Asthma outcomes: Pulmonary physiology

Tepper, Robert S.; Wise, Robert A.; Covar, Ronina; Irvin, Charles G.; Kercsmar, Carolyn M.; Kraft, Monica; Liu, Mark C.; O’Connor, George T.; Peters, Stephen P.; Sorkness, Ronald L.; Togias, Alkis

doi:10.1016/j.jaci.2011.12.986

Cited by 140 publications

(124 citation statements)

References 210 publications

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“…24 PEF variability is the degree to which the PEF varies among multiple measurements performed over time ( Table 2). The management of acute exacerbations has traditionally been guided by PEF measurements.…”

Section: Peak Flowmentioning

confidence: 99%

“…Also, although reference to normal PEF values is important, the "personal best" value, and the trend of change in individual patients, is of greater value in managing their asthma. 24 The advantages of PEF are that it is easier to perform than a spirometric maneuver and it is measurable with a relatively small and inexpensive instrument. Thus, PEF may be suitable for individual testing at home, at school, and in patients who are poor perceivers of their degree of airway obstruction.…”

Section: Peak Flowmentioning

confidence: 99%

“…Overall, PEF monitoring alone has not been shown to be more effective than symptom monitoring on influencing asthma outcomes 26 and is no longer recommended. 1 24 forced vital capacity (FVC), and FEV 1 /FVC ratio, are an integral part of the assessment of asthma severity, control, and response to treatment. 1,2 They have been shown to be associated with the risk of asthma attacks in children.…”

Section: Peak Flowmentioning

confidence: 99%

“…24 However, individual patients, particularly children, may have misleadingly normal spirometry results, despite frequent or severe symptoms. An analysis of 2728 children between 4 and 18 years of age attending a tertiary care facility showed that the majority of asthmatic children had FEV 1 values within normal ranges.…”

Section: Spirometrymentioning

confidence: 99%

“…24 Baseline spirometry is performed and repeated after administration of bronchodilator test agents (eg, 15 minutes after 4 inhalations of albuterol). Change in FEV 1 is the most common parameter followed because the value of reversibility in other measurements is less established (eg, FEV 1 /FVC or FEF25-75).…”

Section: Prebronchodilator and Postbronchodilator Spirometry (Bronchomentioning

confidence: 99%

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Clinical Tools to Assess Asthma Control in Children

Dinakar¹,

Chipps²,

Allergy³

2017

Pediatrics

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Asthma affects an estimated 7 million children and causes significant health care and disease burden. The most recent iteration of the National Heart, Lung and Blood Institute asthma guidelines, the Expert Panel Report 3, emphasizes the assessment and monitoring of asthma control in the management of asthma. Asthma control refers to the degree to which the manifestations of asthma are minimized by therapeutic interventions and the goals of therapy are met. Although assessment of asthma severity is used to guide initiation of therapy, monitoring of asthma control helps determine whether therapy should be maintained or adjusted. The nuances of estimation of asthma control include understanding concepts of current impairment and future risk and incorporating their measurement into clinical practice. Impairment is assessed on the basis of frequency and intensity of symptoms, variations in lung function, and limitations of daily activities. “Risk” refers to the likelihood of exacerbations, progressive loss of lung function, or adverse effects from medications. Currently available ambulatory tools to measure asthma control range are subjective measures, such as patient-reported composite asthma control score instruments or objective measures of lung function, airway hyperreactivity, and biomarkers. Because asthma control exhibits short- and long-term variability, health care providers need to be vigilant regarding the fluctuations in the factors that can create discordance between subjective and objective assessment of asthma control. Familiarity with the properties, application, and relative value of these measures will enable health care providers to choose the optimal set of measures that will adhere to national standards of care and ensure delivery of high-quality care customized to their patients.

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Section: Peak Flowmentioning

confidence: 99%

Section: Peak Flowmentioning

confidence: 99%

Section: Peak Flowmentioning

confidence: 99%

Section: Spirometrymentioning

confidence: 99%

Section: Prebronchodilator and Postbronchodilator Spirometry (Bronchomentioning

confidence: 99%

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Clinical Tools to Assess Asthma Control in Children

Dinakar¹,

Chipps²,

Allergy³

2017

Pediatrics

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Effect of a Soy Isoflavone Supplement on Lung Function and Clinical Outcomes in Patients With Poorly Controlled Asthma

Smith¹,

Kalhan²,

Wise³

et al. 2015

JAMA

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IMPORTANCE Soy isoflavone supplements are used to treat several chronic diseases, although the data supporting their use are limited. Some data suggest that supplementation with soy isoflavone may be an effective treatment for patients with poor asthma control.OBJECTIVE To determine whether a soy isoflavone supplement improves asthma control in adolescent and adult patients with poorly controlled disease. DESIGN, SETTING, AND PARTICIPANTS Multicenter, randomized, double-blind, placebo-controlled trial conducted between May 2010 and August 2012 at 19 adult and pediatric pulmonary and allergy centers in the American Lung Association Asthma Clinical Research Centers network. Three hundred eighty-six adults and children aged 12 years or older with symptomatic asthma while taking a controller medicine and low dietary soy intake were randomized, and 345 (89%) completed spirometry at week 24.INTERVENTIONS Participants were randomly assigned to receive soy isoflavone supplement containing 100 mg of total isoflavones (n=193) or matching placebo (n=193) in 2 divided doses administered daily for 24 weeks. MAIN OUTCOMES AND MEASURESThe primary outcome measure was change in forced expiratory volume in the first second (FEV 1 ) at 24 weeks. Secondary outcome measures were symptoms, episodes of poor asthma control, Asthma Control Test score (range, 5-25; higher scores indicate better control), and systemic and airway biomarkers of inflammation.RESULTS Mean changes in prebronchodilator FEV 1 over 24 weeks were 0.03 L (95% CI, −0.01 to 0.08 L) in the placebo group and 0.01 L (95% CI, −0.07 to 0.07 L) in the soy isoflavone group, which were not significantly different (P = .36). Mean changes in symptom scores on the Asthma Control Test (placebo, 1.98 [95% CI,] vs soy isoflavones, 2.20 [95% CI, 1.53-2.87]; positive values indicate a reduction in symptoms), number of episodes of poor asthma control (placebo, 3.3 [95% CI, 2.7-4.1] vs soy isoflavones, 3.0 [95% CI, 2.4-3.7]), and changes in exhaled nitric oxide (placebo, −3.48 ppb [95% CI, −5.99 to −0.97 ppb] vs soy isoflavones, 1.39 ppb [95% CI, −1.73 to 4.51 ppb]) did not significantly improve more with the soy isoflavone supplement than with placebo. Mean plasma genistein level increased from 4.87 ng/mL to 37.67 ng/mL (P < .001) in participants receiving the supplement.CONCLUSIONS AND RELEVANCE Among adults and children aged 12 years or older with poorly controlled asthma while taking a controller medication, use of a soy isoflavone supplement, compared with placebo, did not result in improved lung function or clinical outcomes. These findings suggest that this supplement should not be used for patients with poorly controlled asthma.

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