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 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 Fração Exalada de Óxido Nítrico no Controlo e Abordagem Terapêutica da Asma

2014 ◽  
Vol 27 (1) ◽  
pp. 59 ◽  
Author(s):  
Bruno Melo ◽  
Patrício Costa ◽  
Ariana Afonso ◽  
Vânia Machado ◽  
Carla Moreira ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Asthma Control ◽  
Peak Expiratory Flow ◽  
Chronic Respiratory Disease ◽  
Exhaled Nitric Oxide ◽  
Fractional Exhaled Nitric Oxide ◽  
Cross Sectional ◽  
Asthmatic Children ◽  
Bronchial Inflammation ◽  
Expiratory Flow

<strong>Introduction:</strong> Asthma is a chronic respiratory disease characterized by hyper-responsiveness and bronchial inflammation. The bronchial inflammation in these patients can be monitored by measuring the fractional exhaled nitric oxide. This study aims to determine fractional exhaled nitric oxide association with peak expiratory flow and with asthma control inferred by the Global Initiative for Asthma.<br /><strong>Material and Methods:</strong> Observational, analytical and cross-sectional study of children with asthma, 6-12 years-old, followed in the Outpatient Respiratory Pathology of Braga Hospital. Sociodemographic and clinical information were collected through a questionnaire. fractional exhaled nitric oxide and peak expiratory flow were determined by portable analyzer Niox Mino® and flow meter, respectively.<br /><strong>Results:</strong> The sample is constituted by 101 asthmatic children, 63 (62.4%) of males and 38 (37.6%) females. The mean age of participants in the sample is 9.18 (1.99) years. The logistic regression performed with the cutoff value obtained by ROC curve, revealed that fractional exhaled nitric oxide (bFENO classes = 0.85; χ2 Wald (1) = 8.71; OR = 2.33; p = 0.003) has a statistical significant effect on the probability of changing level of asthma control. The odds ratio of going from “controlled” to “partly controlled/uncontrolled” is 2.33 per each level of fractional exhaled nitric oxide.<br /><strong>Discussion and Conclusion: </strong>The probability of an asthmatic children change their level of asthma control, from ‘controlled’ to ‘partly controlled/uncontrolled’, taking into account a change in their fractional exhaled nitric oxide level, increases 133%.

scholarly journals Clinical and Economic Consequences of Switching From Omalizumab to Mepolizumab in Uncontrolled Severe Eosinophilic Asthma: an Observational Retrospective Study

2020 ◽  
Author(s):  
Giovanna Elisiana Carpagnano ◽  
Emanuela Resta ◽  
Massimiliano Povero ◽  
Corrado Pelaia ◽  
Mariella D'Amato ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Asthma Control ◽  
Exhaled Nitric Oxide ◽  
Blood Eosinophil ◽  
Fractional Exhaled Nitric Oxide ◽  
Eosinophilic Asthma ◽  
Exacerbation Rate ◽  
Serum Ige ◽  
Severe Eosinophilic Asthma ◽  
Oral Corticosteroids

Abstract Background: Severe asthma is burdened by frequent exacerbations and use of oral corticosteroids, which worsen patients’ health and increase healthcare spending. The aim of this study was to assess the clinical and economic impact of switching from omalizumab to mepolizumab in patients eligible for both biologics, but not optimally controlled by omalizumab.Methods: We retrospectively enrolled uncontrolled severe asthmatic patients, referred to seven asthma clinics in Italy, who switched from omalizumab to mepolizumab during the last two years. Clinical, functional, and laboratory information included blood eosinophil count, asthma control test, spirometry, serum IgE, fractional exhaled nitric oxide, oral corticosteroids intake, use of controller and rescue drugs, exacerbations/hospitalizations, visits and diagnostic exams. Within the perspective of Italian National Health System, a pre- and post-mepolizumab 12-month standardized total cost per patient was calculated.Results: 33 patients were enrolled: 5 males and 28 females, mean age 57 years, mean disease onset 24 years. At omalizumab discontinuation, 88% were oral corticosteroids-dependent with annual mean rate of 4.0 clinically significant exacerbations, 0.30 exacerbations needing emergency room visits or hospitalization; absenteeism due to disease was 10.4 days per patient. Switch to mepolizumab improved all clinical outcomes, reducing total exacerbation rate (RR = 0.06, 95% CI 0.03 to 0.14), oral corticosteroids -dependent patients (OR = 0.02, 95% CI 0.005 to 0.08), and the number of lost working days because of uncontrolled disease (Δ = -7.9, 95% CI -11.2 to -4.6). Pulmonary function improved, as well as serum IgE, fractional exhaled nitric oxide and eosinophils decreased. Mean annual costs were € 12,239 for omalizumab and € 12,639 for mepolizumab (Δ = € 400, 95% CI -1,588 to 2,389); the increment due to drug therapy (+ € 1,581) was almost offset by savings regarding all other cost items (- € 1,181). Conclusions: Patients with severe eosinophilic asthma, not controlled by omalizumab, experienced comprehensive benefits in asthma control by switching to mepolizumab. These relevant improvements were burdened by only very slight increases in economic costs.

Relationship between Exhaled Nitric Oxide and Levels of Asthma Control in Asthma Patients Treated with Inhaled Corticosteroid

2011 ◽  
Vol 71 (2) ◽  
pp. 106 ◽  
Author(s):  
Chang-Hee Han ◽  
You-Il Park ◽  
Hyun Jung Kwak ◽  
Sa Il Kim ◽  
Tae Hyung Kim ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Asthma Control ◽  
Exhaled Nitric Oxide ◽  
Inhaled Corticosteroid ◽  
Asthma Patients

Identifying uncontrolled asthma in children with the childhood asthma control test or exhaled nitric oxide measurement

2012 ◽  
Vol 109 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Suleyman Tolga Yavuz ◽  
Ersoy Civelek ◽  
Umit Murat Sahiner ◽  
Ayse Betul Buyuktiryaki ◽  
Ayfer Tuncer ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Asthma Control ◽  
Childhood Asthma ◽  
Exhaled Nitric Oxide ◽  
Control Test ◽  
Uncontrolled Asthma ◽  
Asthma Control Test ◽  
Asthma In Children

scholarly journals The Relation between Asthma Control and Quality of Life in Children

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
M. Banjari ◽  
Y. Kano ◽  
S. Almadani ◽  
A. Basakran ◽  
M. Al-Hindi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Asthma Control ◽  
Holistic Approach ◽  
Well Being ◽  
Life Questionnaire ◽  
Uncontrolled Asthma ◽  
Asthma Control Test ◽  
Cross Sectional ◽  
Asthmatic Children

Background. Asthma is a common chronic illness worldwide. Asthmatic children are forced to alter their way of living to avoid its complications or exacerbations, which negatively affects their psychological and social well-being. High prevalence of behavioral and emotional difficulties was noticed among children with asthma. Methods. Cross-sectional study that was conducted over 8 months involving asthmatic children within the ages of 7-17 years presenting to two governmental hospitals in Jeddah, Saudi Arabia. Three questionnaires were used: asthma control test, the strengths and difficulties questionnaire, and the pediatrics asthma quality of life questionnaire. Using SPSS, Pearson’s chi-square and independent sample t-tests were used to find associations. Results. Among the 106 respondents, 84% of the sample had poor asthma control. Significantly poorer quality of life was observed in children with uncontrolled asthma (p = <0.001). Children with controlled and uncontrolled asthma were equally affected psychosocially with no relation between asthma control and their psychosocial well-being (p = 0.58). Conclusion. The majority of asthmatic children were uncontrolled with poor quality of life. This study recommends that the psychosocial well-being should be assessed during clinic visits for a better holistic approach and effective improvement of outcome. Further researches are needed to study the psychological effect of asthma.

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