Concordance between bronchial hyperresponsiveness, fractional exhaled nitric oxide, and asthma control in children

Thomas, Biju; Chay, Oh Moh; Allen, John C.; Chiang, Andrea Shu Xian; Pugalenthi, Arun; Goh, Angela; Wong, Petrina; Teo, Ai Huay; Tan, Soh Gin; Teoh, Oon Hoe

doi:10.1002/ppul.23426

Cited by 13 publications

(10 citation statements)

References 36 publications

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“…In addition to the concordance reported here for changes in asthma domains, others have noted the low concordance between domains at a single time point [16,17]. If asthma domains display discordance at a single timepoint, it is logical that changes in these parameters over time would be similar.…”

Section: Discussionsupporting

confidence: 49%

Concordance for changes in allergic asthma domain variables after short-term corticosteroid therapy

Silkoff

Sarno²,

Ssenyange³

et al. 2020

BMC Pulm Med

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Background: Asthma is a complex syndrome with multiple domains including symptoms, lung function, asthma control, and airway inflammation. A study of Fenom PRO™, a novel monitor for exhaled nitric oxide (FeNO), provided an opportunity to look at concordance/discordance (C/D) for changes in multiple asthma domains over a 2-week period after corticosteroid therapy. Methods: Non-steroid-treated adults and children with uncontrolled asthma had asthma domain measures, (FeNO), forced expired volume in 1 s (FEV 1), the 6-item Asthma Control Questionnaire scores (ACQ6), and daily asthma symptoms, assessed before and after a 2-week course of corticosteroids. Asthma symptoms were assessed using a custom novel twice-daily symptom scale (ASX). C/D bidirectional changes in all domains were calculated around both the zero point, and around the minimal important difference (MID) in relevant subjects. Results: There was a highly significant fall in mean FeNO of 51.7% over 2 weeks (p < 0.0001) accompanied by significant improvements in mean FEV 1 , ACQ6 and ASX scores. However, C/D between individual domains varied considerably between subjects. The C/D between parameters for any change around zero for the combined adults and pediatric population was best for FeNO and ACQ6, 79.3/20.7% while FEV 1 was more discordant than other parameters in general. When considering changes around the minimal important difference (MID) in a subset, the level of concordance increased in general, with FeNO and ACQ6 demonstrating a C/D of 93.5/6.6%. Conclusion: This data demonstrates that the concordance between changes in the asthma domains is often substantially less than 100%. Reasons for this may include different time courses for change of the separate domains, the degree of abnormality for each domain at baseline, as well as intrinsic limitations of each parameter.

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Section: Discussionsupporting

confidence: 49%

Concordance for changes in allergic asthma domain variables after short-term corticosteroid therapy

Silkoff

Sarno²,

Ssenyange³

et al. 2020

BMC Pulm Med

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“…FeNO >20 ppb predicted exacerbations in another study in children with mild asthma on low-dose ICS who were switched to montelukast. 149 SOE summary is available in Table 5. Detailed assessment of SOE is available in Appendix Table H.3.…”

Section: Using Feno To Aid In Drug Type Selectionmentioning

confidence: 99%

The Clinical Utility of Fractional Exhaled Nitric Oxide (FeNO) in Asthma Management

Wang¹,

Pianosi²,

Keogh³

et al. 2017

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“…Furthermore, given the fundamantal importance of airway inflammation as a pathological mechanism in asthma, measurement of the breath nitric oxide concentration (FeNO) is widely touted as a useful tool in the assessment of control. However, in one previous study concordance of FeNO with a standard symptom scale metric in children was poor 14 .…”

Section: Introductionmentioning

confidence: 84%

Disparate diagnostic accuracy of lung function tests as predictors of poor asthma control in children

et al. 2019

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Rationale: In practice, asthma control is assessed according to symptom burden and office spirometry. However spirometry poorly tests peripheral lung function, which may be abnormal in asthma. Impluse oscillometry (IOS) and multiple-breath washout (MBW) are novel methods which measure reactance (X5) and ventilation heterogeneity (VH) in the peripheral lung, but how well these tests reflect asthma control is poorly understood. Objective: To compare the diagnostic accuracy of tests of large airways caliber (FEV¬1¬, FEV¬1-/FVC, R20), peripheral zone properties (X5, VH), and airways inflammation (FeNO) as predictors of poor control in asthmatic children (44 poorly-controlled/10 controlled). Methods: 54 children enriched in severe asthma completed a symptom-based control scale (ACT/cACT) and lung function tests after overnight bronchodilator withhold. The accuracy of each variable to predict poor control was ranked by area under the receiver operating characteristic (ROC) curve, sensitivity, and specificity. Results: Among measures of large airways caliber, the FEV¬1¬% had the highest ROC curve area, with low sensitivity but perfect specificity. Among measures of peripheral lung function, X5 and VH in the conducting zone had fair curve areas with higher sensitivity but lower specificity compared to the FEV¬1¬%. VH in the acinar zone and FeNO both had poor accuracy. Conclusion: Tests of large airway and peripheral zone lung function performed disparately as predictors of poor control in a sample of children enriched in severe asthma. Further studies in a larger sample with more diverse phenotypic features are necessary to validate this preliminary conclusion.

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Concordance between bronchial hyperresponsiveness, fractional exhaled nitric oxide, and asthma control in children

Cited by 13 publications

References 36 publications

Concordance for changes in allergic asthma domain variables after short-term corticosteroid therapy

Concordance for changes in allergic asthma domain variables after short-term corticosteroid therapy

The Clinical Utility of Fractional Exhaled Nitric Oxide (FeNO) in Asthma Management

Disparate diagnostic accuracy of lung function tests as predictors of poor asthma control in children

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