Clinical Utility of Fractional exhaled  Nitric Oxide (FeNO) as a Biomarker  to Predict Severity of Disease and  Response to Inhaled Corticosteroid  (ICS) in Asthma Patients

Neelamegan, Revathy

doi:10.7860/jcdr/2016/20656.8950

Cited by 22 publications

(30 citation statements)

References 28 publications

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“…The measurement of fractional exhaled NO (F E NO) is a useful, non‐invasive method to assist with the diagnosis of asthma and monitor treatment effects. In recent years, F E NO has been used as a marker for eosinophilic airway inflammation and asthma, and to identify steroid responsiveness in individuals with chronic respiratory symptoms caused by airway inflammation …”

Section: Introductionmentioning

confidence: 99%

“…In recent years, F E NO has been used as a marker for eosinophilic airway inflammation and asthma, 3 and to identify steroid responsiveness in individuals with chronic respiratory symptoms caused by airway inflammation. 4 For F E NO to be reliable as a biomarker, it is important to know factors that influence F E NO values. Currently, it is known that F E NO values are influenced by age, 5 gender, 5,6 height, 5 atopy, 5,6 smoking, 5,7 respiratory infections, 5 environmental factors, 8 physical activity, 9 and ethnicity.…”

Section: Introductionmentioning

confidence: 99%

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Determinants of fractional exhaled nitric oxide in healthy men and women from the European Community Respiratory Health Survey III

Nerpin

Olivieri

Gislason

et al. 2019

Clin Experimental Allergy

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Introduction The fractional exhaled nitric oxide (FENO) is a marker for type 2 inflammation used in diagnostics and management of asthma. In order to use FENO as a reliable biomarker, it is important to investigate factors that influence FENO in healthy individuals. Men have higher levels of FENO than women, but it is unclear whether determinants of FENO differ by sex. Objective To identify determinants of FENO in men and women without lung diseases. Method Fractional exhaled nitric oxide was validly measured in 3881 healthy subjects that had answered the main questionnaire of the European Community Respiratory Health Survey III without airways or lung disease. Results Exhaled NO levels were 21.3% higher in men compared with women P < 0.001. Being in the upper age quartile (60.3‐67.6 years), men had 19.2 ppb (95% CI: 18.3, 20.2) higher FENO than subjects in the lowest age quartile (39.7‐48.3 years) P = 0.02. Women in the two highest age quartiles (54.6‐60.2 and 60.3‐67.6 years) had 15.4 ppb (14.7, 16.2), P = 0.03 and 16.4 ppb (15.6, 17.1), P = <0.001 higher FENO, compared with the lowest age quartile. Height was related to 8% higher FENO level in men (P < 0.001) and 5% higher FENO levels in women (P = 0.008). Men who smoked had 37% lower FENO levels and women had 30% lower levels compared with never‐smokers (P < 0.001 for both). Men and women sensitized to both grass and perennial allergens had higher FENO levels compared with non‐sensitized subjects 26% and 29%, P < 0.001 for both. Conclusion and Clinical Relevance Fractional exhaled nitric oxide levels were higher in men than women. Similar effects of current smoking, height, and IgE sensitization were found in both sexes. FENO started increasing at lower age in women than in men, suggesting that interpretation of FENO levels in adults aged over 50 years should take into account age and sex.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Determinants of fractional exhaled nitric oxide in healthy men and women from the European Community Respiratory Health Survey III

Nerpin

Olivieri

Gislason

et al. 2019

Clin Experimental Allergy

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“…Asthma is a heterogeneous condition characterized by different phenotypes and endotypes related to specific biomarkers that may predict therapeutic response in selected patient populations . Blood eosinophils and fractional exhaled nitric oxide (FeNO) measurement can facilitate identification of patients exhibiting type 2‐mediated airway inflammation . FeNO has been investigated as a surrogate marker of airway inflammation, which is closely associated with eosinophilic inflammation .…”

Section: Introductionmentioning

confidence: 99%

“…Blood eosinophils and fractional exhaled nitric oxide (FeNO) measurement can facilitate identification of patients exhibiting type 2‐mediated airway inflammation . FeNO has been investigated as a surrogate marker of airway inflammation, which is closely associated with eosinophilic inflammation . FeNO and blood eosinophils could each independently serve as prognostic markers of airway inflammation and severity, and also as predictive biomarkers of treatment effect …”

Section: Introductionmentioning

confidence: 99%

A phase 2 study to evaluate the safety, efficacy and pharmacokinetics of DP2 antagonist GB001 and to explore biomarkers of airway inflammation in mild‐to‐moderate asthma

Ortega

Fitzgerald

Raghupathi

et al. 2019

Clin Experimental Allergy

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Background: GB001 is an oral antagonist of the prostaglandin D2 receptor that may inhibit recruitment and activation of airway eosinophils, reducing airway inflammation.Objective: To assess GB001 safety, efficacy and pharmacokinetics from a Phase 2 study and explore the association between type 2 biomarkers (fractional exhaled nitric oxide and blood eosinophils) and asthma control markers following GB001 administration. Methods:A randomized, placebo-controlled, double-blind study evaluating 36 patients with mild-to-moderate atopic asthma. Patients receiving fluticasone propionate ≤500 mcg/day or equivalent were randomized (2:1) to GB001 (30 mg) or placebo once daily for 28 days. Safety, pharmacokinetics, forced expiratory volume in 1 second, asthma control questionnaire and rescue medication use were assessed. Clinical outcomes were analysed post hoc by baseline fractional exhaled nitric oxide (<35 and ≥35 ppb) and blood eosinophil (<250 and ≥250 cells/µL) subgroups. Results: GB001 was well tolerated and rapidly absorbed with a 14.5-hour terminal half-life. Overall, GB001 demonstrated greater improvement relative to placebo in forced expiratory volume in 1 second at Day 28 (102 mL [95% CI: −110, 314]). Greater effects on forced expiratory volume in 1 second were observed in the high baseline fractional exhaled nitric oxide and blood eosinophil subgroups (207 mL [95% CI: −283, 698];133 mL [95% CI: −422, 687], respectively). These effects were observed as early as Day 2 (229 mL [95% CI: −170, 628]; 163 mL [95% CI: −223, 550] for the high baseline fractional exhaled nitric oxide and blood eosinophil subgroups, respectively) and were sustained through treatment completion. Conclusion and clinical relevance: GB001 was well tolerated, with the estimated half-life supporting once-daily (QD) dosing. GB001 may have a rapid and sustainedThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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“…Although FeNO is recommended as a clinical tool for the assessment of airway disease, considered to be an advance over pulmonary function testing alone for evaluating airway physiology, and its value in identifying airway inflammation is undisputed, 30 some question may remain about the usefulness of FeNO in evaluating asthma severity 31 . Even with this capability, however, diagnosing ACOS may remain a challenge because the features of asthma and COPD may both be present.…”

Section: Discussionmentioning

confidence: 99%

Associations between occupational inhalation risks and FeNO levels in airway obstruction patients: results from the National Health and Nutrition Examination Survey, 2007–2012

Huang

Yang

2017

COPD

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PurposeTo investigate associations between occupational inhalation risks and fractional exhaled nitric oxide (FeNO) levels in patients with chronic obstructive pulmonary disease (COPD).Patients and methodsData of 16,486 subjects who had undergone spirometry with pre-bronchodilator and post-bronchodilator lung function assessment were retrieved from the National Health and Nutrition Examination Survey, 2007–2012 database. After excluding 2,638 subjects with missing spirometry values, data of 13,336 subjects were included for analysis. Factors associated with occupational inhalation, FeNO levels and COPD were analyzed using logistic regression analysis.ResultsCOPD was associated with occupational exposures to mineral dusts, organic dusts, exhaust fumes, other fumes, and second-hand smoking (P<0.05). Long-term exposure to these occupational hazards carried significantly higher risk for subjects with COPD than for controls (crude odds ratios [ORs]: mineral dusts: 2.364, organic dusts: 2.427, exhaust fumes: 2.728, other fumes: 2.144). In subgroup analysis, COPD correlated positively with long-term exposures to organic dusts and exhaust fumes in subjects with FeNO ≤50 ppb (ORs 1.361 and 1.314, respectively); conversely, COPD correlated negatively with intermediate to long-term exposures to organic dusts and exhaust fumes in those with FeNO >50 ppb (ORs 0.058 and 0.210, respectively).ConclusionOccupational exposures to airborne pollutants carries higher risk of COPD than non-exposure and the risk is higher the longer the duration of exposure. Exposure–response relationships are inconsistent in subjects with suspected asthmatic airway inflammation (FeNO ≥50 ppb). More careful risk assessment is needed in occupational inhalation exposure, since COPD with asthmatic airway inflammation, or asthma-COPD overlapping syndrome, may have the distinguishing features of both COPD and asthma.

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Clinical Utility of Fractional exhaled Nitric Oxide (FeNO) as a Biomarker to Predict Severity of Disease and Response to Inhaled Corticosteroid (ICS) in Asthma Patients

Cited by 22 publications

References 28 publications

Determinants of fractional exhaled nitric oxide in healthy men and women from the European Community Respiratory Health Survey III

Determinants of fractional exhaled nitric oxide in healthy men and women from the European Community Respiratory Health Survey III

A phase 2 study to evaluate the safety, efficacy and pharmacokinetics of DP2 antagonist GB001 and to explore biomarkers of airway inflammation in mild‐to‐moderate asthma

Associations between occupational inhalation risks and FeNO levels in airway obstruction patients: results from the National Health and Nutrition Examination Survey, 2007–2012

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Clinical Utility of Fractional exhaled Nitric Oxide (FeNO) as a Biomarker to Predict Severity of Disease and Response to Inhaled Corticosteroid (ICS) in Asthma Patients

Cited by 22 publications

References 28 publications

Determinants of fractional exhaled nitric oxide in healthy men and women from the European Community Respiratory Health Survey III

Determinants of fractional exhaled nitric oxide in healthy men and women from the European Community Respiratory Health Survey III

A phase 2 study to evaluate the safety, efficacy and pharmacokinetics of DP2 antagonist GB001 and to explore biomarkers of airway inflammation in mild‐to‐moderate asthma

Associations between occupational inhalation risks and FeNO levels in airway obstruction patients: results from the National Health and Nutrition Examination Survey, 2007&ndash;2012

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About

Associations between occupational inhalation risks and FeNO levels in airway obstruction patients: results from the National Health and Nutrition Examination Survey, 2007–2012