Diagnosing Asthma with and without Aerosol-Generating Procedures

Drake, S; Wang, Ran; Healy, L; Roberts, Stephen A; Murray, Clare; Simpson, Angela; Fowler, Stephen J.

doi:10.1016/j.jaip.2021.07.006

Cited by 8 publications

(12 citation statements)

References 10 publications

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“…Spirometry with bronchodilation tests has been the starting point if adult asthma is suspected. If the test is not diagnostic, other lung function tests, including PEF monitoring, provocation tests, and empiric steroid treatment tests, should be considered [ 37 ]. We analysed the spirometry with the highest BDR from each patient, but pre-bronchodilator FEV 1 /FVC <0.7 was still found in only one-third of measurements, and the sensitivity of the ΔFEV 1 ≥12% and 200 mL in our adult-onset asthma patients was only 36%.…”

Section: Discussionmentioning

confidence: 99%

Clinical value of bronchodilator response for diagnosing asthma in steroid-naïve adults

et al. 2021

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Spirometry and testing for bronchodilator response have been recommended to detect asthma, and a bronchodilator response (BDR) of ≥12% and ≥200 mL has been suggested to confirm asthma. However, the clinical value of bronchodilation tests in newly diagnosed steroid-naïve adult patients with asthma remains unknown. We evaluated the sensitivity of BDR in FEV1 as a diagnostic test for asthma in a real-life cohort of participants in the Seinäjoki Adult Asthma Study (SAAS). In the diagnostic phase, 369 spirometry tests with bronchodilation were performed for 219 steroid-naïve patients. The fulfilment of each test threshold was assessed. According to the algorithm of the National Institute for Health and Care Excellence, we divided the patients into obstructive (FEV11/FVC<0.70) and non-obstructive (FEV1/FVC≥0.70) groups. Of the overall cohort, 35.6% fulfilled ΔFEV1≥12% and ≥200mL for the initial FEV1, 18.3% fulfilled ΔFEV1≥15% and ≥400 mL for the initial FEV1 and 36.1% fulfilled ΔFEV1≥9% of predicted FEV1 at least once. One-third (31%) of these steroid-naïve patients was obstructive (pre-bronchodilator FEV1/FVC<0.7). Of the obstructive patients, 55.9%, 26.5% and 48.5%, respectively, met the same thresholds. In multivariate logistic regression analysis, different thresholds recognized different kinds of asthma patients. In steroid-naïve adult patients, the current BDR threshold (ΔFEV1≥12% and ≥200 mL) has low diagnostic sensitivity (36%) for asthma. In obstructive patients, sensitivity is somewhat higher (56%) but far from optimal. If the first spirometry test with bronchodilation is not diagnostic but asthma is suspected, spirometry should be repeated, and other lung function tests should be used to confirm the diagnosis.

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Section: Discussionmentioning

confidence: 99%

Clinical value of bronchodilator response for diagnosing asthma in steroid-naïve adults

et al. 2021

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“…To define what constitutes the upper limit of normal for F ENO , we developed an F ENO percentile chart within nonasthmatic children using data from the Manchester Asthma and Allergy Study (MAAS) [ 15 ]. We externally validated the percentile chart in the Study of Eczema and Asthma to Observe the Influence of Nutrition (SEATON) cohort [ 16 ], before testing in a diagnostic setting (Rapid Access Diagnostics for Asthma (RADicA) study) [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

“…We prospectively tested our newly proposed percentiles of FeNO for the probability of asthma in symptomatic children and young adults in the RADicA study (ISRCTN 11676160; https://www.radica.org.uk) described in detail elsewhere [17]. Briefly, symptomatic (wheeze, shortness of breath, chest tightness or cough), treatment-naïve patients with clinician suspicion of asthma were recruited from primary care.…”

Section: Population 3: Symptomatic and Treatment-naïve Patients (Radica)mentioning

confidence: 99%

Defining the normal range of fractional exhaled nitric oxide in children: one size does not fit all

et al. 2022

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BackgroundThe normal range of fractional exhaled nitric oxide (FeNO) is influenced by demographic factors. However, single, fixed cut-off values are used for clinical interpretation in children despite rapid growth. We aimed to define the normal range of FeNO during childhood and evaluate its utility in the diagnostic setting.MethodFeNO percentile charts were developed using data from non-asthmatic children in a population-based birth cohort (MAAS). Children were skin prick tested and FeNO measured at the age of 8, 11, 13–16 and 18 years and clinical information was collected. This chart was externally validated in the SEATON cohort before being prospectively tested in symptomatic, treatment-naïve patients with suspected asthma in a diagnostic setting (RADicA study).ResultsHeight, weight, BMI and age were predictive of FeNO in univariate analysis using 1219 FeNO measurements. Only height remained significant after adjustment in the overall, non-atopic and atopic populations, and was included in the predictive equations for 50th, 75th 90th and 98th percentiles. The proposed percentile lines corresponded to the 57th (95%CI:53–61st), 80th (76–83rd), 90th (87–92nd) and 98th (96–99th) percentiles in the SEATON cohort (660 measurements). When tested in 73 symptomatic treatment-naïve children and young adults (median [IQR] age: 11 [8–14] years), a FeNO >90th percentile gave a 96% specificity and positive predictive value of 97%, identifying 59% of children who were subsequently diagnosed with asthma after extensive testing.ConclusionWe developed a height-based FeNO percentile chart which quantifies the probability of asthma in symptomatic children and merits further validation towards clinical implementation.

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“…As SARS-CoV-2 has the characteristics of a high fatality rate, COVID-19 affecting global health and economy has become a serious public health emergency (1,3). Although efforts to develop vaccines and therapeutic drugs to combat COVID-19 are proceeding at the fastest scale, COVID-19 still has a negative impact on human health (4)(5)(6). The access to aerosol is very restrictive in resourcepoor countries for the COVID-19 pandemic, resulting in exacerbating the incidence and development of asthma (4).…”

Section: Introductionmentioning

confidence: 99%

“…Although efforts to develop vaccines and therapeutic drugs to combat COVID-19 are proceeding at the fastest scale, COVID-19 still has a negative impact on human health (4)(5)(6). The access to aerosol is very restrictive in resourcepoor countries for the COVID-19 pandemic, resulting in exacerbating the incidence and development of asthma (4). There are good reasons to worry about the possible "dangerous liaison" between COVID-19 and asthma.…”

Section: Introductionmentioning

confidence: 99%

A Practical Strategy for Exploring the Pharmacological Mechanism of Luteolin Against COVID-19/Asthma Comorbidity: Findings of System Pharmacology and Bioinformatics Analysis

Xie

Peng

et al. 2022

Front. Immunol.

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Asthma patients may increase their susceptibility to SARS-CoV-2 infection and the poor prognosis of coronavirus disease 2019 (COVID-19). However, anti-COVID-19/asthma comorbidity approaches are restricted on condition. Existing evidence indicates that luteolin has antiviral, anti-inflammatory, and immune regulation capabilities. We aimed to evaluate the possibility of luteolin evolving into an ideal drug and explore the underlying molecular mechanisms of luteolin against COVID-19/asthma comorbidity. We used system pharmacology and bioinformatics analysis to assess the physicochemical properties and biological activities of luteolin and further analyze the binding activities, targets, biological functions, and mechanisms of luteolin against COVID-19/asthma comorbidity. We found that luteolin may exert ideal physicochemical properties and bioactivity, and molecular docking analysis confirmed that luteolin performed effective binding activities in COVID-19/asthma comorbidity. Furthermore, a protein–protein interaction network of 538 common targets between drug and disease was constructed and 264 hub targets were obtained. Then, the top 6 hub targets of luteolin against COVID-19/asthma comorbidity were identified, namely, TP53, AKT1, ALB, IL-6, TNF, and VEGFA. Furthermore, the enrichment analysis suggested that luteolin may exert effects on virus defense, regulation of inflammation, cell growth and cell replication, and immune responses, reducing oxidative stress and regulating blood circulation through the Toll-like receptor; MAPK, TNF, AGE/RAGE, EGFR, ErbB, HIF-1, and PI3K–AKT signaling pathways; PD-L1 expression; and PD-1 checkpoint pathway in cancer. The possible “dangerous liaison” between COVID-19 and asthma is still a potential threat to world health. This research is the first to explore whether luteolin could evolve into a drug candidate for COVID-19/asthma comorbidity. This study indicated that luteolin with superior drug likeness and bioactivity has great potential to be used for treating COVID-19/asthma comorbidity, but the predicted results still need to be rigorously verified by experiments.

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Diagnosing Asthma with and without Aerosol-Generating Procedures

Cited by 8 publications

References 10 publications

Clinical value of bronchodilator response for diagnosing asthma in steroid-naïve adults

Clinical value of bronchodilator response for diagnosing asthma in steroid-naïve adults

Defining the normal range of fractional exhaled nitric oxide in children: one size does not fit all

A Practical Strategy for Exploring the Pharmacological Mechanism of Luteolin Against COVID-19/Asthma Comorbidity: Findings of System Pharmacology and Bioinformatics Analysis

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