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Association between Fractional Exhaled Nitric Oxide and Asthma Control
21
Multiple-Flow Analysis Of Exhaled Nitric Oxide In Asthma M. Nagao, H. Tanida, K. Hosoki, T. Fujisawa; Institute for Clinical Research, Mie National Hospital, Tsu, JAPAN. RATIONALE: Exhaled nitric oxide (NO) is considered to be a useful biomarker for asthma. However, high FENO levels in stable asthmatics are sometimes observed and make its interpretation to be difficult. To improve clinical utility of NO in asthma, we analyzed alveolar NO levels by employing a multiple-flow measurement of exhaled NO. METHODS: Ninety eight children and young adults with asthma on 187 occasions were evaluated for asthma control; totally controlled, well-controlled, and uncontrolled. NO was measured using a chemiluminescence analyzer,CLD88sp, at flow rate of 25, 50, 100, and 300 ml/s. In addition to the standard FENO at 50ml/s, the H€ogman and Meril€ainen algorism assuming a non-linear model of NO production in the lung was applied to calculate the flow-independent parameters including alveolar concentration of NO (CaNO). Impulse oscillometry (IOS) was also performed. RESULTS: There were no significant differences in FENO among the groups. However, when patients with allergic rhinitis (AR) were excluded, FENO in uncontrolled group were significantly higher than in controlled groups, suggesting that FENO values is, at least in part, influenced by AR. CaNO in uncontrolled group was significantly higher than the others regardless of AR. Parameters for small airway pathology in IOS, AX and Fres, were also significantly higher in uncontrolled group. CONCLUSIONS: The presence of AR may lead to high FENO levels. Alveolar NO, however, is not affected by AR and may a good marker for asthma control, possibly representing small airway inflammation in asthma.
22
Long-term Patterns of Total Serum IgE in ABPA during Exacerbation and Exacerbation-free Intervals R. Shah, P. A. Greenberger; Northwestern University Feinberg School of Medicine, Chicago, IL. RATIONALE: During ABPA exacerbations there is an elevation of total serum IgE concentration. Total serum IgE typically remains elevated but varies during quiescent intervals before surging when an exacerbation occurs. Classic exacerbations include a 100% increase in total serum IgE and new CXR and or CT infiltrates. METHOD: Review of laboratory tests, radiographic studies, and medical records over at least 5 years for patients with known stage III (recurrent exacerbation) or IV (corticosteroid dependent asthma)ABPA. Clinical exacerbation was defined as change in respiratory status (increased sputum production and plugs, wheezing, dyspnea, cough), rise in total IgE, with or without new CXR infiltrates. RESULTS: Twelve patients were identified; 6 had sufficient clinical data for analysis. Baseline mean total serum IgE in patients with ABPA during exacerbation-free intervals varied from 420 kU/L to 4291 kU/L. Three of 6 patients had SD > 50% of the mean during exacerbation-free intervals. During an exacerbation, the percent increase from exacerbation-free mean total serum IgE ranged from 40% to 175%. In addition, 2/6 patients had prolonged or sequential exacerbations that lasted over six months despite treatment. CONCLUSION: 1. Exacerbation of ABPA can occur with just 40% increase in total serum IgE, as compared to classic dogma of 100% increase. 2. There can be large variations of total serum IgE during exacerbation-free intervals. 3. Prolonged or sequential exacerbations were identified lasting greater than 6 months.
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Association between Fractional Exhaled Nitric Oxide and Asthma Control P. Prottasan, K. Maneechotesuwan, P. Vichyanond, O. Jirapongsananuruk, P. Pacharn, N. Visitsunthorn; Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THAILAND. RATIONALE: The most important way to achieve and maintain asthma control is to reduce airway inflammation. FeNO levels have been used as the marker of airway inflammation. This study aimed to prove the association between FeNO levels and the levels of asthma control. METHODS: This was a cross-sectional study in patients with atopic _ 7 years. Asthma control assessment was obtained by using asthma aged > the criteria from GINA. FeNO levels and spirometry were measured. Asthma medications were recorded. Association between FeNO levels vs asthma control and the usage of asthma medications were statistically analyzed. RESULTS: Preliminary analysis in 63 cases, 38 males, with the median age of 12.6 years (6.4-26.7). Most of the patients had mild persistent asthma (79.4%) and inhaled corticosteroid (ICS) usage (76.4%). According to GINA, 33.3% of cases were controlled, 55.6% were partly controlled and 11.1% were uncontrolled. The median of FeNO levels were lower in the controlled group than the partly controlled group 19.9 (5.1-108.9) vs 25 (4-81.8) ppb. High dose ICS and the usage of other asthma controller (LTRA and immunotherapy) had negative association with FeNO levels. Median of FeNO levels was lower in the uncontrolled group, 12.9 (5.4-92.6) ppb. The dose of ICS usage in the uncontrolled group was higher than in other groups. CONCLUSIONS: FeNO levels were lower in the controlled group than the partly controlled group. The low level of FeNO in the uncontrolled group was explained by the usage of higher dose ICS and other controllers.
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Treadmill Challenge For Confirmation Of Exercise-induced Bronchoconstriction. C. C. Randolph; Center for Allergy, Asthma & Immunology, Waterbury, CT. RATIONALE: Since treadmill challenge is a recommended diagnostic procedures that is adaptible to office practice setting we evaluated the sensitivity and specificity to confirm the history of presence of exercise -induced bronchospasm METHODS: IRB approved retrospective and prospective chart review of of 33 individuals with a history of exercise -induced bronchoconstriction (EIB) who were evaluated by treadmill challenge per American Thoracic Society guidelines..The procedure consists of a 6minute run on the treadmill acheiving 95% maximum heart rate monitored by pulse oximetry at room temperature with spirometry performed prior to,immediately after then every 5minutes to 30minutes post challenge.Bronchodilator is then administered and postbronchodilator spirometry measured. Positive challenge is regarded as a 10% decline in FEVI by at least two time points after challenge. RESULTS: There were 25(76%) female and 8(24%) male, 32(97%) Caucasian, 1(3%) AfroAmerican aged 7-58 years (median 16 years, mean 19 years) who were evaluated by treadmill challenge over a 2 year period (2008-2010). There were 10(30%) of individuals with history of asthma, 24(73%) had history of allergic rhinitis confirmed by skin testing to inhalants. There were 16(48%) with negative challenge, 2(6%) indeterminate secondary to insufficient duration and effort and 15/33(46%) with positive challenge. The range of decline in FEVI was 10-40% (mean 17.5%, median 15%). The treadmill challenge had a specificity of 89%, sensitivity of 100%, positive predictive value (PPV) of 88% and negative predictive value (NPV) of 100% for diagnosis of EIB. If a decline of FEVI >/515% is defined as positive the specificity is 94%, sensitivity declines to 67% with PPV 91% and NPV declines to 76%. CONCLUSIONS: Treadmill challenge is highly specific and but less sensitive diagnostic procedure to confirm EIB suggested by history.
SATURDAY
Abstracts AB9
J ALLERGY CLIN IMMUNOL VOLUME 127, NUMBER 2
Multiple-Flow Analysis Of Exhaled Nitric Oxide In Asthma M. Nagao, H. Tanida, K. Hosoki, T. Fujisawa; Institute for Clinical Research, Mie National Hospital, Tsu, JAPAN. RATIONALE: Exhaled nitric oxide (NO) is considered to be a useful biomarker for asthma. However, high FENO levels in stable asthmatics are sometimes observed and make its interpretation to be difficult. To improve clinical utility of NO in asthma, we analyzed alveolar NO levels by employing a multiple-flow measurement of exhaled NO. METHODS: Ninety eight children and young adults with asthma on 187 occasions were evaluated for asthma control; totally controlled, well-controlled, and uncontrolled. NO was measured using a chemiluminescence analyzer,CLD88sp, at flow rate of 25, 50, 100, and 300 ml/s. In addition to the standard FENO at 50ml/s, the H€ogman and Meril€ainen algorism assuming a non-linear model of NO production in the lung was applied to calculate the flow-independent parameters including alveolar concentration of NO (CaNO). Impulse oscillometry (IOS) was also performed. RESULTS: There were no significant differences in FENO among the groups. However, when patients with allergic rhinitis (AR) were excluded, FENO in uncontrolled group were significantly higher than in controlled groups, suggesting that FENO values is, at least in part, influenced by AR. CaNO in uncontrolled group was significantly higher than the others regardless of AR. Parameters for small airway pathology in IOS, AX and Fres, were also significantly higher in uncontrolled group. CONCLUSIONS: The presence of AR may lead to high FENO levels. Alveolar NO, however, is not affected by AR and may a good marker for asthma control, possibly representing small airway inflammation in asthma.
22
Long-term Patterns of Total Serum IgE in ABPA during Exacerbation and Exacerbation-free Intervals R. Shah, P. A. Greenberger; Northwestern University Feinberg School of Medicine, Chicago, IL. RATIONALE: During ABPA exacerbations there is an elevation of total serum IgE concentration. Total serum IgE typically remains elevated but varies during quiescent intervals before surging when an exacerbation occurs. Classic exacerbations include a 100% increase in total serum IgE and new CXR and or CT infiltrates. METHOD: Review of laboratory tests, radiographic studies, and medical records over at least 5 years for patients with known stage III (recurrent exacerbation) or IV (corticosteroid dependent asthma)ABPA. Clinical exacerbation was defined as change in respiratory status (increased sputum production and plugs, wheezing, dyspnea, cough), rise in total IgE, with or without new CXR infiltrates. RESULTS: Twelve patients were identified; 6 had sufficient clinical data for analysis. Baseline mean total serum IgE in patients with ABPA during exacerbation-free intervals varied from 420 kU/L to 4291 kU/L. Three of 6 patients had SD > 50% of the mean during exacerbation-free intervals. During an exacerbation, the percent increase from exacerbation-free mean total serum IgE ranged from 40% to 175%. In addition, 2/6 patients had prolonged or sequential exacerbations that lasted over six months despite treatment. CONCLUSION: 1. Exacerbation of ABPA can occur with just 40% increase in total serum IgE, as compared to classic dogma of 100% increase. 2. There can be large variations of total serum IgE during exacerbation-free intervals. 3. Prolonged or sequential exacerbations were identified lasting greater than 6 months.
23
Association between Fractional Exhaled Nitric Oxide and Asthma Control P. Prottasan, K. Maneechotesuwan, P. Vichyanond, O. Jirapongsananuruk, P. Pacharn, N. Visitsunthorn; Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THAILAND. RATIONALE: The most important way to achieve and maintain asthma control is to reduce airway inflammation. FeNO levels have been used as the marker of airway inflammation. This study aimed to prove the association between FeNO levels and the levels of asthma control. METHODS: This was a cross-sectional study in patients with atopic _ 7 years. Asthma control assessment was obtained by using asthma aged > the criteria from GINA. FeNO levels and spirometry were measured. Asthma medications were recorded. Association between FeNO levels vs asthma control and the usage of asthma medications were statistically analyzed. RESULTS: Preliminary analysis in 63 cases, 38 males, with the median age of 12.6 years (6.4-26.7). Most of the patients had mild persistent asthma (79.4%) and inhaled corticosteroid (ICS) usage (76.4%). According to GINA, 33.3% of cases were controlled, 55.6% were partly controlled and 11.1% were uncontrolled. The median of FeNO levels were lower in the controlled group than the partly controlled group 19.9 (5.1-108.9) vs 25 (4-81.8) ppb. High dose ICS and the usage of other asthma controller (LTRA and immunotherapy) had negative association with FeNO levels. Median of FeNO levels was lower in the uncontrolled group, 12.9 (5.4-92.6) ppb. The dose of ICS usage in the uncontrolled group was higher than in other groups. CONCLUSIONS: FeNO levels were lower in the controlled group than the partly controlled group. The low level of FeNO in the uncontrolled group was explained by the usage of higher dose ICS and other controllers.
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Treadmill Challenge For Confirmation Of Exercise-induced Bronchoconstriction. C. C. Randolph; Center for Allergy, Asthma & Immunology, Waterbury, CT. RATIONALE: Since treadmill challenge is a recommended diagnostic procedures that is adaptible to office practice setting we evaluated the sensitivity and specificity to confirm the history of presence of exercise -induced bronchospasm METHODS: IRB approved retrospective and prospective chart review of of 33 individuals with a history of exercise -induced bronchoconstriction (EIB) who were evaluated by treadmill challenge per American Thoracic Society guidelines..The procedure consists of a 6minute run on the treadmill acheiving 95% maximum heart rate monitored by pulse oximetry at room temperature with spirometry performed prior to,immediately after then every 5minutes to 30minutes post challenge.Bronchodilator is then administered and postbronchodilator spirometry measured. Positive challenge is regarded as a 10% decline in FEVI by at least two time points after challenge. RESULTS: There were 25(76%) female and 8(24%) male, 32(97%) Caucasian, 1(3%) AfroAmerican aged 7-58 years (median 16 years, mean 19 years) who were evaluated by treadmill challenge over a 2 year period (2008-2010). There were 10(30%) of individuals with history of asthma, 24(73%) had history of allergic rhinitis confirmed by skin testing to inhalants. There were 16(48%) with negative challenge, 2(6%) indeterminate secondary to insufficient duration and effort and 15/33(46%) with positive challenge. The range of decline in FEVI was 10-40% (mean 17.5%, median 15%). The treadmill challenge had a specificity of 89%, sensitivity of 100%, positive predictive value (PPV) of 88% and negative predictive value (NPV) of 100% for diagnosis of EIB. If a decline of FEVI >/515% is defined as positive the specificity is 94%, sensitivity declines to 67% with PPV 91% and NPV declines to 76%. CONCLUSIONS: Treadmill challenge is highly specific and but less sensitive diagnostic procedure to confirm EIB suggested by history.
SATURDAY
Abstracts AB9
J ALLERGY CLIN IMMUNOL VOLUME 127, NUMBER 2