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

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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Is FEV1 associated with quality of life in children with cystic fibrosis? An original article

Immunopathologia Persa ◽

10.15171/ipp.2020.06 ◽

2019 ◽

Vol 6 (1) ◽

pp. e06-e06

Author(s):

Rohola Shirzadi ◽

Safoura Navaei ◽

Mohammadreza Modaresi ◽

Farzad Masiha

Keyword(s):

Quality Of Life ◽

Cystic Fibrosis ◽

Pulmonary Function ◽

Medical Center ◽

Cross Sectional Study ◽

Forced Expiratory Volume ◽

Psychological Status ◽

Cross Sectional ◽

The Mean

Introduction: Cystic fibrosis (CF) is a serious genetic life-shortening disease. Quality of life (QoL) measurement related to CF children is a relatively new field of research, which includes the patient’s perspective in research and clinical practice. Objectives: This study aimed to evaluate the QoL in children with CF and its association with FEV1 (forced expiratory volume in 1 second). Patients and Methods: This cross-sectional study was carried out on 7-14 years old children with CF attending children’s medical center from March 2017 to March 2018. Throat swab cultures and spirometry evaluation was performed for all patients. FEV1 was determined and the 6-min walk test (6MWT) was conducted. The patient’s psychological status was assessed using the Persian version of pediatric QoL inventory. ANOVA, t test, and chisquare tests were used for data analysis. Results: Seventy-six subjects with the mean age of 10.49±3.18 years were studied since 59% of them (n=44) were boys. The mean total QoL was 65.34±17.73. Patients with lower pulmonary function had a lower QoL. There was a significant association between FEV1 and school and emotional functioning (P=0.005 and P=0.002, respectively). A significant association was found between SPO2 (peripheral capillary oxygen saturation) reduction after 6MWT and FEV1 decline (P=0.001). Additionally, a significant association was detected between FEV1 and the distance walked during 6MWT (P=0.030). Conclusion: Regarding the association between pulmonary function and QoL in CF patients and lower QoL score in our study, the importance of assessing pulmonary function in these patients should not be neglected.

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Alexithymia and asthma

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.252 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S145-S146

Author(s):

M. Turki ◽

R. Naoui ◽

N. Moussa ◽

S. Sellami ◽

I. Gassrara ◽

...

Keyword(s):

Asthma Control ◽

Inhaled Corticosteroids ◽

Negative Impact ◽

Control Level ◽

Asthma Control Test ◽

Cross Sectional ◽

The Mean ◽

Act Score ◽

Tas 20

IntroductionAlexithymia refers to difficulties in verbal expression of emotions, commonly observed in patients with psychosomatic symptoms. In this context, asthma is described as one of psychosomatic diseases.ObjectivesIdentify clinical profile of asthmatic patients and assess the alexithymia level as well as associated factors.MethodsWe conducted a cross-sectional, descriptive and analytic study, including 30 patients followed for asthma at pulmonary outpatient department, Hedi Chaker Hospital, Sfax, Tunisia, during September and October 2015. We collected socio-demographic and clinical characteristics. Asthma control level was assessed by the Asthma Control Test (ACT). Alexithymia was measured using Toronto Alexithymia Scale (TAS 20).ResultsThe mean age was 51 ans. Sex-ratio F/M was 14. The mean duration of disease was 11 years. Long-term control medicines were: inhaled corticosteroids, long-acting beta agonists and theophylline respectively in 86.7%, 33.3% and 26.7%. Two thirds of our patients had a bad therapeutic adherence. The average ACT score was 16.8 points. Asthma was uncontrolled in 1/3 and well controlled in 1/3 of cases. The average TAS 20 score was 64.8 points. Twenty percent of patients were non-alexithymic, 13.3% had a probable alexithymia and 66.7% were alexithymic. This score was positively correlated to bad asthma control (P < 0.001), long term evolution (P = 0.002) and use of inhaled corticoids (P < 0.001). It was inversely correlated to ACT score (P < 0.001).ConclusionOur study shows the high prevalence of alexithymia in patients with asthma and its negative impact in asthma control. Psychological support aiming specifically alexithymic dimension in these patients is indispensable.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Quality of life questionnaires in children with bronchial asthma at Jordan University Hospital: an observational study

Current Respiratory Medicine Reviews ◽

10.2174/1573398x16999201009155509 ◽

2020 ◽

Vol 16 ◽

Author(s):

Enas M. Al-Zayadneh ◽

Ala’ Dia-Eddin Arafah ◽

Sarah Muwaffag Ibrahim ◽

Maram Abdalla Glessa ◽

Montaha Al-Iede

Keyword(s):

Quality Of Life ◽

Asthma Control ◽

University Hospital ◽

P Value ◽

Life Questionnaire ◽

Asthma Control Test ◽

Cross Sectional ◽

The Mean ◽

Act Score

Background: Asthma is a common chronic illness worldwide. Identifying and treating impaired health-related quality of life is now recognized as an important component of asthma management. High prevalence of behavioral and emotional difficulties was noticed among children with asthma. Methods: Cross-sectional study that was conducted over 8 weeks involving 45 asthmatic children within the ages of 7-17 years old presented to Jordan University Hospital in Amman, Jordan. General demographic characteristics were collected, two questionnaires were used: asthma control test (ACT), and the pediatric asthma quality of life questionnaire (PAQLQ). We also used the feeling thermometer scale, and a pulmonary function test was done for patients. SAS Software version 9.4 USA and Pearsons coefficient were used to find associations. Results and Discussion: Among 45 patients, 53% of the sample had poor asthma control. The mean FEV1 on lung function testing was 80% (± 16.18) of predicted. The mean for asthma clinical scores (ACT) were 18.8 ± 4.53 (out of 25). FEV1 was significantly higher in children with good control compared to those with a low ACT score (P value <0.05). Mean total PAQLQ score was 5.3 ± 1.06 and it correlated significantly with ACT score (P value <0.001). Conclusion: This study highlights the association of poorly controlled asthma with a poor quality of life. It is recommended that the quality of life of children should be assessed and observed during clinic visits, for a better comprehensive approach and effective improvement of outcome.

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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

Canadian Respiratory Journal ◽

10.1155/2020/5735128 ◽

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.

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The effect of the socioeconomic status on the measurement of asthma control

Allergy and Asthma Proceedings ◽

10.2500/aap.2022.43.210103 ◽

2022 ◽

Vol 43 (1) ◽

pp. e11-e16 ◽

Cited By ~ 1

Author(s):

Preetam Ganti ◽

Annya Suman ◽

Shivani Chaudhary ◽

Brijit Sangha ◽

Larick David ◽

...

Keyword(s):

Socioeconomic Status ◽

Asthma Control ◽

Cross Sectional Study ◽

Forced Expiratory Volume ◽

Federal Poverty Level ◽

Poverty Level ◽

Asthma Control Test ◽

Cross Sectional ◽

Fractional Concentration ◽

Education Status

Background: The Asthma Control Test (ACT) is a commonly used scoring system for evaluation of asthma control in the pediatric and adult populations. Asthma control has been deemed poor in those economically disadvantaged. Objective: To study whether the ACT is affected by socioeconomic status (SES) as evaluated by the percentage of the federal poverty level and the education level. Methods: This was a cross-sectional study (N = 307), in which the patients were surveyed for demographics data and underwent ACT scoring, spirometry (forced expiratory volume in the first second of expiration) and fractional concentration of exhaled nitric oxide testing. Results: There was a positive correlation of improved mean score on the ACT (p < 0.001) with higher education status and higher federal poverty level status. Conclusion: SES plays a factor in the way patients perceived their asthma control, and therefore affected how they scored on the ACT.

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What Is the Impact of Prior Authorization on the Incidence of Pediatric Tonsillectomy?

Otolaryngology ◽

10.1177/0194599820969631 ◽

2020 ◽

pp. 019459982096963

Author(s):

Vanessa F. Torrecillas ◽

Kaden Neuberger ◽

Alexander Ramirez ◽

Paul Krakovitz ◽

Jeremy D. Meier

Keyword(s):

Elective Surgery ◽

Lag Time ◽

Cross Sectional Study ◽

Health Claims ◽

Third Party ◽

Prior Authorization ◽

Cross Sectional ◽

Before And After ◽

The Mean ◽

The Impact

Objective Third-party payers advocate for prior authorization (PA) to reduce overutilization of health care resources. The impact of PA in elective surgery is understudied, especially in cases where evidence-based clinical practice guidelines define operative candidacy. The objective of this study is to investigate the impact of PA on the incidence of pediatric tonsillectomy. Study Design Cross-sectional study. Setting Health claims database from a third-party payer. Methods Any pediatric patient who had evaluation for tonsillectomy from 2016 to 2019 was eligible for inclusion. A time series analysis was used to evaluate the change in incidence of tonsillectomy before and after PA. Lag time from consultation to surgery before and after PA was compared with segmented regression. Results A total of 10,047 tonsillectomy claims met inclusion and exclusion criteria. Female patients made up 51% of claims, and the mean age was 7.9 years. Just 1.5% of claims were denied after PA implementation. There was no change in the incidence of tonsillectomy for all plan types ( P = .1). Increased lag time from consultation to surgery was noted immediately after PA implementation by 2.38 days (95% CI, 0.23-4.54; P = .030); otherwise, there was no significant change over time ( P = .98). Conclusion A modest number of tonsillectomy claims were denied approval after implementation of PA. The value of PA for pediatric tonsillectomy is questionable, as it did not result in decreased incidence of tonsillectomy in this cohort.

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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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Effect of obesity on lung volumes among adults

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20203094 ◽

2020 ◽

Vol 8 (8) ◽

pp. 2828

Author(s):

Gurmeet Kaur ◽

Sandeep Kaur ◽

Geetika Gupta ◽

Rajneet Kaur

Keyword(s):

Lung Function Test ◽

Cross Sectional Study ◽

Forced Expiratory Volume ◽

Respiratory Physiology ◽

Sectional Study ◽

Cross Sectional ◽

Lung Volumes ◽

Respiratory Parameters ◽

Function Test ◽

The Relationship

Background: Obesity has long been recognized to have significant effect on respiratory functions. Many studies have reported exponential decrease in pulmonary function test (PFT) with increasing body mass index (BMI), which is a crude indicator of obesity. Also, the relationship between BMI and PFTs varies with age, race, geographical region and the different obesity standards used. To the best of our knowledge, not many studies have been done to examine the relationship between obesity and lung volumes among adults in our region, Jammu. This cross-sectional study was carried out with the objective of evaluating the effect of obesity on lung function test in obese but otherwise healthy adults of Jammu region.Methods: This cross-sectional study was conducted in Jammu region on subjects selected randomly from different colleges in the age group of 18-40 years. The study involved 300 subjects; divided into three groups of 100 each, based on BMI into normal, overweight and obese groups. Four respiratory parameters viz. FVC (Forced Vital Capacity), FEV1 (Forced Expiratory Volume in 1 second), FEV3 (Forced Expiratory Volume in 3 seconds), and MVV (Maximum Voluntary Ventilation) were used to assess their lung functions.Results: All the respiratory parameters exhibited statistically significant decrease in obese groups as compared to normal and overweight groups.Conclusions: The present study suggests that obesity alters the respiratory physiology by producing a restrictive ventilatory pattern.

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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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