Asthma and lower airway diseaseDifferent patterns of exhaled nitric oxide response to β2-agonists in asthmatic patients according to the site of bronchodilation
Section snippets
Subjects
Asthmatic patients exhibiting airway obstruction defined according to Global Initiative for Asthma guidelines (FEV1/forced vital capacity ratio < 0.75)17 were recruited from the outpatient asthma clinic (CUB-Erasme University Hospital, Brussels, Belgium). Asthma was defined according to standard criteria.17 Asthma control level at the time of inclusion was evaluated through the Asthma Control Questionnaire.18 Subjects were requested to halt short- and long-acting β2-agonists for 6 and 24 hours,
Results
We recruited a total of 68 asthmatic patients, including 10 who had received a new diagnosis and were yet untreated. After bronchodilation, 16 (23%) patients had a change in Feno values of less than 10% of baseline (Feno= group), 23 (34%) patients had an increase of greater than 10% (Feno+ group), and 29 (43%) patients had a decrease of greater than 10% (Feno− group). Fig 2 shows Feno value changes in the 3 groups.
Discussion
This study documents 3 different patterns of Feno response to β2-agonist action in patients with uncontrolled asthma, and the responses most likely depend on the site of pre-existing airway obstruction. A large proportion of subjects exhibit a Feno value decrease that seems related to the relief of airway obstruction up to the lung periphery (ie, from the central up to the intra-acinar airways), as assessed by changes occurring in ventilation distribution indices. In contrast, a Feno value
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Cited by (14)
The Impact of Airway Obstruction on FENO Values in Asthma Patients
2024, Journal of Allergy and Clinical Immunology: In PracticeExhaled nitric oxide and its predictive power related to lung function and bronchial inflammation
2020, Biochemical PharmacologyCitation Excerpt :Though this interference of airway caliber with FeNO levels may temper the keenness to use FeNO in a daily clinical setting, it may also suggest a new role for FeNO as a sensitive marker of peripheral airway obstruction, and which is easy to use in the clinical setting. As previously mentioned, after β2-agonist induced bronchodilation, 3 distinct FeNO patterns were observed in asthma patients, that were distinctly related to central, pre-acinar and intra-acinar bronchodilation [62,69]. Similar recent experiments in chronic obstructive pulmonary disease identified patients with an intra-acinar airway obstruction reversibility [70].
Exhaled nitric oxide in clinical practice
2020, Breathborne Biomarkers and the Human VolatilomeEffects of bronchodilation on biomarkers of peripheral airway inflammation in COPD
2018, Pharmacological ResearchCitation Excerpt :In fact, to a higher quantity of FENO will also correspond an increased accessible lung volume, that will, at least, not increase the concentration of FENO. On the contrary, a reduction in FENO in asthma after administration of β2-agonists [40] was hypothesised as the result of intra-acinar bronchodilation, resulting in the improvement of NO back-diffusion. The latter effect may be unlikely in our experiment because: i) DLCO and KCO did not change after bronchodilator administration and ii) the majority of patients had a non-preserved intra-acinar anatomy due to severe disease [41].
Advances in asthma in 2016: Designing individualized approaches to management
2017, Journal of Allergy and Clinical ImmunologyCitation Excerpt :The ultimate challenge will be optimization of prevention strategies that can be implemented in children identified as being at risk of a noncommunicable disease, such as asthma, through use of biomarkers. Blood and sputum eosinophils, along with exhaled nitric oxide were listed as supplementary biomarkers to be considered optional in asthma research (Table IV).62-69 Zeiger et al63 reported observations from a Kaiser Permanente Southern California database of patients 12 years and older that a high blood eosinophil count (≥400 cells/mm3) was an independent risk factor for 2 or more asthma exacerbations or any asthma emergency department visit or hospitalization but not direct costs in patients with severe uncontrolled asthma.
A CLINICAL INVESTIGATION INTO THE USEFULNESS OF FRACTIONAL EXHALED NITRIC OXIDE IN GUIDING GLUCOCORTICOID THERAPY IN CHILDREN WITH BRONCHIAL ASTHMA
2022, Journal of Physiology and Pharmacology
Chiesi provided a grant for the Immunobiology of Asthma Unit.
Disclosure of potential conflict of interest: A. Michils has received research support from and is a board member for Chiesi, Novartis, and AstraZeneca; has received lecture fees from AstraZeneca, GlaxoSmithKline, Stallergène, and Chiesi; and has received travel support from Chiesi, GlaxoSmithKline, and Novartis. A. Haccuria has received research support from and is a board member for Chiesi. A. Van Muylem has received research support and lecture fees from Chiesi. The rest of the authors declare that they have no relevant conflicts of interest.