Clinical control of asthma associates with measures of airway inflammation

Volbeda, Franke; Broekema, Martine; Lodewijk, Monique E.; Hylkema, Machteld N.; Reddel, Helen K.; Timens, Wim; Postma, Dirkje S.; Hacken, Nick H. T. ten

doi:10.1136/thoraxjnl-2012-201861

Cited by 60 publications

(55 citation statements)

References 33 publications

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“…Our new findings indicate that the daily fluctuation and the diurnal variation of FeNO provided more information regarding the control of asthma and the future risk of exacerbation. Our data is in agreement with recent studies reporting that monitoring of FeNO revealed changes in FeNO prior to the onset of moderate exacerbations [32], and that analysis of the fluctuation of daily FeNO provided useful information on asthma control [17].…”

Section: Discussionsupporting

confidence: 83%

“…However, several studies have shown its limitation in monitoring asthma therapy [28][29][30]. Support for a greater usefulness of daily FeNO measurements has recently been obtained [17,18,31,32]. In the current study, a single measurement of FeNO correlated well with FEV1 % pred and with percentage of sputum eosinophils, indicating that FeNO reflected both the inflammatory component as well as airflow obstruction.…”

Section: Discussionsupporting

confidence: 55%

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Domiciliary diurnal variation of exhaled nitric oxide fraction for asthma control

Saito

Gibeon

Macedo

et al. 2013

European Respiratory Journal

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A major goal of asthma management is maintaining optimal control. Current assessment is based on symptoms and lung function.We evaluated whether domiciliary daily home exhaled nitric oxide fraction (FeNO) monitoring could be useful as an index of asthma control. 50 asthmatic subjects and 15 healthy volunteers with a range of asthma severity underwent asthma control questionnaire (ACQ), spirometry before and after salbutamol and sputum induction. FeNO and peak expiratory flow (PEF) were measured twice daily for 2 weeks. A record of exacerbations was obtained 3 months later.Diurnal FeNO variation in uncontrolled asthmatics was significantly greater than in controlled asthmatics (p,0.01). PEF variation was not different. The daily variation of FeNO levels was also greater in uncontrolled asthmatics compared with controlled asthmatic and healthy subjects (p,0.01). 80% of uncontrolled asthmatics experienced at least one or more exacerbations over the 3 months after the enrolment. The combination of diurnal FeNO variation o16.6% and ACQ scores o1.8 was best at predicting uncontrolled asthma (area under curve 0.91, 95% CI 0.86-0.97; p,0.001).Diurnal variation in FeNO can be used as a biomarker of asthma control and as a predictor of the risk of future exacerbation. Prospective studies are warranted. @ERSpublications Diurnal variation in FeNO can be used as a biomarker of asthma control and a predictor of the risk of future exacerbation

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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 55%

Domiciliary diurnal variation of exhaled nitric oxide fraction for asthma control

Saito

Gibeon

Macedo

et al. 2013

European Respiratory Journal

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“…Some studies have looked at airway eosinophils in bronchoalveolar lavage (BAL) [21], induced sputum [11,12,14,[16][17][18] and bronchial biopsies [19,20], while others focused on systemic inflammation through blood eosinophil count measurement [20]. Discrepancies between studies may be linked to the different compartments sampled and, for some of the studies, to the limited number of subjects investigated.…”

Section: Introductionmentioning

confidence: 99%

“…There is a huge controversy about the role of eosinophils as a key player in asthma severity [10][11][12][13][14][15][16][17][18][19][20][21]. Some studies have looked at airway eosinophils in bronchoalveolar lavage (BAL) [21], induced sputum [11,12,14,[16][17][18] and bronchial biopsies [19,20], while others focused on systemic inflammation through blood eosinophil count measurement [20].…”

Section: Introductionmentioning

confidence: 99%

Importance of concomitant local and systemic eosinophilia in uncontrolled asthma

Schleich

Chevremont

Paulus

et al. 2014

European Respiratory Journal

179

106

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Systemic and airway eosinophilia are recognised features of asthma. There are, however, patients who exhibit discordance between local and systemic eosinophilia. In this study, we sought to determine the prevalence and characteristics of patients with concordant and discordant systemic and bronchial eosinophilia.We conducted a retrospective study on 508 asthmatics with successful sputum induction. We assessed the relationship between blood and sputum eosinophils by breaking down the population into four groups according to blood (o400 cells per mm 3 ) and sputum (o3%) eosinophils. Then, we prospectively reassessed the link between eosinophils and asthma control (Asthma Control Questionnaire (ACQ)) and exacerbation rate in a new cohort of 250 matched asthmatics.In our retrospective cohort, asthmatics without eosinophilic inflammation were the largest group (49%). The group with isolated sputum eosinophilia (25%) was, compared with noneosinophilic asthma, associated with lower forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity ratio and higher bronchial hyperresponsiveness and exhaled nitric oxide fraction (FeNO). Asthmatics exhibiting isolated systemic eosinophilia (7%) had similar characteristics as noneosinophilic asthmatics. The group with concordant systemic and airway eosinophilia (19%) showed remarkable male predominance, and had the lowest airway calibre, asthma control and quality of life, and the highest bronchial hyperresponsiveness, FeNO and exacerbation rate. The prospective cohort confirmed the different subgroup proportions and the higher ACQ and exacerbation rates in cases of diffuse eosinophilia compared with noneosinophilic asthmatics.Concomitant systemic and bronchial eosinophilic inflammation contribute to poor asthma control.@ERSpublications Concomitant systemic and bronchial eosinophilic inflammation contributes to poor asthma control

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“…It has a high burden of morbidity especially if not controlled [1]. Airway inflammation, a major element of asthma pathophysiology, and related to asthma severity [2,3] and asthma control [4] and causing systemic signs of inflammation as well [5]. Easily obtainable markers of systemic inflammation especially those related to clinical control of asthma may help in clinical decision-making.…”

Section: Introductionmentioning

confidence: 99%

Urinary Glycosaminoglycans in Asthmatic Children in Relation to Disease Control by Inhaled Corticosteroids

B¹

2015

J Allergy Ther

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Clinical control of asthma associates with measures of airway inflammation

Cited by 60 publications

References 33 publications

Domiciliary diurnal variation of exhaled nitric oxide fraction for asthma control

Domiciliary diurnal variation of exhaled nitric oxide fraction for asthma control

Importance of concomitant local and systemic eosinophilia in uncontrolled asthma

Urinary Glycosaminoglycans in Asthmatic Children in Relation to Disease Control by Inhaled Corticosteroids

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