Assessment of asthma control in adult patients by Fractional Exhaled Nitric oxide and Asthma Control Test
Main Article Content
Abstract
Background: The most crucial step in achieving and keeping asthma under control is to lessen the inflammation in the airways. Nitric oxide fractional exhaled (FeNO) levels have been utilised as an indicator of airway inflammation. Uncertainty regarding the potential function and properties of exhaled fractional nitric oxide in asthma management.
Objective: To determine whether FeNO and Asthma Control Test (ACT) can objectively assess asthma control in adult patients and identify any potential relationships between FeNO and both the ACT score and the spirometry data of patients. Also determine their use in reducing the dose of inhaled steroids.
Methods: The design of the study was a systematic review. A qualitative research methodology based on an analysis of previously published materials.
Results: This study thoroughly examined the literature on the Asthma Control Test and Fractional Exhaled Nitric Oxide assessment of asthma control in adult patients. Finally, 16 scientific studies were analysed. The highest variations in FeNO values during diagnosis were significantly linked with FeNO levels at diagnosis during conventional asthma treatment. Evaluating adherence and FeNO response to monitored inhaled corticosteroid treatment may prevent the needless progression to biologic therapy in asthmatic patients with high Type-2 biomarker levels. There is a close connection between the ACT score and the treatment modifications as well as the measurements of lung function. FeNO may be able to detect poor asthma control; however, it cannot substitute for clinical judgment and may only be beneficial in a subset of asthmatics. The average and percentage variation of standards following asthma treatment did not show any significant relationship between FeNO levels and various other factors are related (expiratory volume in one second (FEV1) or ACT scoring), however, there were strong positive correlations between ACT scores and FEV1.
Conclusion: Research revealed a highly significant link between the level of FeNO at diagnosis and the biggest variations in FeNO readings after diagnosis. Using FeNO as a supplementary non-invasive method for assessing asthma control may be effective in both steroid-naive asthmatics and those who are being treated with steroids.
Key Words: Asthma, FeNO, Asthma control test
Keywords:
asthma, FeNO, Asthma control test
Article Details
How to Cite
AYOOB, MUHAMMED ANAS; MOHAMMED ISMAIL, Soumya Mol; PRASAD, Dr..
Assessment of asthma control in adult patients by Fractional Exhaled Nitric oxide and Asthma Control Test.
Medical Research Archives, [S.l.], v. 11, n. 11, nov. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4706>. Date accessed: 16 may 2024.
doi: https://doi.org/10.18103/mra.v11i11.4706.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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12. Murray CS, Jackson DJ, Teague WG. Prevention and Outpatient Treatment of Asthma Exacerbations in Children. The Journal of Allergy and Clinical Immunology: In Practice. 2021;9(7):2567-2576. doi:https://doi.org/10.1016/j.jaip.2021.03.035
13. Olin AC, Rosengren A, Thelle DS, Lissner L, Torén K. Increased Fraction of Exhaled Nitric Oxide Predicts New-Onset Wheeze in a General Population. American Journal of Respiratory and Critical Care Medicine. 2010;181(4):324-327. doi:https://doi.org/10.1164/rccm.200907-1079oc
14. Duong-Quy S. Clinical Utility Of The Exhaled Nitric Oxide (NO) Measurement With Portable Devices In The Management Of Allergic Airway Inflammation And Asthma. Journal of Asthma and Allergy. 2019;Volume 12:331-341. doi:https://doi.org/10.2147/jaa.s190489
15. Malinovschi A, Ludviksdottir D, Tufvesson E, et al. Application of nitric oxide measurements in clinical conditions beyond asthma. European Clinical Respiratory Journal. 2015;2(1):28517. doi:https://doi.org/10.3402/ecrj.v2.28517
16. Lehtimäki L, Csonka P, Mäkinen E, Isojärvi J, Hovi SL, Ahovuo-Saloranta A. Predictive value of exhaled nitric oxide in the management of asthma: a systematic review. European Respiratory Journal. 2016;48(3):706-714. doi:https://doi.org/10.1183/13993003.00699-2016
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18. White J, Paton JY, Niven R, Pinnock H. Guidelines for the diagnosis and management of asthma: a look at the key differences between BTS/SIGN and NICE. Thorax. 2018;73(3):293-297. doi:https://doi.org/10.1136/thoraxjnl-2017-211189
19. van Dijk BCP, Svedsater H, Heddini A, Nelsen L, Balradj JS, Alleman C. Relationship between the Asthma Control Test (ACT) and other outcomes: a targeted literature review. BMC Pulmonary Medicine. 2020;20(1). doi:https://doi.org/10.1186/s12890-020-1090-5
20. de Abreu FC, da Silva Júnior JLR, Rabahi MF. The Fraction Exhaled Nitric Oxide as a Biomarker of Asthma Control. Biomarker Insights. 2019;14. doi:https://doi.org/10.1177/1177271919826550
21. Saito J, Sato S, Fukuhara A, et al. Association of Asthma Education with Asthma Control Evaluated by Asthma Control Test, FEV1, and Fractional Exhaled Nitric Oxide. Journal of Asthma. 2012;50(1):97-102. doi:https://doi.org/10.3109/02770903.2012.741638
22. Kalu FA, Bwalya JC. What makes qualitative research good research? An exploratory analysis of critical elements. International Journal of Social Science Research. 2017;5(2):43. doi:https://doi.org/10.5296/ijssr.v5i2.10711
23. Butler CA, Heaney LG. Fractional exhaled nitric oxide and asthma treatment adherence. Current Opinion in Allergy & Clinical Immunology. 2020;21(1):59-64. doi:https://doi.org/10.1097/aci.0000000000000704
24. Mohan A, Kavitha V, Madan K, Hadda V, Khilnani G, Guleria R. Fractional exhaled nitric oxide is a useful adjunctive modality for monitoring bronchial asthma. Lung India. 2017;34(2):132. doi:https://doi.org/10.4103/0970-2113.201322
25. Kostikas K, Papaioannou AI, Tanou K, et al. Exhaled NO and exhaled breath condensate pH in the evaluation of asthma control. Respiratory Medicine. 2011;105(4):526-532. doi:https://doi.org/10.1016/j.rmed.2010.10.015
26. Nguyen VN, Chavannes NH. Correlation between fractional exhaled nitric oxide and Asthma Control Test score and spirometry parameters in on-treatment- asthmatics in Ho Chi Minh City. Journal of Thoracic Disease. 2020;12(5):2197-2209. doi:https://doi.org/10.21037/jtd.2020.04.01
27. Bora M, Alpaydin A, Yorgancioglu A, et al. Does asthma control as assessed by the asthma control test reflect airway inflammation? Multidisciplinary Respiratory Medicine. 2011;6(5):291. doi:https://doi.org/10.1186/2049-6958-6-5-291
28. Neelamegan R. Clinical Utility of Fractional exhaled Nitric Oxide (FeNO) as a Biomarker to Predict Severity of Disease and Response to Inhaled Corticosteroid (ICS) in Asthma Patients. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. Published online 2016. doi:https://doi.org/10.7860/jcdr/2016/20656.8950
29. Manu M, Kriti C, Mohapatra A, Kamath A. Comparison of fractional exhaled nitric oxide, spirometry, and Asthma Control Test, in predicting asthma exacerbations: A prospective cohort study. Lung India. 2020;37(5):394. doi:https://doi.org/10.4103/lungindia.lungindia_546_19
30. Karrasch S, Linde K, Rücker G, et al. Accuracy of FENOfor diagnosing asthma: a systematic review. Thorax. 2016;72(2):109-116. doi:https://doi.org/10.1136/thoraxjnl-2016-208704
31. Calhoun WJ. Comparison of Physician-, Biomarker-, and Symptom-Based Strategies for Adjustment of Inhaled Corticosteroid Therapy in Adults With Asthma. JAMA. 2012;308(10):987. doi:https://doi.org/10.1001/2012.jama.10893
32. Syed Shahid Habib, Alzoghaibi MA, Abba AA, Hassan M. Relationship of the Arabic version of the asthma control test with ventilatory function tests and levels of exhaled nitric oxide in adult asthmatics. PubMed. 2014;35(4):397-402.
33. Sato S, Saito J, Fukuhara A, et al. The clinical role of fractional exhaled nitric oxide in asthma control. Annals of Allergy, Asthma & Immunology. 2017;119(6):541-547. doi:https://doi.org/10.1016/j.anai.2017.09.059
34. Perez-de-Llano LA, Carballada F, Castro Anon O, et al. Exhaled nitric oxide predicts control in patients with difficult-to-treat asthma. European Respiratory Journal. 2009;35(6):1221-1227. doi:https://doi.org/10.1183/09031936.00118809
35. Shirai T, Furuhashi K, Suda T, Chida K. Relationship of the Asthma Control Test with pulmonary function and exhaled nitric oxide. Annals of Allergy, Asthma & Immunology. 2008;101(6):608-613. doi:https://doi.org/10.1016/s1081-1206(10)60223-2
36. Domínguez-Ortega J, Phillips-Anglés E, Barranco P, Quirce S. Cost-effectiveness of asthma therapy: a comprehensive review. Journal of Asthma. 2015;52(6):529-537. doi:https://doi.org/10.3109/02770903.2014.999283
37. Papakosta D, Latsios D, Manika K, Porpodis K, Kontakioti E, Gioulekas D. Asthma Control Test Is Correlated to FEV1and Nitric Oxide in Greek Asthmatic Patients: Influence of Treatment. Journal of Asthma. 2011;48(9):901-906. doi:https://doi.org/10.3109/02770903.2011.611958
38. Caminati M, Luca Cegolon, Vianello A, et al. Mepolizumab for severe eosinophilic asthma: a real-world snapshot on clinical markers and timing of response. Expert Review of Respiratory Medicine. 2019;13(12):1205-1212. doi:https://doi.org/10.1080/17476348.2019.1676734
39. Hanxiang N, Jiong Y, Yanwei C, et al. Persistent airway inflammation and bronchial hyperresponsiveness in patients with totally controlled asthma. International Journal of Clinical Practice. 2007;62(4):599-605. doi:https://doi.org/10.1111/j.1742-1241.2007.01373.x
40. Quaedvlieg V, Sele J, Henket M, Louis R. Association between asthma control and bronchial hyperresponsiveness and airways inflammation: a cross-sectional study in daily practice. Clinical & Experimental Allergy. 2009;39(12):1822-1829. doi:https://doi.org/10.1111/j.1365-2222.2009.03332.x
41. Hüsamettin Sazlıdere, Serhat Çelikel, Handan İnönü, et al. The relation between nitric oxide levels in exhaled breath condensate and asthma control questionnaires in asthma patients. Tüberküloz ve toraks. 2010;58(1):5-15.
42. KO FWS, LEUNG TF, HUI DSC, et al. Asthma Control Test correlates well with the treatment decisions made by asthma specialists. Respirology. 2009;14(4):559-566. doi:https://doi.org/10.1111/j.1440-1843.2009.01514.x
43. Menzies D, Jackson C, Mistry C, Houston R, Lipworth BJ. Symptoms, spirometry, exhaled nitric oxide, and asthma exacerbations in clinical practice. Annals of Allergy, Asthma & Immunology. 2008;101(3):248-255. doi:https://doi.org/10.1016/s1081-1206(10)60489-9
44. Ulrik CS, Lange P, Hilberg O. Fractional exhaled nitric oxide as a determinant for the clinical course of asthma: a systematic review. European Clinical Respiratory Journal. 2021;8(1). doi:https://doi.org/10.1080/20018525.2021.1891725
2. British Guideline on the Management of Asthma a National Clinical Guideline.; 2003. https://www.brit-thoracic.org.uk/document-library/guidelines/asthma/bts-sign-guideline-for-the-management-of-asthma-2019/
3. Hanania NA, Massanari M, Jain N. Measurement of fractional exhaled nitric oxide in real-world clinical practice alters asthma treatment decisions. Annals of Allergy, Asthma & Immunology. 2018;120(4):414-418.e1. doi:https://doi.org/10.1016/j.anai.2018.01.031
4. British Lung Foundation Final Debrief Taskforce for Lung Health -Scoping Research.; 2018. https://www.blf.org.uk/sites/default/files/BLF171153BT_Taskforce%20for%20lung%20health%20scoping%20research_Final%20report_Presentation%20Deck_16.01.18.pdf
5. Gill R, Williams EM. Agreement between self-reported asthma symptoms and exhaled nitric oxide levels: impact on inhaled corticosteroid prescribing in general practice. An observational study. Allergy, Asthma & Clinical Immunology. 2019;15(1). doi:https://doi.org/10.1186/s13223-019-0390-x
6. Koyasu S, Moro K. Type 2 innate immune responses and the natural helper cell. Immunology. 2011;132(4):475-481. doi:https://doi.org/10.1111/j.1365-2567.2011.03413.x
7. Schneider A, Gindner L, Tilemann L, et al. Diagnostic accuracy of spirometry in primary care. BMC Pulmonary Medicine. 2009;9(1). doi:https://doi.org/10.1186/1471-2466-9-31
8. Gelman A, Sokolovsky V, Furman E, Kalinina N, Furman G. Artificial intelligence in the respiratory sounds analysis and computer diagnostics of bronchial asthma. Published online November 21, 2021.
doi:https://doi.org/10.1101/2021.11.18.21266503
9. O’Byrne PM, Jenkins C, Bateman ED. The paradoxes of asthma management: time for a new approach? European Respiratory Journal. 2017;50(3):1701103. doi:https://doi.org/10.1183/13993003.01103-2017
10. Petsky HL, Cates CJ, Kew KM, Chang AB. Tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils): a systematic review and meta-analysis. Thorax. 2018;73(12):1110-1119. doi:https://doi.org/10.1136/thoraxjnl-2018-211540
11. Petsky HL, Kew KM, Turner C, Chang AB. Exhaled nitric oxide levels to guide treatment for adults with asthma. Cochrane Database of Systematic Reviews. Published online September 1, 2016. doi:https://doi.org/10.1002/14651858.cd011440.pub2
12. Murray CS, Jackson DJ, Teague WG. Prevention and Outpatient Treatment of Asthma Exacerbations in Children. The Journal of Allergy and Clinical Immunology: In Practice. 2021;9(7):2567-2576. doi:https://doi.org/10.1016/j.jaip.2021.03.035
13. Olin AC, Rosengren A, Thelle DS, Lissner L, Torén K. Increased Fraction of Exhaled Nitric Oxide Predicts New-Onset Wheeze in a General Population. American Journal of Respiratory and Critical Care Medicine. 2010;181(4):324-327. doi:https://doi.org/10.1164/rccm.200907-1079oc
14. Duong-Quy S. Clinical Utility Of The Exhaled Nitric Oxide (NO) Measurement With Portable Devices In The Management Of Allergic Airway Inflammation And Asthma. Journal of Asthma and Allergy. 2019;Volume 12:331-341. doi:https://doi.org/10.2147/jaa.s190489
15. Malinovschi A, Ludviksdottir D, Tufvesson E, et al. Application of nitric oxide measurements in clinical conditions beyond asthma. European Clinical Respiratory Journal. 2015;2(1):28517. doi:https://doi.org/10.3402/ecrj.v2.28517
16. Lehtimäki L, Csonka P, Mäkinen E, Isojärvi J, Hovi SL, Ahovuo-Saloranta A. Predictive value of exhaled nitric oxide in the management of asthma: a systematic review. European Respiratory Journal. 2016;48(3):706-714. doi:https://doi.org/10.1183/13993003.00699-2016
17. Jia CE, Zhang HP, Lv Y, et al. The Asthma Control Test and Asthma Control Questionnaire for Assessing Asthma Control: Systematic Review and Meta-Analysis. Centre for Reviews and Dissemination (UK); 2013. Accessed January 1, 2023. https://www.ncbi.nlm.nih.gov/books/NBK133152/
18. White J, Paton JY, Niven R, Pinnock H. Guidelines for the diagnosis and management of asthma: a look at the key differences between BTS/SIGN and NICE. Thorax. 2018;73(3):293-297. doi:https://doi.org/10.1136/thoraxjnl-2017-211189
19. van Dijk BCP, Svedsater H, Heddini A, Nelsen L, Balradj JS, Alleman C. Relationship between the Asthma Control Test (ACT) and other outcomes: a targeted literature review. BMC Pulmonary Medicine. 2020;20(1). doi:https://doi.org/10.1186/s12890-020-1090-5
20. de Abreu FC, da Silva Júnior JLR, Rabahi MF. The Fraction Exhaled Nitric Oxide as a Biomarker of Asthma Control. Biomarker Insights. 2019;14. doi:https://doi.org/10.1177/1177271919826550
21. Saito J, Sato S, Fukuhara A, et al. Association of Asthma Education with Asthma Control Evaluated by Asthma Control Test, FEV1, and Fractional Exhaled Nitric Oxide. Journal of Asthma. 2012;50(1):97-102. doi:https://doi.org/10.3109/02770903.2012.741638
22. Kalu FA, Bwalya JC. What makes qualitative research good research? An exploratory analysis of critical elements. International Journal of Social Science Research. 2017;5(2):43. doi:https://doi.org/10.5296/ijssr.v5i2.10711
23. Butler CA, Heaney LG. Fractional exhaled nitric oxide and asthma treatment adherence. Current Opinion in Allergy & Clinical Immunology. 2020;21(1):59-64. doi:https://doi.org/10.1097/aci.0000000000000704
24. Mohan A, Kavitha V, Madan K, Hadda V, Khilnani G, Guleria R. Fractional exhaled nitric oxide is a useful adjunctive modality for monitoring bronchial asthma. Lung India. 2017;34(2):132. doi:https://doi.org/10.4103/0970-2113.201322
25. Kostikas K, Papaioannou AI, Tanou K, et al. Exhaled NO and exhaled breath condensate pH in the evaluation of asthma control. Respiratory Medicine. 2011;105(4):526-532. doi:https://doi.org/10.1016/j.rmed.2010.10.015
26. Nguyen VN, Chavannes NH. Correlation between fractional exhaled nitric oxide and Asthma Control Test score and spirometry parameters in on-treatment- asthmatics in Ho Chi Minh City. Journal of Thoracic Disease. 2020;12(5):2197-2209. doi:https://doi.org/10.21037/jtd.2020.04.01
27. Bora M, Alpaydin A, Yorgancioglu A, et al. Does asthma control as assessed by the asthma control test reflect airway inflammation? Multidisciplinary Respiratory Medicine. 2011;6(5):291. doi:https://doi.org/10.1186/2049-6958-6-5-291
28. Neelamegan R. Clinical Utility of Fractional exhaled Nitric Oxide (FeNO) as a Biomarker to Predict Severity of Disease and Response to Inhaled Corticosteroid (ICS) in Asthma Patients. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. Published online 2016. doi:https://doi.org/10.7860/jcdr/2016/20656.8950
29. Manu M, Kriti C, Mohapatra A, Kamath A. Comparison of fractional exhaled nitric oxide, spirometry, and Asthma Control Test, in predicting asthma exacerbations: A prospective cohort study. Lung India. 2020;37(5):394. doi:https://doi.org/10.4103/lungindia.lungindia_546_19
30. Karrasch S, Linde K, Rücker G, et al. Accuracy of FENOfor diagnosing asthma: a systematic review. Thorax. 2016;72(2):109-116. doi:https://doi.org/10.1136/thoraxjnl-2016-208704
31. Calhoun WJ. Comparison of Physician-, Biomarker-, and Symptom-Based Strategies for Adjustment of Inhaled Corticosteroid Therapy in Adults With Asthma. JAMA. 2012;308(10):987. doi:https://doi.org/10.1001/2012.jama.10893
32. Syed Shahid Habib, Alzoghaibi MA, Abba AA, Hassan M. Relationship of the Arabic version of the asthma control test with ventilatory function tests and levels of exhaled nitric oxide in adult asthmatics. PubMed. 2014;35(4):397-402.
33. Sato S, Saito J, Fukuhara A, et al. The clinical role of fractional exhaled nitric oxide in asthma control. Annals of Allergy, Asthma & Immunology. 2017;119(6):541-547. doi:https://doi.org/10.1016/j.anai.2017.09.059
34. Perez-de-Llano LA, Carballada F, Castro Anon O, et al. Exhaled nitric oxide predicts control in patients with difficult-to-treat asthma. European Respiratory Journal. 2009;35(6):1221-1227. doi:https://doi.org/10.1183/09031936.00118809
35. Shirai T, Furuhashi K, Suda T, Chida K. Relationship of the Asthma Control Test with pulmonary function and exhaled nitric oxide. Annals of Allergy, Asthma & Immunology. 2008;101(6):608-613. doi:https://doi.org/10.1016/s1081-1206(10)60223-2
36. Domínguez-Ortega J, Phillips-Anglés E, Barranco P, Quirce S. Cost-effectiveness of asthma therapy: a comprehensive review. Journal of Asthma. 2015;52(6):529-537. doi:https://doi.org/10.3109/02770903.2014.999283
37. Papakosta D, Latsios D, Manika K, Porpodis K, Kontakioti E, Gioulekas D. Asthma Control Test Is Correlated to FEV1and Nitric Oxide in Greek Asthmatic Patients: Influence of Treatment. Journal of Asthma. 2011;48(9):901-906. doi:https://doi.org/10.3109/02770903.2011.611958
38. Caminati M, Luca Cegolon, Vianello A, et al. Mepolizumab for severe eosinophilic asthma: a real-world snapshot on clinical markers and timing of response. Expert Review of Respiratory Medicine. 2019;13(12):1205-1212. doi:https://doi.org/10.1080/17476348.2019.1676734
39. Hanxiang N, Jiong Y, Yanwei C, et al. Persistent airway inflammation and bronchial hyperresponsiveness in patients with totally controlled asthma. International Journal of Clinical Practice. 2007;62(4):599-605. doi:https://doi.org/10.1111/j.1742-1241.2007.01373.x
40. Quaedvlieg V, Sele J, Henket M, Louis R. Association between asthma control and bronchial hyperresponsiveness and airways inflammation: a cross-sectional study in daily practice. Clinical & Experimental Allergy. 2009;39(12):1822-1829. doi:https://doi.org/10.1111/j.1365-2222.2009.03332.x
41. Hüsamettin Sazlıdere, Serhat Çelikel, Handan İnönü, et al. The relation between nitric oxide levels in exhaled breath condensate and asthma control questionnaires in asthma patients. Tüberküloz ve toraks. 2010;58(1):5-15.
42. KO FWS, LEUNG TF, HUI DSC, et al. Asthma Control Test correlates well with the treatment decisions made by asthma specialists. Respirology. 2009;14(4):559-566. doi:https://doi.org/10.1111/j.1440-1843.2009.01514.x
43. Menzies D, Jackson C, Mistry C, Houston R, Lipworth BJ. Symptoms, spirometry, exhaled nitric oxide, and asthma exacerbations in clinical practice. Annals of Allergy, Asthma & Immunology. 2008;101(3):248-255. doi:https://doi.org/10.1016/s1081-1206(10)60489-9
44. Ulrik CS, Lange P, Hilberg O. Fractional exhaled nitric oxide as a determinant for the clinical course of asthma: a systematic review. European Clinical Respiratory Journal. 2021;8(1). doi:https://doi.org/10.1080/20018525.2021.1891725