Non-adherence to inhaled corticosteroid therapy as an explanation for persistently elevated exhaled nitric oxide levels in patients with asthma: Effect of directly observed therapy with inhaled corticosteroids (DOT-ICS)

2015 ◽  
Author(s):  
Charles Knoery ◽  
Ben Brockway ◽  
Jan Cowan ◽  
Emma Cox ◽  
Robin Taylor
Keyword(s):  
Nitric Oxide ◽  
Corticosteroid Therapy ◽  
Inhaled Corticosteroids ◽  
Exhaled Nitric Oxide ◽  
Directly Observed Therapy ◽  
Inhaled Corticosteroid

Persistent Exhaled Nitric Oxide Elevation And Augmentation Of Inhaled Corticosteroid Therapy In Asthma

2012 ◽  
Author(s):  
Tsunahiko Hirano ◽  
Kazuto Matsunaga ◽  
Hisatoshi Sugiura ◽  
Yoshiaki Minakata ◽  
Akira Koarai ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Corticosteroid Therapy ◽  
Exhaled Nitric Oxide ◽  
Inhaled Corticosteroid

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at least 15% or a decrease in PC20of at least fourfold.RESULTS: Two patients had a respiratory infection and were withdrawn from the study.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 Short-term responses to high-dose inhaled corticosteroid treatment in patients with chronic obstructive pulmonary disease with a fractional nitric oxide concentration over 35 parts per billion: A single-centre pre–post study

2020 ◽  
Vol 4 (1) ◽  
pp. 012-017
Author(s):  
Shiroshita Akihiro ◽  
Tanaka Yu ◽  
Nakashima Kei ◽  
Shiraishi Atsushi ◽  
Matsui Hiroki ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Inhaled Corticosteroids ◽  
Corticosteroid Treatment ◽  
Exhaled Nitric Oxide ◽  
Chronic Obstructive ◽  
Inhaled Corticosteroid ◽  
Fractional Exhaled Nitric Oxide ◽  
Copd Patients ◽  
Oxide Concentration ◽  
Nitric Oxide Concentration

Introduction: There is currently no strategy for identifying chronic obstructive pulmonary disease (COPD) patients whose pulmonary function could benefit from inhaled corticosteroids. We investigated whether a 28-day regime of inhaled corticosteroids improved pulmonary function test results among COPD patients with a fractional exhaled nitric oxide concentration > 35 parts per billion. Methods: This single-centre one-arm pre–post trial included COPD patients with a fractional exhaled nitric oxide concentration > 35 parts per billion treated at our institution from September 2018 to August 2019. Patients were administered budesonide (200 μg, 8 puffs daily) for 28 days. The primary outcome measure was the difference between the forced expiratory volume in 1 s (FEV1) at baseline and after 28 days of inhaled corticosteroid treatment. Secondary outcomes included differences in COPD Assessment Test scores, %FEV1, and that between the percent forced vital capacity (%FVC) at baseline and after 28 days of treatment. Results: Twenty patients completed the 28-day inhaled corticosteroid regime. The mean difference in FEV1 between day 1 and day 28 was 340 mL (95% confidence interval: −100 to 770 mL; p = 0.122). The mean differences in secondary outcomes were: %FVC, −0.16% (95% confidence interval [CI]: −2.84 to 2.53%; p = 0.905); %FEV1, 1.63% (95%CI: −4.56 to 7.81%; p = 0.589); COPD Assessment Test score, −2.50 (95%CI: −5.72 to 0.72; p = 0.121). Conclusion: The 28-day course of inhaled corticosteroids yielded no significant difference in FEV1 for COPD patients with a fractional exhaled nitric oxide concentration > 35 parts per billion. Trial registration: University Hospital Medical Information Network Center, UMIN000034005. Registered 3 September 2018, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000038557

Persistent elevation of exhaled nitric oxide and modification of corticosteroid therapy in asthma

2013 ◽  
Vol 51 (2) ◽  
pp. 84-91 ◽  
Author(s):  
Tsunahiko Hirano ◽  
Kazuto Matsunaga ◽  
Hisatoshi Sugiura ◽  
Yoshiaki Minakata ◽  
Akira Koarai ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Corticosteroid Therapy ◽  
Exhaled Nitric Oxide ◽  
Persistent Elevation

scholarly journals Fractional exhaled nitric oxide for the management of asthma in adults: a systematic review

2016 ◽  
Vol 47 (3) ◽  
pp. 751-768 ◽  
Author(s):  
Munira Essat ◽  
Sue Harnan ◽  
Tim Gomersall ◽  
Paul Tappenden ◽  
Ruth Wong ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Rate Ratio ◽  
Clinical Effectiveness ◽  
Exhaled Nitric Oxide ◽  
Severe Exacerbation ◽  
Inhaled Corticosteroid ◽  
Class Effect ◽  
Fractional Exhaled Nitric Oxide ◽  
Study Characteristics ◽  
Meta Analyses

The aim of this review was to evaluate the clinical effectiveness of fractional exhaled nitric oxide (FeNO) measured in a clinical setting for the management of asthma in adults.13 electronic databases were searched and studies were selected against predefined inclusion criteria. Quality assessment was conducted using QUADAS-2. Class effect meta-analyses were performed.Six studies were included. Despite high levels of heterogeneity in multiple study characteristics, exploratory class effect meta-analyses were conducted. Four studies reported a wider definition of exacerbation rates (major or severe exacerbation) with a pooled rate ratio of 0.80 (95% CI 0.63–1.02). Two studies reported rates of severe exacerbations (requiring oral corticosteroid use) with a pooled rate ratio of 0.89 (95% CI 0.43–1.72). Inhaled corticosteroid use was reported by four studies, with a pooled standardised mean difference of −0.24 (95% CI −0.56–0.07). No statistically significant differences for health-related quality of life or asthma control were found.FeNOguided management showed no statistically significant benefit in terms of severe exacerbations or inhaled corticosteroid use, but showed a statistically significant reduction in exacerbations of any severity. However, further research is warranted to clearly define which management protocols (including cut-off points) offer best efficacy and which patient groups would benefit the most.

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