Combined use of fractional exhaled nitric oxide and bronchodilator response in predicting future loss of asthma control among children with atopic asthma. Issue 3 (26th October 2016)

• Record Type: Journal Article
• Authors: Kim, Je‐Kyung; Jung, Jae‐Yub; Kim, Heon; Eom, Sang‐Yong; Hahn, Youn‐Soo
• Is Part Of: Respirology. Volume 22:Issue 3(2017)
• Page Start: 466
• Page End: 472
• Publication Date: 2016-10-26
• Subjects: asthma -- atopy -- bronchodilator response -- child -- fractional exhaled nitric oxide -- loss of asthma control; Respiratory organs -- Diseases -- Periodicals; Respiratory organs -- Periodicals; 612.2
• DOI: 10.1111/resp.12934
• Languages: English
• ISSNs: 1323-7799

Abstract

ABSTRACT: Background and objective: Recognition of patients at risk of asthma exacerbation is important for future asthma care and improved outcome. The aim of the present study was to see whether measurements of bronchodilator response (BDR) and fractional exhaled nitric oxide (FeNO) in combination provide prognostic information superior to either measurement alone in children with atopic asthma. Methods: A total of 201 atopic children aged 8–16 years with intermittent or mild persistent asthma were included. Pulmonary function tests including BDR and FeNO were serially monitored 10 times or more over 2 years when subjects were not receiving controller medications. After completion of monitoring, 1‐year observation for a loss of asthma control was performed. Results: During the monitoring period, positive BDRs (≥12% in forced expiratory volume in 1 s (FEV1 ) from pre‐bronchodilator value) and FeNO higher than 35 parts per billion (ppb) were observed at least once in 59% and 77% of participants. When analysed as continuous variables, both BDR (hazard ratio (HR): 1.21; 95% CI: 1.04–1.41; P = 0.014) and FeNO (HR: 1.27; 95% CI: 1.09–1.49; P = 0.003) were associated with increased risks for a control loss. Compared with patients showing either positive BDRs (HR: 3.19; 95% CI: 1.05–9.64) or FeNO higher than 35 ppb (HR: 4.70; 95% CI: 1.68–13.11), patients with both findings (HR: 7.08; 95% CI: 2.57–19.49) had greater risks for a control loss. Conclusion: These data support that combined use of BDR and FeNO measurements can modify predictive risk obtained from either measurement alone. Abstract : High bronchodilator response (BDR) as well as high fractional exhaled nitric oxide (FeNO) are associated with increased risk of asthma control losses among children with atopic asthma. Combined use of BDR and FeNO measurements could improve the prediction capacity for upcoming asthma control losses.