Utility of fractional exhaled nitric oxide suppression as a prediction tool for progression to biologic therapy

Butler, Claire A.; McMichael, Alan; Honeyford, Kirsty; Wright, Louise; Logan, J.I.; Holmes, Joshua; Busby, John; Hanratty, Catherine; Yang, Freda; Smith, Steven J.; Murray, Kirsty; Chaudhuri, Rekha; Heaney, Liam G.

doi:10.1183/23120541.00273-2021

Cited by 9 publications

(3 citation statements)

References 19 publications

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“…Corrected Proof corticosteroid therapy identified nonadherent patients and was introduced as the FeNO suppression test (327) . Conversely, nonsuppression of FeNO levels can identify corticosteroid resistance in type 2 asthma patients and to predict the possible need for biological therapy (328,329) . The role of FeNO levels in the choice of biological therapy for severe asthma has also been investigated.…”

Section: Fraction Exhaled Nitric Oxide (Feno)mentioning

confidence: 99%

Outcome measures for chronic rhinosinusitis with nasal polyps

Sedaghat,

Campbell,

Douglas

et al. 2024

Rhin

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Background: With the recent proliferation of novel therapeutics for chronic rhinosinusitis with nasal polyps (CRSwNP), there is an immediate need for comprehensive means to assess CRSwNP disease status as well as to determine treatment efficacy. Outcome measures exist in different forms. Patient-reported outcome measures (PROMs) allow patients to provide direct input about their condition that is not possible to obtain in any other way. Common constructs that are measured using PROMs include quality of life or the burden of disease manifestations (e.g., symptom severity). Outcomes may also include the results of objective diagnostic testing/measurement of clinical signs or measured using psychophysical tests. Biomarkers represent an emerging class of outcome measures for CRSwNP and are chosen to directly reflect the active pathophysiologic processes of CRSwNP in the peripheral blood, sinus/polyp tissues, and sinonasal mucus. Methods: Narrative review of the literature, identifying and describing outcome measures that may be used in the evaluation of CRSwNP and for assessment of treatment responses. Results: In this review, we identify many different outcome measures for CRSwNP that fall under the categories of PROM, objective test, psychophysical test or biomarker. We describe the history of each - including seminal studies - and demonstrate the formal validation, psychometric performance, and limitations of each. Conclusions: PROMs, objective tests, psychophysical tests and biomarkers represent different classes of outcome measures that are complementary means of assessing CRSwNP disease status and treatment efficacy. The choice or interpretation of a CRSwNP outcome measure should be undertaken with full knowledge of its formal validation, psychometric performance, and limitations.

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Section: Fraction Exhaled Nitric Oxide (Feno)mentioning

confidence: 99%

Outcome measures for chronic rhinosinusitis with nasal polyps

Sedaghat,

Campbell,

Douglas

et al. 2024

Rhin

View full text Add to dashboard Cite

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“…By that time, 64% ( N = 54) of the patients had experienced considerable improvements in their symptoms and lung function thanks to effective adherence to long-acting beta-agonist (LABA) and ICS. 81 With the development of computer technology and the application of clinical biological reaction markers, clinicians can gradually objectively evaluate the adherence of children with asthma through the FeNO suppression test to identify DA and then improve the management measures for children with DA.…”

Section: Evaluation and Management Of Damentioning

confidence: 99%

Progress in diagnosis and treatment of difficult-to-treat asthma in children

Zhou,

Zhang,

Tan

et al. 2023

Ther Adv Respir Dis

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At present, medications containing inhaled corticosteroids (ICS-containing) are the keystones of asthma treatment. The majority of asthmatic children can significantly improve clinical outcomes with little worsening by standardized inhaled glucocorticoid treatment, but there is still a small proportion of children who are unable to achieve good symptom control even after the maximum standardized treatment, known as ‘children with difficult-to-treat asthma (DA)’. The high heterogeneity of DA makes therapy challenging and expensive, which poses a serious risk to children’s health and makes it extremely difficult for clinical physicians to accurately identify and treat children with DA. This article reviews the definition, evaluation, and treatment of this asthma in order to provide a reference for optimal clinical decision-making.

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“…A retrospective analysis of 162 subjects who attended the Difficult Asthma Centres in Belfast and Glasgow and experienced FeNO suppression testing (FeNOSuppT) was performed ( 51 ). This test consists in tele-monitoring of inhaler use in conjunction with daily FeNO measurement to identify non-adherence to inhaled corticosteroid (ICS) treatment.…”

Section: Introductionmentioning

confidence: 99%

What is the added value of FeNO as T2 biomarker?

Marcos

Serrano

2022

Front. Allergy

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There is increasing evidence about the role of nitric oxide in type 2 (T2) immune response. Fraction of exhaled nitric oxide (FeNO) is a product of airways inflammation and it is increased in patients with asthma. Since Gustaffson published the first article about this biomarker in the 1990s, interest has continued to grow. Compared with other T2 biomarkers such as blood eosinophil count, induced sputum, or serum periostin, FeNO has some remarkable advantages, including its not invasive nature, easy repeatability, and possibility to be performed even in patients with severe airway obstruction. It is considered as an indicator of T2 inflammation and, by the same token, a useful predictor for inhaled steroid response. It is difficult to determine the utility of nitric oxide (NO) for initial asthma diagnosis. In such a heterogenous disease, a single parameter would probably not be enough to provide a complete picture. There is also an important variability among authors concerning FeNO cutoff values and the percentage of sensibility and specificity for diagnosis. Its high specificity indicates a potential role to “rule in” asthma; however, its lower sensibility could suggest a lower capacity to “rule out” this pathology. For this reason, if a diagnosis of asthma is being considered, FeNO should be considered along with other tests. FeNO has also shown its utility to detect response to steroids, adherence to treatment, and risk of exacerbation. Even though there is not enough quality of evidence to establish overall conclusions, FeNO could be an alternative procedure to diagnose or exclude asthma and also a predictive tool in asthma treated with corticosteroids.

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Utility of fractional exhaled nitric oxide suppression as a prediction tool for progression to biologic therapy

Cited by 9 publications

References 19 publications

Outcome measures for chronic rhinosinusitis with nasal polyps

Outcome measures for chronic rhinosinusitis with nasal polyps

Progress in diagnosis and treatment of difficult-to-treat asthma in children

What is the added value of FeNO as T2 biomarker?

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