Exhaled nitric oxide reflects asthma severity and asthma control

Delgado-Corcoran, Claudia; Kissoon, Niranjan; Murphy, Suzanne P.; Duckworth, Laurie

doi:10.1097/01.ccm.0000105310.00799.51

Cited by 62 publications

(41 citation statements)

References 27 publications

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“…These studies were very heterogeneous (19,20), presence of wheezing during the previous year (21) or weekly b2-adrenergic agonist consumption (14,22,23). Eight of these studies showed a correlation between exhaled NO and asthma control (14,16,17,19,20,(22)(23)(24). In these studies, exhaled NO was higher in the case of uncontrolled asthma or if there were recent symptoms.…”

Section: Relation Between Symptoms and Inflammationmentioning

confidence: 99%

Relation between inflammation and symptoms in asthma

Tillie‐Leblond

Montani

Crestani

et al. 2009

Allergy

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Asthma symptoms are the main reason for healthcare utilization and are a fundamental parameter for the evaluation of asthma control. Currently, asthma is defined as a chronic inflammatory disease. A French expert group studied the association between inflammation and asthma symptoms by carrying out a critical review of the international literature. Uncontrolled asthmatics have an increased number of polynuclear eosinophils in the induced sputum and an increased production of exhaled NO. Control by anti‐inflammatory treatment is accompanied by a reduction in bronchial eosinophilia and exhaled NO. Asthma symptoms are the result of complex mechanisms and many factors modify their perception. Experimental data suggest that there is a relationship between the perception of symptoms and eosinophilic inflammation and that inhaled corticoid therapy improves this perception. Although they are still not applicable in routine practice, follow‐up strategies based on the evaluation of inflammation are thought to be more effective in reducing exacerbations than those usually recommended based on symptoms and sequential analysis of respiratory function. Inhaled corticosteroid therapy is the reference disease‐modifying therapy for persistent asthma. Recent studies demonstrated that adjustment of anti‐inflammatory treatment based on symptoms is an effective strategy to prevent exacerbations and reduce the total number of doses of inhaled corticosteroids.

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Section: Relation Between Symptoms and Inflammationmentioning

confidence: 99%

Relation between inflammation and symptoms in asthma

Tillie‐Leblond

Montani

Crestani

et al. 2009

Allergy

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“…As a free radical that reacts with oxidants and antioxidants, nitric oxide (NO) in exhaled breath (FE NO ) reflects the redox state of the airway and has been proposed as a marker of airway inflammation and guide for antiinflammatory therapy in asthma (7). High levels of FE NO are well documented in nonsevere asthma (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) and decrease in response to treatment with corticosteroids (22)(23)(24)(25)(26)(27). However, measures of FE NO in 50 patients with severe asthma in the European multicenter study of chronic severe asthma suggest that FE NO levels of patients with severe asthma, who are refractory to conventional treatments, may not be suppressed by corticosteroids (28).…”

mentioning

confidence: 99%

Use of Exhaled Nitric Oxide Measurement to Identify a Reactive, at-Risk Phenotype among Patients with Asthma

Dweik

Sorkness

Wenzel

et al. 2010

Am J Respir Crit Care Med

248

199

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Rationale: Exhaled nitric oxide (FE NO ) is a biomarker of airway inflammation in mild to moderate asthma. However, whether FE NO levels are informative regarding airway inflammation in patients with severe asthma, who are refractory to conventional treatment, is unknown. Here, we hypothesized that classification of severe asthma based on airway inflammation as defined by FE NO levels would identify a more reactive, at-risk asthma phenotype. Methods: FE NO and major features of asthma, including airway inflammation, airflow limitation, hyperinflation, hyperresponsiveness, and atopy, were determined in 446 individuals with various degrees of asthma severity (175 severe, 271 nonsevere) and 49 healthy subjects enrolled in the Severe Asthma Research Program. Measurements and Main Results: FE NO levels were similar among patients with severe and nonsevere asthma. The proportion of individuals with high FE NO levels (.35 ppb) was the same (40%) among groups despite greater corticosteroid therapy in severe asthma. All patients with asthma and high FE NO had more airway reactivity (maximal reversal in response to bronchodilator administration and by methacholine challenge), more evidence of allergic airway inflammation (sputum eosinophils), more evidence of atopy (positive skin tests, higher serum IgE and blood eosinophils), and more hyperinflation, but decreased awareness of their symptoms. High FE NO identified those patients with severe asthma characterized by the greatest airflow obstruction and hyperinflation and most frequent use of emergency care. Conclusions: Grouping of asthma by FE NO provides an independent classification of asthma severity, and among patients with severe asthma identifies the most reactive and worrisome asthma phenotype.

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“…38 Studies in children suggest that FENO correlates with severity and with asthma control. 42 FENO reduces in a dose-dependent manner with corticosteroid treatment 43 and has been shown to increase with deterioration in asthma control. 44 The value of additional FENO monitoring in children whose asthma is appropriately managed using guideline-based strategies is unproven, 28, 45 -47 and insurance payment for this test varies by geographic location.…”

Section: Exhaled Nitric Oxidementioning

confidence: 99%

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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Exhaled nitric oxide reflects asthma severity and asthma control

Abstract: Our data suggest that a) FENO may be a practical tool to evaluate asthma severity and asthma control over time and b) FENO may be used as a marker of compliance with steroids even when FEV1 has not decreased significantly.

Cited by 62 publications

References 27 publications

Relation between inflammation and symptoms in asthma

Relation between inflammation and symptoms in asthma

Use of Exhaled Nitric Oxide Measurement to Identify a Reactive, at-Risk Phenotype among Patients with Asthma

Clinical Tools to Assess Asthma Control in Children

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