scholarly journals The Fraction Exhaled Nitric Oxide as a Biomarker of Asthma Control

2019 ◽  
Vol 14 ◽  
pp. 117727191982655 ◽  
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.

scholarly journals 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

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Vinh Nguyen Nhu ◽  
Pham Le An ◽  
Niels H. Chavannes
Keyword(s):  
Asthma Control ◽  
Roc Curve ◽  
Medical Center ◽  
Asthma Management ◽  
Cross Sectional Study ◽  
Uncontrolled Asthma ◽  
Roc Curve Analysis ◽  
Asthma Control Test ◽  
Cross Sectional ◽  
Asthmatic Patients

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.

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

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.

scholarly journals Asthma Control According to the Community Pharmacists: Evidence and Potential Implications from an Italian Cross-Sectional Study

2020 ◽  
Author(s):  
Marco Caminati ◽  
Luca Cegolon ◽  
Marco Bacchini ◽  
Nadia Segala ◽  
Annarita Dama ◽  
...  
Keyword(s):  
Asthma Control ◽  
Multinomial Logistic Regression ◽  
Treatment Compliance ◽  
Asthma Severity ◽  
Cross Sectional Study ◽  
Community Pharmacies ◽  
Sectional Study ◽  
Cross Sectional ◽  
Severity Level ◽  
Asthmatic Patients

Abstract Background. Asthma control and monitoring still represents a challenge worldwide. Although the international guidelines suggest the interplay with primary care as an effective strategy, the community pharmacies’are rarely involved in asthma management.The present cross-sectional study aimed at providing a picture of the relationship between asthma severity and control according to the community pharmacies’ perspective of the health district of Verona (North-Eastern Italy).Methods. A call for participation was launched through the Pharmacists’ Association of Verona.Patients referring to the participating pharmacies with an anti-asthmatic drug medical prescription and an asthma exemption code were asked to completethe Asthma Control Testand a brief questionnaire collecting information on their age, sex, smoking status, aerobic physical exercise and usual asthma therapy, which also defined the severity level of asthma.A multinomial logistic regression model was fitted to investigate the risk of uncontrolled as well as poorly controlled vs. controlled asthma (base). Results were expressed as relative risk ratios (RRR) with 95% confidence interval (95%CI).Results.57 community pharmacies accepted to participate and 584 asthmatic patients (54% females; mean-age: 51 ± 19 years) were recruited. According to the ACT score 50.5% patients hada controlled asthma, 22.3% a poorly controlled and 27.2% uncontrolled. A variable proportion patients with uncontrolled asthma was observed at every level of severity, although more frequently in mild persistent form of disease. Most patients (92%) reported regular compliance with therapy. At multinomial regression analysis, patients under regular asthma treatment course (RRR=0.33; 95%CI: 0.15; 0.77) were less likely to have an ACT<16 compared to those not taking medications regularly.Conclusions.Overall, our findings highlighted an unsatisfactory asthma control from the pharmacists’ perspective, independently of the asthma severity level. The relevance of community pharmacies as a first line interface suggest their involvement inan effective asthma management plan, from disease control and treatment compliance assessment to referral of asthmatic patients to medical consultancies.

scholarly journals Changes in quantifiable breathing pattern components predict asthma control: an observational cross-sectional study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Panagiotis Sakkatos ◽  
Anne Bruton ◽  
Anna Barney
Keyword(s):  
Asthma Control ◽  
Breathing Pattern ◽  
Cross Sectional Study ◽  
Uncontrolled Asthma ◽  
Asthma Control Questionnaire ◽  
Cross Sectional ◽  
Mean Values ◽  
Subject Variability ◽  
Asthma Patients ◽  
Within Subject Variability

Abstract Background Breathing pattern disorders are frequently reported in uncontrolled asthma. At present, this is primarily assessed by questionnaires, which are subjective. Objective measures of breathing pattern components may provide additional useful information about asthma control. This study examined whether respiratory timing parameters and thoracoabdominal (TA) motion measures could predict and classify levels of asthma control. Methods One hundred twenty-two asthma patients at STEP 2- STEP 5 GINA asthma medication were enrolled. Asthma control was determined by the Asthma Control Questionnaire (ACQ7-item) and patients divided into ‘well controlled’ or ‘uncontrolled’ groups. Breathing pattern components (respiratory rate (RR), ratio of inspiration duration to expiration duration (Ti/Te), ratio of ribcage amplitude over abdominal amplitude during expiration phase (RCampe/ABampe), were measured using Structured Light Plethysmography (SLP) in a sitting position for 5-min. Breath-by-breath analysis was performed to extract mean values and within-subject variability (measured by the Coefficient of Variance (CoV%). Binary multiple logistic regression was used to test whether breathing pattern components are predictive of asthma control. A post-hoc analysis determined the discriminant accuracy of any statistically significant predictive model. Results Fifty-nine out of 122 asthma patients had an ACQ7-item < 0.75 (well-controlled asthma) with the rest being uncontrolled (n = 63). The absolute mean values of breathing pattern components did not predict asthma control (R2 = 0.09) with only mean RR being a significant predictor (p < 0.01). The CoV% of the examined breathing components did predict asthma control (R2 = 0.45) with all predictors having significant odds ratios (p < 0.01). The ROC curve showed that cut-off points > 7.40% for the COV% of the RR, > 21.66% for the CoV% of Ti/Te and > 18.78% for the CoV% of RCampe/ABampe indicated uncontrolled asthma. Conclusion The within-subject variability of timing parameters and TA motion can be used to predict asthma control. Higher breathing pattern variability was associated with uncontrolled asthma suggesting that irregular resting breathing can be an indicator of poor asthma control.

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 Characteristics of Acute Asthma Patients Based on Visits to The Emergency Unit and Treatment Costs in Jakarta Islamic Hospital Pondok Kopi

2021 ◽  
Vol 1 (1) ◽  
pp. 193-204
Author(s):  
Muhammad Fachri ◽  
Farabillah Afifah
Keyword(s):  
Emergency Department ◽  
Acute Asthma ◽  
Asthma Patient ◽  
Cross Sectional Study ◽  
Treatment Costs ◽  
Uncontrolled Asthma ◽  
Cross Sectional ◽  
Asthmatic Patients ◽  
Asthma Patients ◽  
Relationship Of

Proper handling of asthmatics can maintain the patient's quality of life. Visits of asthmatic patients to the Emergency Department (ER) indicate uncontrolled asthma and a marker of risk for future asthma exacerbations. Uncontrolled asthma can increase health costs, the risk of hospitalization, and can also cause death. This research at to determine the relationship of acute asthma patients who visit the emergency department with costs of treatment. Analytical descriptive research with cross-sectional study design. The population of this study was acute asthma sufferers who went to the emergency department of RSIJ Pondok Kopi in the period August 1, 2016 – August 1, 2017, and all of the population was used as a sample of 35 people. Data collection is done by studying the documentation of medical record data. The results showed 32.4% of respondents aged 41-49 years, 62.9% were female and had a high school education level (SMA), 40% of respondents were housewives (IRT), 65.7% had acute asthma. moderate, and the most precipitating factor is respiratory tract infection. Most visits to the ER were 30 patients (85.7%) with 1 visit and not accompanied by complications. The results of the highest treatment costs ranged from Rp. 300,000 – Rp. 400,000 as many as 22 patients (62.9%) with guaranteed treatment used were non-BPJS. The costs incurred by each acute asthma patient with 1 visit to the ER are lower than 2 times or more than 2 visits. It was also found that the number of acute asthma patients with complications was greater in costs than those without complications.

scholarly journals Quantifiable Breathing Pattern Components Can Predict Asthma Control: an Observational Cross-sectional Study

2021 ◽  
Author(s):  
Panagiotis Sakkatos ◽  
Anne Bruton ◽  
Anna Barney
Keyword(s):  
Asthma Control ◽  
Breathing Pattern ◽  
Cross Sectional Study ◽  
Uncontrolled Asthma ◽  
Asthma Control Questionnaire ◽  
Cross Sectional ◽  
Mean Values ◽  
Subject Variability ◽  
Asthma Patients ◽  
Within Subject Variability

Abstract Background: Breathing pattern disorders are frequently reported in uncontrolled asthma. At present, this is primarily assessed by questionnaires, which are subjective. Objective measures of breathing pattern components can provide additional useful information about asthma control. This study examined whether respiratory timing parameters and thoracoabdominal (TA) motion measures could predict and classify levels of asthma control. Methods: 122 asthma patients at STEP 2- STEP 5 GINA asthma medication were enrolled. Asthma control was determined by the Asthma Control Questionnaire (ACQ7-item) and patients divided into ‘well controlled’ or ‘uncontrolled’ groups. Breathing pattern components (respiratory rate (RR), ratio of inspiration duration to expiration duration (Ti/Te), ratio of ribcage amplitude over abdominal amplitude during expiration phase (RCampe/ABampe), were measured using Structured Light Plethysmography (SLP) in a sitting position for 5-minutes. Breath-by-breath analysis was performed to extract mean values and within-subject variability (measured by the Coefficient of Variance (CoV%). Binary multiple logistic regression was used to test whether breathing pattern components are predictive of asthma control. A post-hoc analysis determined the discriminant accuracy of any statistically significant predictive model. Results: Fifty-nine out of 122 asthma patients had an ACQ7-item < 0.75 (well-controlled asthma) with the rest being uncontrolled (n= 63). The absolute mean values of breathing pattern components did not predict asthma control (R2 = 0.09) with only mean RR being a significant predictor (p < 0.01). The CoV% of the examined breathing components did predict asthma control (R2 = 0.45) with all predictors having significant odds ratios (p < 0.01). The ROC curve showed that cut-off points > 7.40% for the COV% of the RR, > 21.66% for the CoV% of Ti/Te and > 18.78% for the CoV% of RCampe/ABampe indicated uncontrolled asthma. Conclusion: The within-subject variability of timing parameters and TA motion can be used to predict asthma control. Higher breathing pattern variability was associated with uncontrolled asthma suggesting that irregular resting breathing is an indicator of poor asthma control.

scholarly journals Prevalence of obesity in asthma and its relations with asthma severity and control

2013 ◽  
Vol 59 (6) ◽  
pp. 594-599 ◽  
Author(s):  
Gabriele Carra Forte ◽  
Denis Maltz Grutcki ◽  
Samuel Millán Menegotto ◽  
Rosemary Petrik Pereira ◽  
Paulo de Tarso Roth Dalcin
Keyword(s):  
Asthma Control ◽  
Pulmonary Function Tests ◽  
Asthma Severity ◽  
Cross Sectional Study ◽  
Normal Weight ◽  
Asthma Control Questionnaire ◽  
Cross Sectional ◽  
Control Female ◽  
Asthmatic Patients ◽  
Prevalence Of Obesity

OBJECTIVE: To determine the prevalence of obesity in asthmatic patients attending at an outpatient clinic, and to investigate its relationships with asthma severity and level of asthma control. METHODS: In a cross-sectional study we recruited patients aged 11 years and older with confirmed asthma diagnosis from the outpatient asthma clinic of Hospital de Clínicas de Porto Alegre, Brazil. They underwent an evaluation by a general questionnaire, an asthma control questionnaire and by pulmonary function tests. Nutritional status was classified by body mass index (BMI). RESULTS: 272 patients were included in the study. Mean age was 51.1 ± 16.5 years and there were 206 (74.9%) female patients. Mean BMI was 27.5 ± 5.3 kg/m², and 96 (35.3%) patients were classified as normal weight, 97 (35.7%) as overweight and 79 (29%) as obesity. There was a significant higher proportion of female than male patients (34.3% vs. 13.2%, p = 0.002) in the obesity group. There were no significant differences with respect to asthma control (p = 0.741) and severity classification (p = 0.506). The FEV1% predicted was significantly higher in the obese than in the non-obese group (73.7% vs. 67.2%, p = 0.037). Logistic regression analysis identified sex (OR = 3.84, p = 0.002) as an independent factor associated with obesity. CONCLUSIONS: This study showed a high prevalence of obesity in asthmatic patients. Obese and non-obese subjects were similar in regard to asthma severity and level of asthma control. Female sex was associated with obesity in this asthma population.

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