory reaction in the patient airways that can be prevented with inhaled corticosteroids. It is known that there is no cure for asthma, so the goal of asthma management is to obtain controlled asthma. The level of asthma control can be assessed by using Asthma Control Test (ACT) questionnaire, this method is subjective but its validity has been tested. The objective of this study was to determine the association between regularity of inhaled corticosteroids application and patient’s level of asthma control based on ACT in the Lung Clinic of Dr. M. Djamil Padang Hospital. A cross sectional analitic was conducted from September to December 2013. The population is patient aged ≥14 years old who were diagnosed with asthma by a doctor. The number of samples is 96 people. The data were processed and analyzed using the Kolmogorov-Smirnov test. The incidence of asthma was highest in the elderly (60,4%). Most patients do not regularly use inhaled corticosteroids (63.5%) and patients with uncontrolled asthma had the highest proportion (59.4%) in this research. Based on statistic analisys, there was significant association between regularity of inhaled corticosteroids application and patient’s level of asthma control based on ACT in the lung clinic of Dr. M. Djamil Padang Hospital (p=0,002).Keywords: inhaled corticosteroids, ACT, level of asthma control

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Higher Omega-3 Index Is Associated with Better Asthma Control and Lower Medication Dose: A Cross-Sectional Study

Nutrients ◽

10.3390/nu12010074 ◽

2019 ◽

Vol 12 (1) ◽

pp. 74 ◽

Cited By ~ 2

Author(s):

Isobel Stoodley ◽

Manohar Garg ◽

Hayley Scott ◽

Lesley Macdonald-Wicks ◽

Bronwyn Berthon ◽

...

Keyword(s):

Fatty Acids ◽

Asthma Control ◽

Inhaled Corticosteroids ◽

Asthma Management ◽

Airway Disease ◽

Cross Sectional Study ◽

Erythrocyte Membranes ◽

Omega 3 ◽

Asthma Control Questionnaire ◽

Cross Sectional

Asthma is a chronic inflammatory airway disease, associated with systemic inflammation. Omega-3 polyunsaturated fatty acids (n-3 PUFA) have established anti-inflammatory effects, thus having potential as an adjunct therapy in asthma. This study aimed to compare erythrocyte n-3 PUFA in adults with (n = 255) and without (n = 137) asthma and determine the relationship between erythrocyte n-3 PUFA and clinical asthma outcomes. Subjects had blood collected, lung function measured and Juniper Asthma Control Questionnaire (ACQ) score calculated. Fatty acids were measured in erythrocyte membranes by gas chromatography, and the omega-3 index (O3I) was calculated (% eicosapentaenoic acid + % docosahexaenoic acid). O3I was similar in subjects with and without asthma (p = 0.089). A higher O3I was observed in subjects with controlled or partially controlled asthma (ACQ < 1.5) compared to subjects with uncontrolled asthma (ACQ ≥ 1.5) (6.0% (5.4–7.2) versus 5.6% (4.6–6.4) p = 0.033). Subjects with a high O3I (≥8%) had a lower maintenance dose of inhaled corticosteroids (ICS) compared to those with a low O3I (<8%) (1000 μg (400–1000) versus 1000 μg (500–2000) p = 0.019). This study demonstrates that a higher O3I is associated with better asthma control and with lower ICS dose, suggesting that a higher erythrocyte n-3 PUFA level may have a role in asthma management.

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Association of hand and arm disinfection with asthma control in US nurses

Occupational and Environmental Medicine ◽

10.1136/oemed-2017-104740 ◽

2018 ◽

Vol 75 (5) ◽

pp. 378-381 ◽

Cited By ~ 8

Author(s):

Orianne Dumas ◽

Raphäelle Varraso ◽

Krislyn M Boggs ◽

Alexis Descatha ◽

Paul K Henneberger ◽

...

Keyword(s):

Hand Hygiene ◽

Asthma Control ◽

Smoking Status ◽

Cross Sectional Study ◽

Health Study ◽

Asthma Control Test ◽

Cross Sectional ◽

Occupational Risk Factor ◽

Race Ethnicity ◽

Female Nurses

ObjectivesTo investigate the association between occupational exposure to disinfectants/antiseptics used for hand hygiene and asthma control in nurses.MethodsIn 2014, we invited female nurses with asthma drawn from the Nurses’ Health Study II to complete two supplemental questionnaires on their occupation and asthma (cross-sectional study, response rate: 80%). Among 4055 nurses (mean age: 59 years) with physician-diagnosed asthma and asthma medication use in the past year, we examined asthma control, as defined by the Asthma Control Test (ACT). Nurses were asked about the daily frequency of hand hygiene tasks: ‘wash/scrub hands with disinfectants/hand sanitizers’ (hand hygiene) and ‘wash/scrub arms with disinfecting products’ (surrogate of surgical hand/arm antisepsis). Analyses were adjusted for age, race, ethnicity, smoking status and body mass index.ResultsNurses with partly controlled asthma (ACT: 20–24, 50%) and poorly controlled asthma (ACT ≤19, 18%) were compared with nurses with controlled asthma (ACT=25, 32%). In separate models, both hand and arm hygiene were associated with poorly controlled asthma. After mutual adjustment, only arm hygiene was associated with poorly controlled asthma: OR (95% CI) for <1 time/day, 1.38 (1.06 to 1.80); ≥1 time/day, 1.96 (1.52 to 2.51), versus never. We observed a consistent dose–response relationship between frequency of arm hygiene tasks (never to >10 times/day) and poor asthma control. Associations persisted after further adjustment for surfaces/instruments disinfection tasks.ConclusionsFrequency of hand/arm hygiene tasks in nurses was associated with poor asthma control. The results suggest an adverse effect of products used for surgical hand/arm antisepsis. This potential new occupational risk factor for asthma warrants further study.

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Serum diiodotyrosine—a biomarker to differentiate destructive thyroiditis from Graves’ disease

Acta Endocrinologica ◽

10.1530/eje-21-0901 ◽

2021 ◽

Author(s):

Naoya Fujita ◽

Yosuke Ono ◽

Azusa Sano ◽

Motohiro Kimata ◽

Seigo Oyama ◽

...

Keyword(s):

Roc Curve ◽

Operating Characteristic ◽

Cross Sectional Study ◽

Curve Analysis ◽

Diagnostic Methods ◽

Graves Disease ◽

Roc Curve Analysis ◽

Cross Sectional ◽

Chromatography Tandem Mass Spectrometry ◽

Liquid Chromatography Tandem Mass

Objective: Conventional diagnostic methods are limited in their ability to differentiate destructive thyroiditis from Graves’ disease. We hypothesised that serum diiodotyrosine (DIT) and monoiodotyrosine (MIT) levels could be biomarkers for differentiating destructive thyroiditis from Graves’ disease. Design: Patients with destructive thyroiditis (n = 13) and Graves’ disease (n = 22) were enrolled in this cross-sectional study. Methods: We assayed the serum DIT and MIT levels using liquid chromatography-tandem mass spectrometry. A receiver operating characteristic (ROC) curve analysis was used to determine the sensitivity and specificity of the serum DIT and MIT levels as biomarkers for differentiating destructive thyroiditis from Graves’ disease. Results: The serum DIT and MIT levels were significantly higher in patients with destructive thyroiditis than in those with Graves’ disease. The ROC curve analysis showed that the serum DIT levels (≥ 359.9 pg/mL) differentiated destructive thyroiditis from Graves’ disease, significantly, with 100.0% sensitivity and 95.5% specificity (P < .001). The diagnostic accuracy of the serum MIT levels (≥119.4 pg/mL) was not as high as that of the serum DIT levels (sensitivity, 84.6%; specificity, 77.3%; P = .001). Conclusions: The serum DIT levels may serve as a novel diagnostic biomarker for differentiating destructive thyroiditis from Graves’ disease.

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