Identifying uncontrolled asthma in children with the childhood asthma control test or exhaled nitric oxide measurement

Yavuz, Süleyman Tolga; Civelek, Ersoy; Şahiner, Ümit Murat; Büyüktiryaki, Ayşe Betül; Tuncer, Ayfer; Karabulut, Erdem; Şekerel, Bülent Enis

doi:10.1016/j.anai.2012.05.011

Cited by 22 publications

(20 citation statements)

References 26 publications

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“…Patients with severe asthma and high FeNO levels had a tendency to be younger, to exhibit the greatest airway reactivity, and to have the least awareness of their asthma symptoms . The findings provide evidence that FeNO levels provide a valuable tool for classifying asthma phenotypes and allow the identification of a particularly worrisome subgroup of patients with persistent asthma .…”

Section: Discussionmentioning

confidence: 79%

Increased IL‐17A secreting CD4⁺ T cells, serum IL‐17 levels and exhaled nitric oxide are correlated with childhood asthma severity

Chien

Lin

Yang

et al. 2013

Clin Experimental Allergy

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Section: Discussionmentioning

confidence: 79%

Increased IL‐17A secreting CD4⁺ T cells, serum IL‐17 levels and exhaled nitric oxide are correlated with childhood asthma severity

Chien

Lin

Yang

et al. 2013

Clin Experimental Allergy

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“…Other studies have recently shown, both in children and adults, that an increased FeNO is associated with a worse current asthma control and an increased risk of exacerbations, and is predictive of a better response to anti-inflammatory therapy [5,8,24,25]. However, FeNO determinations have shown inferior performance to evaluate asthma control in comparison with standardized symptom questionnaires, with or without spirometry values included [9,10]. Consistently with the prior reports, our data series showed that 30.2% of asthmatics were identified as not well controlled by FeNO on visit 2, as opposed to 59.9% identified by ACQ-7.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have suggested that treated asthma patients who have high FeNO values suffer from more severe disease [5], have poorer asthma control, and are at greater risk for asthma exacerbations [6-8]. Conversely, other studies showed that the addition of FeNO measurements to the determinations usually employed to evaluate asthma control [9,10] and adjust therapy [11], such as standardized symptom questionnaires and spirometry, does not result in a better assessment of the current asthma control level nor the risk of exacerbation. A systematic review, which included a Cochrane based meta-analysis on six controlled randomized studies (two on adults and four on children/adolescents), showed data discrepancy in adults versus children and concluded that current evidence is not supportive on the use of FeNO for treatment adjustment [12].…”

Section: Introductionmentioning

confidence: 99%

Exhaled Nitric Oxide Fraction as an Add-On to ACQ-7 for Not Well Controlled Asthma Detection

et al. 2013

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BackgroundThe measurement of fractional nitric oxide concentration in exhaled breath (FeNO), a noninvasive indicator of airway inflammation, remains controversial as a tool to assess asthma control. Guidelines currently limit asthma control assessment to symptom and spirometry based appraisals such as the Asthma Control Questionnaire-7 (ACQ-7). We aimed at determining whether adding FeNO to ACQ-7 improves current asthma clinical control assessment, through enhanced detection of not well controlled asthma.MethodsAsthmatic subjects, classified as not well controlled as per ACQ-7 on regular clinical practice, were included in a prospective, multicenter fashion, and had their maintenance treatment adjusted on visit 1. On follow-up (visit 2) four weeks later, the subjects were reevaluated as controlled or not well controlled using ACQ-7 versus a combination of FeNO and ACQ-7.ResultsOut of 381 subjects enrolled, 225 (59.1%) had not well controlled asthma on visit 2 as determined by ACQ-7, and 264 (69.3%) as per combined FeNO and ACQ-7. The combination of FeNO to ACQ-7 increased by 14.8% the detection of not well controlled asthma following maintenance therapy adjustment.ConclusionsThe addition of FeNO to ACQ-7 increased the detectability of not well controlled asthma upon adjustment of maintenance therapy. Adding a measure of airway inflammation to usual symptom and spirometry based scores increases the efficacy of current asthma clinical control assessment.

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“…Other works, however, have yielded less convincing results [30,[52][53][54][55], probably because of the numerous factors that can influence the measurement of FeNO: the intensity of the ICS treatment, passive smoking, epithelial airway surface, and gender [56]. In a recent Swedish study, high FeNO levels were associated with failure to control asthma and greater bronchial hyperreactivity when co-occurring with blood eosinophilia [57].…”

Section: Fractional Exhaled Nitric Oxide (Feno)mentioning

confidence: 99%

Biomarkers for severe allergic asthma in children: could they be useful to guide disease control and use of omalizumab?

Amat

Labbé

2018

Expert Review of Respiratory Medicine

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Although symptom controls in asthmatic children can be achieved through compliant use of conventional medication, some children have uncontrolled severe persistent asthma, especially if they are allergic. For these children, omalizumab (approved by the EMA and FDA in children aged > 6 years) could be a therapeutic option. However, response to omalizumab varies from one child to another. Predictive biomarkers of omalizumab effectiveness could be useful to monitor response to treatment. Area covered: The authors searched in the PubMed database for publications related to the use of biomarkers in allergic asthma. Supported by their own experience in phenotyping asthma in children, they analyzed whether these biomarkers could be useful in assessing response to omalizumab. Expert commentary: Th2 inflammation in children with allergic asthma can be assessed by measuring several biomarkers (blood eosinophil, serum ECP or periostin, FeNO). While a single measurement may be insufficient, a combination of biomarkers assessments may improve the follow-up of children treated by omalizumab.

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Identifying uncontrolled asthma in children with the childhood asthma control test or exhaled nitric oxide measurement

Cited by 22 publications

References 26 publications

Increased IL‐17A secreting CD4⁺ T cells, serum IL‐17 levels and exhaled nitric oxide are correlated with childhood asthma severity

Increased IL‐17A secreting CD4⁺ T cells, serum IL‐17 levels and exhaled nitric oxide are correlated with childhood asthma severity

Exhaled Nitric Oxide Fraction as an Add-On to ACQ-7 for Not Well Controlled Asthma Detection

Biomarkers for severe allergic asthma in children: could they be useful to guide disease control and use of omalizumab?

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Identifying uncontrolled asthma in children with the childhood asthma control test or exhaled nitric oxide measurement

Cited by 22 publications

References 26 publications

Increased IL‐17A secreting CD4+ T cells, serum IL‐17 levels and exhaled nitric oxide are correlated with childhood asthma severity

Increased IL‐17A secreting CD4+ T cells, serum IL‐17 levels and exhaled nitric oxide are correlated with childhood asthma severity

Exhaled Nitric Oxide Fraction as an Add-On to ACQ-7 for Not Well Controlled Asthma Detection

Biomarkers for severe allergic asthma in children: could they be useful to guide disease control and use of omalizumab?

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Resources

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Increased IL‐17A secreting CD4⁺ T cells, serum IL‐17 levels and exhaled nitric oxide are correlated with childhood asthma severity

Increased IL‐17A secreting CD4⁺ T cells, serum IL‐17 levels and exhaled nitric oxide are correlated with childhood asthma severity