Exhaled nitric oxide predicts lung function decline in difficult-to-treat asthma

Veen, Ilonka H. van; Brinke, Anneke ten; Sterk, Peter J.; Sont, Jacob K.; Gauw, Stefanie A.; Rabe, Klaus F.; Bel, Elisabeth H.

doi:10.1183/09031936.00135907

Cited by 114 publications

(86 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Higher FeNO values, perhaps due to the higher reported inducible nitric oxide synthase expression in severe asthmatic epithelial cells, have been associated with a more exacerbation prone phenotype in severe asthma, as well as more rapid decline in FEV1 [76,[91][92][93]. In addition, higher levels of oxidative stress have been associated with a reduction in superoxide dismutase and s-nitrosothiol depletion [94,95].…”

Section: Activation Of Innate Immune Pathwaysmentioning

confidence: 99%

See 1 more Smart Citation

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

et al. 2013

View full text Add to dashboard Cite

Severe or therapy-resistant asthma is increasingly recognised as a major unmet need. A Task Force, supported by the European Respiratory Society and American Thoracic Society, reviewed the definition and provided recommendations and guidelines on the evaluation and treatment of severe asthma in children and adults.A literature review was performed, followed by discussion by an expert committee according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach for development of specific clinical recommendations.When the diagnosis of asthma is confirmed and comorbidities addressed, severe asthma is defined as asthma that requires treatment with high dose inhaled corticosteroids plus a second controller and/or systemic corticosteroids to prevent it from becoming “uncontrolled” or that remains “uncontrolled” despite this therapy. Severe asthma is a heterogeneous condition consisting of phenotypes such as eosinophilic asthma. Specific recommendations on the use of sputum eosinophil count and exhaled nitric oxide to guide therapy, as well as treatment with anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty are provided.Coordinated research efforts for improved phenotyping will provide safe and effective biomarker-driven approaches to severe asthma therapy.

show abstract

Section: Activation Of Innate Immune Pathwaysmentioning

confidence: 99%

“…Prospective studies of lung function decline in severe asthma are limited, but suggest that male sex, smoking, increased FeNO and African ancestry are contributors, while interestingly, allergic status may be protective [93,126].…”

Section: Physiologymentioning

confidence: 99%

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Because this study had a cross-sectional design, it is as yet unclear whether this represents merely an association or whether abnormalities in small airways may be used as a predictor of subsequent exacerbations. In addition, VAN VEEN et al [43] had observed that exhaled NO predicts lung function decline in severe asthmatics during 5 yrs of prospective follow-up [43]. Interestingly, this relationship was only found in subjects with baseline FEV1 .80% pred, whereas no relationship was found in subjects with FEV1 f80%, suggesting that these findings may be related to small airways rather than larger airways [43].…”

Section: Relevance Of Small Airways In Asthmamentioning

confidence: 84%

The role of small airways in obstructive airway diseases: Figure 1.

Burgel¹

2011

Eur Respir Rev

196

139

View full text Add to dashboard Cite

This review article is a summary of a seminar organised by the European Respiratory Society on ''The role of small airways in obstructive airway diseases'' which was held in October 2010 in Amsterdam, the Netherlands.The aims of the seminar were to identify important questions related to small airways involvement in asthma and chronic obstructive pulmonary disease (COPD), and to discuss future approaches based on current and evolving knowledge. Data obtained by pathological and physiological measurements in small airways and their relevance to clinical manifestations and therapeutics in asthma and COPD were reviewed.It was concluded that our knowledge on the roles of small airways in asthma and COPD is limited. Studies of large numbers of well-characterised subjects using multiple methods (genetic characterisation, cell biology and physiology, imaging) and integration of the data using mathematical models are suggested to be of interest. The availability of these techniques coupled with our ability to better target inhaled molecules to small airways provide a unique opportunity for a reappraisal of the relevance of small airways in chronic airway diseases.

show abstract

“…Further studies are needed to determine the nature of the interaction between NO and TLC in asthma, but the current study shows that FE NO is associated with hyperinflation in asthma. Furthermore, FE NO in severe asthma might reflect airway-remodeling processes (48,49). Because many of the variables that are related to NO are also related to severity, relationships between variables and FE NO were also evaluated within severity group by multivariate analyses.…”

Section: Discussionmentioning

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

250

200

View full text Add to dashboard Cite

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.

show abstract

Exhaled nitric oxide predicts lung function decline in difficult-to-treat asthma

Cited by 114 publications

References 32 publications

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

The role of small airways in obstructive airway diseases: Figure 1.

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

Contact Info

Product

Resources

About