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Treatment of Acute Asthma Requiring Emergency Department Care of Adults Results in Acute Increase in Exhaled Nitric Oxide Levels
AB186 Abstracts
728
The Association of Exhaled Nitric Oxide (FeNO) with Asthma Control and Severity in Children S. Monforte1,2, J. Malka-Rais1, J. D. Spahn1; 1National Jewish Health, Denver, CO, 2The Children’s Hospital, Denver, CO. RATIONALE: Little is known regarding the association of exhaled nitric oxide (FeNO) with other measures of severity and control in children with asthma. METHODS: 248 consecutive children (4-18 years old) from July 2008 to July 2009 undergoing new outpatient evaluations for asthma or suspected asthma were studied. Data collected included asthma history, day and nighttime symptoms, exacerbations, in addition to spirometry (pre- and post-albuterol), epicutaneous aeroallergen testing, and FeNO. RESULTS: The mean age was 9.9 +/- 3.7 years, with 60% male. Elevated FeNO levels were associated with physician diagnosis of asthma (p 5 0.03), days per week with daytime symptoms (p 5 0.03), increased level of asthma severity (p 5 0.01), and need for prednisone burst at clinic visit (p 5 0.003). FeNO was inversely related to FEV1/FVC (p 5 0.003) and F25-75 (p 5 0.01). but not FEV1 (p 5 0.07). FeNO was also positively associated with % change in FEV1 (p 5 0.01) and FEV1/FVC (p 5 0.012) post-albuterol inhalation. FeNO levels were not significantly different with respect to gender, BMI, inhaled corticosteroid use or dose, chronic oral steroid use, monteleukast use, or pet/tobacco exposure. CONCLUSIONS: FeNO values were elevated in children with asthma. In addition, FeNO was associated with daytime symptoms, airflow limitation (FEV1/FVC ratio and FEF25-75), beta-agonist responsiveness and asthma severity based on the NHLBI guidelines. FeNO is a useful tool in the diagnosis and assessment of asthma severity/control in the outpatient clinic setting.
729
MONDAY
Development And Validation Of The Asthma Burden Index C. A. Sorkness1,2, J. J. Wildfire3, H. Mitchell3, W. Morgan4; 1 University of Wisconsin, Madison, WI, 2Inner City Asthma Consortium Investigators, Madison, WI, 3Rho Federal Systems Division, Chapel Hill, NC, 4University of Arizona, Tucson, AZ. RATIONALE: Since asthma outcomes may be confounded by treatment in studies with frequent medication adjustments, we have developed an outcome variable that combines symptoms, medication and other factors to measure total asthma burden. METHODS: Using the Inner City Asthma Consortium’s (ICAC) Asthma Control Evaluation (ACE) Study data, we conducted an exploratory factor analysis to identify components that measure independent aspects of asthma severity. 26 ICAC investigators were surveyed by modified Delphi technique about the best way to combine those factors to measure asthma burden. The survey-based index was compared to a simple a priori definition of asthma burden based on a non-weighted sum of medication level and days of symptoms to determine whether the more complex measure matched the intuitive definition. RESULTS: Factor analysis found five components which contributed independently to asthma burden: ‘‘Controller and Medication Usage’’, ‘‘Spirometry’’, ‘‘Daytime Symptoms’’, Nighttime Symptoms’’ and ‘‘Health Care Utilization.’’ Survey results were normally distributed and gave each factor roughly equal importance; Health Care Utilization was most burdensome (25% of burden) and Spirometry the least (15% of burden). Each of the other factors account for 20% of total burden. In the ACE study, the survey-based index is highly correlated with the a priori definition (0.80, p < 0.001). The combination of statistical techniques and clinician expertise used to create the index thus rigorously recreates the simple intuitive concept. CONCLUSIONS: The asthma burden index is an innovative composite approach to combining components of a complex disease into a single outcome. Funded by NIAID/NIH (NO1-AI-25496 and NO1-AI-25482)
J ALLERGY CLIN IMMUNOL FEBRUARY 2010
730
Treatment of Acute Asthma Requiring Emergency Department Care of Adults Results in Acute Increase in Exhaled Nitric Oxide Levels M. Rodenas1, R. Shams1, M. S. Dzhindzikashvili1, S. Kumar1, R. Sinert2, R. Joks1; 1Center for Allergy and Asthma Research at SUNY Downstate Medical Center, Brooklyn, NY, 2Kings County Hospital Center, Brooklyn, NY. RATIONALE: Measurement of exhaled nitric oxide levels (eNO) from asthmatics provides a noninvasive marker of airway inflammation in both adults and children. While previous studies of children have shown no change in levels of eNO during the course of acute treatment of an exacerbation, effect of emergent therapy on asthma/COPD on eNO levels from adults has not been studied. METHODS: Exhaled nitric oxide (eNO)(NIOX Mino, Aerocrine, Inc.) and peak flow (PF) were measured at arrival and before discharge for adult asthmatic subjects (n 5 28) treated for acute exacerbations in the Emergency Department at Kings County Hospital Center in Fall 2008 and Spring 2009. Total serum IgE (Immunocap, Pharmacia), absolute eosinophil count (AEC), and tobacco smoking history were determined. Local grass, tree, and weed pollen counts were provided with permission from the National Allergy Bureau and its participating station, Brooklyn, NY. As part of routine treatment all patients received prednisone 60 mg po upon arrival to the emergency department (ED). RESULTS: Both eNO and PF increased significantly after treatment of all subjects (p < 0.001). The extent of eNO and PF change did not differ significantly between smokers and non-smokers (p 5 0.823 and 0.544, respectively). The extent of increase in eNO levels and peak flow with treatment correlated with AEC, but not IgE or pollen count. CONCLUSIONS: eNO levels increase after routine ED treatment of acute asthma in adult asthmatics regardless of tobacco history. Routine treatment of acute obstruction in asthmatics may allow for greater ventilation and measurement of nitric oxide produced in previously acutely obstructed airways.
731
Cigarette Smoking: An Important Predictor Of Asthma Severity And Poor Asthma Control C. Russo1, P. Caponnetto1, M. Sarva`2, M. Malaguarnera1, W. K. Al-Delaimy3, R. Polosa1; 1University of Catania, Italy, Catania, ITALY, 2Fondazione Salvatore Maugeri – U.O. Neuroriabilitazione Intensiva, Mistretta (Messina), ITALY., Mistretta (ME), ITALY, 3Department of Family and Preventive Medicine, University of California, San Diego, USA., San Diego, CA. RATIONALE: Little is known about the association between smoking and asthma severity. We calculated asthma severity and control to determine the importance of smoking as a determinant of disease severity and control in a cohort of clinic-referred allergic subjects. METHODS: Allergic rhinitis subjects with no asthma were followed-up for 10 years and routinely examined for asthma diagnosis. In those who developed asthma, clinical severity class was calculated by GINA 2002 severity class. Levels of asthma control were determined by NAEPP EPR3 criteria. RESULTS: When comparing current or past smokers to never smokers they had a higher risk of severe asthma. The categories of pack-years were significantly related to severe asthma in a dose-response relationship: compared to 0 pack-years, those who smoked 1-10 pack-years had an OR(95% CI) of 1.47(0.46-4.68), those who smoked 11-20 pack-years had an OR of 2.85(1.09-7.46) and those who smoked more than 20 packyears had an OR of 5.59(1.44-21.67). Smokers with asthma were also more likely to have uncontrolled disease with a significant dose-response relationship. Those who smoked 1-10 pack-years had an OR of 5.51(1.73-17.54) and those who smoked more than 10 pack-years had an OR of 13.38(4.57-39.19). CONCLUSIONS: Cigarette smoking is an important predictor of asthma severity and poor asthma control.
728
The Association of Exhaled Nitric Oxide (FeNO) with Asthma Control and Severity in Children S. Monforte1,2, J. Malka-Rais1, J. D. Spahn1; 1National Jewish Health, Denver, CO, 2The Children’s Hospital, Denver, CO. RATIONALE: Little is known regarding the association of exhaled nitric oxide (FeNO) with other measures of severity and control in children with asthma. METHODS: 248 consecutive children (4-18 years old) from July 2008 to July 2009 undergoing new outpatient evaluations for asthma or suspected asthma were studied. Data collected included asthma history, day and nighttime symptoms, exacerbations, in addition to spirometry (pre- and post-albuterol), epicutaneous aeroallergen testing, and FeNO. RESULTS: The mean age was 9.9 +/- 3.7 years, with 60% male. Elevated FeNO levels were associated with physician diagnosis of asthma (p 5 0.03), days per week with daytime symptoms (p 5 0.03), increased level of asthma severity (p 5 0.01), and need for prednisone burst at clinic visit (p 5 0.003). FeNO was inversely related to FEV1/FVC (p 5 0.003) and F25-75 (p 5 0.01). but not FEV1 (p 5 0.07). FeNO was also positively associated with % change in FEV1 (p 5 0.01) and FEV1/FVC (p 5 0.012) post-albuterol inhalation. FeNO levels were not significantly different with respect to gender, BMI, inhaled corticosteroid use or dose, chronic oral steroid use, monteleukast use, or pet/tobacco exposure. CONCLUSIONS: FeNO values were elevated in children with asthma. In addition, FeNO was associated with daytime symptoms, airflow limitation (FEV1/FVC ratio and FEF25-75), beta-agonist responsiveness and asthma severity based on the NHLBI guidelines. FeNO is a useful tool in the diagnosis and assessment of asthma severity/control in the outpatient clinic setting.
729
MONDAY
Development And Validation Of The Asthma Burden Index C. A. Sorkness1,2, J. J. Wildfire3, H. Mitchell3, W. Morgan4; 1 University of Wisconsin, Madison, WI, 2Inner City Asthma Consortium Investigators, Madison, WI, 3Rho Federal Systems Division, Chapel Hill, NC, 4University of Arizona, Tucson, AZ. RATIONALE: Since asthma outcomes may be confounded by treatment in studies with frequent medication adjustments, we have developed an outcome variable that combines symptoms, medication and other factors to measure total asthma burden. METHODS: Using the Inner City Asthma Consortium’s (ICAC) Asthma Control Evaluation (ACE) Study data, we conducted an exploratory factor analysis to identify components that measure independent aspects of asthma severity. 26 ICAC investigators were surveyed by modified Delphi technique about the best way to combine those factors to measure asthma burden. The survey-based index was compared to a simple a priori definition of asthma burden based on a non-weighted sum of medication level and days of symptoms to determine whether the more complex measure matched the intuitive definition. RESULTS: Factor analysis found five components which contributed independently to asthma burden: ‘‘Controller and Medication Usage’’, ‘‘Spirometry’’, ‘‘Daytime Symptoms’’, Nighttime Symptoms’’ and ‘‘Health Care Utilization.’’ Survey results were normally distributed and gave each factor roughly equal importance; Health Care Utilization was most burdensome (25% of burden) and Spirometry the least (15% of burden). Each of the other factors account for 20% of total burden. In the ACE study, the survey-based index is highly correlated with the a priori definition (0.80, p < 0.001). The combination of statistical techniques and clinician expertise used to create the index thus rigorously recreates the simple intuitive concept. CONCLUSIONS: The asthma burden index is an innovative composite approach to combining components of a complex disease into a single outcome. Funded by NIAID/NIH (NO1-AI-25496 and NO1-AI-25482)
J ALLERGY CLIN IMMUNOL FEBRUARY 2010
730
Treatment of Acute Asthma Requiring Emergency Department Care of Adults Results in Acute Increase in Exhaled Nitric Oxide Levels M. Rodenas1, R. Shams1, M. S. Dzhindzikashvili1, S. Kumar1, R. Sinert2, R. Joks1; 1Center for Allergy and Asthma Research at SUNY Downstate Medical Center, Brooklyn, NY, 2Kings County Hospital Center, Brooklyn, NY. RATIONALE: Measurement of exhaled nitric oxide levels (eNO) from asthmatics provides a noninvasive marker of airway inflammation in both adults and children. While previous studies of children have shown no change in levels of eNO during the course of acute treatment of an exacerbation, effect of emergent therapy on asthma/COPD on eNO levels from adults has not been studied. METHODS: Exhaled nitric oxide (eNO)(NIOX Mino, Aerocrine, Inc.) and peak flow (PF) were measured at arrival and before discharge for adult asthmatic subjects (n 5 28) treated for acute exacerbations in the Emergency Department at Kings County Hospital Center in Fall 2008 and Spring 2009. Total serum IgE (Immunocap, Pharmacia), absolute eosinophil count (AEC), and tobacco smoking history were determined. Local grass, tree, and weed pollen counts were provided with permission from the National Allergy Bureau and its participating station, Brooklyn, NY. As part of routine treatment all patients received prednisone 60 mg po upon arrival to the emergency department (ED). RESULTS: Both eNO and PF increased significantly after treatment of all subjects (p < 0.001). The extent of eNO and PF change did not differ significantly between smokers and non-smokers (p 5 0.823 and 0.544, respectively). The extent of increase in eNO levels and peak flow with treatment correlated with AEC, but not IgE or pollen count. CONCLUSIONS: eNO levels increase after routine ED treatment of acute asthma in adult asthmatics regardless of tobacco history. Routine treatment of acute obstruction in asthmatics may allow for greater ventilation and measurement of nitric oxide produced in previously acutely obstructed airways.
731
Cigarette Smoking: An Important Predictor Of Asthma Severity And Poor Asthma Control C. Russo1, P. Caponnetto1, M. Sarva`2, M. Malaguarnera1, W. K. Al-Delaimy3, R. Polosa1; 1University of Catania, Italy, Catania, ITALY, 2Fondazione Salvatore Maugeri – U.O. Neuroriabilitazione Intensiva, Mistretta (Messina), ITALY., Mistretta (ME), ITALY, 3Department of Family and Preventive Medicine, University of California, San Diego, USA., San Diego, CA. RATIONALE: Little is known about the association between smoking and asthma severity. We calculated asthma severity and control to determine the importance of smoking as a determinant of disease severity and control in a cohort of clinic-referred allergic subjects. METHODS: Allergic rhinitis subjects with no asthma were followed-up for 10 years and routinely examined for asthma diagnosis. In those who developed asthma, clinical severity class was calculated by GINA 2002 severity class. Levels of asthma control were determined by NAEPP EPR3 criteria. RESULTS: When comparing current or past smokers to never smokers they had a higher risk of severe asthma. The categories of pack-years were significantly related to severe asthma in a dose-response relationship: compared to 0 pack-years, those who smoked 1-10 pack-years had an OR(95% CI) of 1.47(0.46-4.68), those who smoked 11-20 pack-years had an OR of 2.85(1.09-7.46) and those who smoked more than 20 packyears had an OR of 5.59(1.44-21.67). Smokers with asthma were also more likely to have uncontrolled disease with a significant dose-response relationship. Those who smoked 1-10 pack-years had an OR of 5.51(1.73-17.54) and those who smoked more than 10 pack-years had an OR of 13.38(4.57-39.19). CONCLUSIONS: Cigarette smoking is an important predictor of asthma severity and poor asthma control.