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In moderate-to-severe asthma patients monitoring exhaled nitric oxide during exacerbation is not a good predictor of spirometric response to oral corticosteroid.
- Source :
- Journal of Allergy & Clinical Immunology; Jun2012, Vol. 129 Issue 6, p1491-1498, 8p
- Publication Year :
- 2012
-
Abstract
- Background: The importance of monitoring exhaled nitric oxide (NO) in asthma remains controversial. Objective: To measure exhaled NO, postnebulized albuterol/ipratropium spirometry, and Asthma Control Test (ACT) during asthma exacerbation requiring 8- to 10-day tapering oral corticosteroid in nonsmoking patients with moderate-to-severe asthma on moderate-dose inhaled corticosteroid and long-acting β<subscript>2</subscript>-agonist but not maintenance oral corticosteroid. Methods: After measuring the fraction of exhaled NO (Feno [ppb]) at 50, 100, 150, and 200 mL/s, the total Feno at 50 mL/s (ppb), large central airway NO flux (J′<subscript>awNO</subscript> [nL/s]), and peripheral small airway/alveolar NO concentration (C<subscript>ANO</subscript> [ppb]) were calculated and corrected for NO axial back-diffusion. Outpatient exacerbation required the patient with asthma to be afebrile with normal chest x-ray and white blood cell count. Results: Group 1 included 17 patients (6 men) with asthma, age 52 ± 12 years, studied at baseline, during 18 exacerbations with abnormal Feno at 50 mL/s, J′<subscript>awNO</subscript>, and/or C<subscript>ANO</subscript>, and post 8- to 10-day tapering 40 mg prednisone (recovery). Baseline: IgE, 332 ± 243 Kμ; total blood eosinophils, 304 ± 266 cells/μL; body mass index, 28 ± 6; ACT, 16 to 19; and FEV<subscript>1</subscript>, 2.5 ± 0.7 L (86% ± 20% predicted); exacerbation: FEV<subscript>1</subscript>, 1.7 ± 0.4 L (60% ± 17%) (P < .001); recovery: FEV<subscript>1</subscript>, 2.5 ± 0.7 L (85% ± 13%) (P < .001). Group 2 included 11 (7 men) similarly treated patients with asthma, age 49 ± 14 years, studied at baseline, during 15 exacerbations with normal Feno at 50 mL/s, J′<subscript>awNO</subscript>, and C<subscript>ANO</subscript>. Baseline: IgE, 307 ± 133 Kμ; total blood eosinophils, 296 ± 149 cells/μL; body mass index, 28 ± 6; ACT, 16 to 19; and FEV<subscript>1</subscript>, 2.7 ± 0.9 L (71% ± 12% predicted); exacerbation: FEV<subscript>1</subscript>, 1.7 ± 0.6 L (54% ± 19%) (P < .006); recovery: FEV<subscript>1</subscript>, 2.7 ± 0.9 L (70% ± 14%) (P = .002). On comparing group 1 versus group 2, there was no significant difference for baseline IgE, eosinophils, body mass index, and ACT and similar significant (≤.006) decrease from baseline in FEV<subscript>1</subscript> (L) during exacerbation and similar increase (≤.006) at recovery. Conclusions: Increased versus normal exhaled NO during outpatient exacerbation in patients with moderate-to-severe asthma on inhaled corticosteroid and long-acting β<subscript>2</subscript>-agonist but not maintenance oral corticosteroid does not preclude a robust clinical and spirometric response to tapering oral prednisone. [Copyright &y& Elsevier]
Details
- Language :
- English
- ISSN :
- 00916749
- Volume :
- 129
- Issue :
- 6
- Database :
- Supplemental Index
- Journal :
- Journal of Allergy & Clinical Immunology
- Publication Type :
- Academic Journal
- Accession number :
- 76327179
- Full Text :
- https://doi.org/10.1016/j.jaci.2012.03.036