BACKGROUND: Fractional exhaled Nitric Oxide (FeNO) is a biomarker for eosinophilic airway inflammation and can be measured at home on a daily basis. A short-term increase in FeNO may indicate a higher risk of future asthma exacerbations. OBJECTIVE: To assess changes in FeNO before and after asthma exacerbations compared to a stable control period. METHODS: A post hoc analysis was performed on daily FeNO measurements over 30 weeks in children with asthma (n = 77). Moderate exacerbations were defined by an increase in symptom scores and severe exacerbations by prescription of prednisone. Individual mean and maximum FeNO, the variability of FeNO assessed by the coefficient of variation (CV), and slopes of FeNO in time were all quantified in 3-week blocks. Cross-correlation of FeNO with symptoms and autocorrelation of FeNO were assessed in relation to exacerbations and examined as predictors for exacerbations compared to reference periods using logistic regression. RESULTS: Fractional exhaled nitric oxide could be assessed in relation to 25 moderate and 12 severe exacerbations. The CV, slope, cross-correlation, and autocorrelation of daily FeNO increased before moderate exacerbations. Increases in slope were also randomly seen in 19% of 2-week blocks of children without exacerbations. At least 3-5 FeNO measurements in the 3 weeks before an exacerbation were needed to calculate a slope that could predict moderate exacerbations. No specific pattern of FeNO was seen before severe exacerbations. CONCLUSION: Fractional exhaled nitric oxide monitoring revealed changes in FeNO prior to moderate exacerbations. Whether this can be used to prevent loss of asthma control should be further explored.
BACKGROUND: Fractional exhaled Nitric Oxide (FeNO) is a biomarker for eosinophilic airway inflammation and can be measured at home on a daily basis. A short-term increase in FeNO may indicate a higher risk of future asthma exacerbations. OBJECTIVE: To assess changes in FeNO before and after asthma exacerbations compared to a stable control period. METHODS: A post hoc analysis was performed on daily FeNO measurements over 30 weeks in children with asthma (n = 77). Moderate exacerbations were defined by an increase in symptom scores and severe exacerbations by prescription of prednisone. Individual mean and maximum FeNO, the variability of FeNO assessed by the coefficient of variation (CV), and slopes of FeNO in time were all quantified in 3-week blocks. Cross-correlation of FeNO with symptoms and autocorrelation of FeNO were assessed in relation to exacerbations and examined as predictors for exacerbations compared to reference periods using logistic regression. RESULTS: Fractional exhaled nitric oxide could be assessed in relation to 25 moderate and 12 severe exacerbations. The CV, slope, cross-correlation, and autocorrelation of daily FeNO increased before moderate exacerbations. Increases in slope were also randomly seen in 19% of 2-week blocks of children without exacerbations. At least 3-5 FeNO measurements in the 3 weeks before an exacerbation were needed to calculate a slope that could predict moderate exacerbations. No specific pattern of FeNO was seen before severe exacerbations. CONCLUSION: Fractional exhaled nitric oxide monitoring revealed changes in FeNO prior to moderate exacerbations. Whether this can be used to prevent loss of asthma control should be further explored.
Authors: N G Papadopoulos; H Arakawa; K-H Carlsen; A Custovic; J Gern; R Lemanske; P Le Souef; M Mäkelä; G Roberts; G Wong; H Zar; C A Akdis; L B Bacharier; E Baraldi; H P van Bever; J de Blic; A Boner; W Burks; T B Casale; J A Castro-Rodriguez; Y Z Chen; Y M El-Gamal; M L Everard; T Frischer; M Geller; J Gereda; D Y Goh; T W Guilbert; G Hedlin; P W Heymann; S J Hong; E M Hossny; J L Huang; D J Jackson; J C de Jongste; O Kalayci; N Aït-Khaled; S Kling; P Kuna; S Lau; D K Ledford; S I Lee; A H Liu; R F Lockey; K Lødrup-Carlsen; J Lötvall; A Morikawa; A Nieto; H Paramesh; R Pawankar; P Pohunek; J Pongracic; D Price; C Robertson; N Rosario; L J Rossenwasser; P D Sly; R Stein; S Stick; S Szefler; L M Taussig; E Valovirta; P Vichyanond; D Wallace; E Weinberg; G Wennergren; J Wildhaber; R S Zeiger Journal: Allergy Date: 2012-06-15 Impact factor: 13.146
Authors: Cindy Thamrin; Urs Frey; David A Kaminsky; Helen K Reddel; Andrew J E Seely; Béla Suki; Peter J Sterk Journal: Am J Respir Crit Care Med Date: 2016-11-01 Impact factor: 21.405
Authors: Eric D Bateman; David B Price; Hao-Chien Wang; Adel Khattab; Patricia Schonffeldt; Angelina Catanzariti; Ralf J P van der Valk; Maarten J H I Beekman Journal: Eur Respir J Date: 2022-05-05 Impact factor: 33.795
Authors: Maria José Rosa; Matthew S Perzanowski; Adnan Divjan; Steven N Chillrud; Lori Hoepner; Hanjie Zhang; Robert Ridder; Frederica P Perera; Rachel L Miller Journal: Nitric Oxide Date: 2014-05-27 Impact factor: 4.427
Authors: Ralf Jp van der Valk; Liesbeth Duijts; Nicolas J Timpson; Muhammad T Salam; Marie Standl; John A Curtin; Jon Genuneit; Marjan Kerhof; Eskil Kreiner-Møller; Alejandro Cáceres; Anna Gref; Liming L Liang; H Rob Taal; Emmanuelle Bouzigon; Florence Demenais; Rachel Nadif; Carole Ober; Emma E Thompson; Karol Estrada; Albert Hofman; André G Uitterlinden; Cornélia van Duijn; Fernando Rivadeneira; Xia Li; Sandrah P Eckel; Kiros Berhane; W James Gauderman; Raquel Granell; David M Evans; Beate St Pourcain; Wendy McArdle; John P Kemp; George Davey Smith; Carla Mt Tiesler; Claudia Flexeder; Angela Simpson; Clare S Murray; Oliver Fuchs; Dirkje S Postma; Klaus Bønnelykke; Maties Torrent; Martin Andersson; Patrick Sleiman; Hakon Hakonarson; William O Cookson; Miriam F Moffatt; Lavinia Paternoster; Erik Melén; Jordi Sunyer; Hans Bisgaard; Gerard H Koppelman; Markus Ege; Adnan Custovic; Joachim Heinrich; Frank D Gilliland; Alexander J Henderson; Vincent Wv Jaddoe; Johan C de Jongste Journal: J Allergy Clin Immunol Date: 2013-12-06 Impact factor: 10.793