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FENO Measurement (feno + measurement)
Selected AbstractsAn economic evaluation of NIOX MINO airway inflammation monitor in the United KingdomALLERGY, Issue 3 2009D. Price Background:, Fractional exhaled nitric oxide (FENO), a marker of eosinophilic airway inflammation, is easily measured by noninvasive means. The objective of this study was to determine the cost-effectiveness of FENO measurement using a hand-held monitor (NIOX MINO), at a reimbursement price of £23, for asthma diagnosis and management in the UK. Methods:, We constructed two decision trees to compare FENO measurement with standard diagnostic testing and guideline recommendations for management. For asthma diagnosis, we compared FENO measurement with lung function and reversibility testing, bronchial provocation and sputum eosinophil count. For asthma management, we evaluated the impact on asthma control, including inhaled corticosteroid use, exacerbations and hospitalizations, of monitoring with FENO measurement vs symptoms and lung function as in standard care. Resource use and health outcomes were evaluated over a 1-year time frame. Direct costs were calculated from a UK health-care payer perspective (2005 £). Results:, An asthma diagnosis using FENO measurement cost £43 less per patient as compared with standard diagnostic tests. Asthma management using FENO measurement instead of lung function testing resulted in annual cost-savings of £341 and 0.06 quality-adjusted life-years gained for patients with mild to severe asthma and cost-savings of £554 and 0.004 quality-adjusted life-years gained for those with moderate to severe asthma. Conclusions:, Asthma diagnosis based on FENO measurement with NIOX MINO alone is less costly and more accurate than standard diagnostic methods. Asthma management based on FENO measurement is less costly than asthma management based on standard guidelines and provides similar health benefits. [source] The Role of Exhaled Nitric Oxide in Evaluation of Acute Asthma in a Pediatric Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 1 2009Maria Y. Kwok MD Abstract Objectives:, Fractional excretion of nitric oxide (FENO) has been used as a noninvasive marker to assess and manage chronic asthma in adults and children. The aim of this study was to determine the feasibility of obtaining FENO concentrations in children treated in the emergency department (ED) for acute asthma exacerbation and to examine the association between FENO concentrations and other measures of acute asthma severity. Methods:, This was a cross-sectional study of a convenience sample of children 2,18 years old who were seen in an urban ED for acute asthma exacerbation. Using a tidal breathing method with real-time display, the authors measured FENO concentrations before and 1 hour after the administration of corticosteroids and at discharge from the ED. Outcome measures included pulmonary index score (PIS), hospital admission, and short-term outcomes (e.g., missed days of school). Results:, A total of 133 subjects were enrolled. Sixty-eight percent (95% confidence interval [CI] = 60% to 76%) of the subjects provided adequate breaths for FENO measurement. There was no difference in the median initial FENO concentration among subjects, regardless of the severity of their acute asthma. Most subjects showed no change in their FENO concentrations from the start to the end of treatment. FENO concentrations were not significantly associated with other short-term outcomes. Conclusions:, Measurement of FENO is difficult for a large proportion of children with acute asthma exacerbation. FENO concentration during an asthma exacerbation does not correlate with other measures of acute severity and has limited utility in the ED management of acute asthma in children. [source] Exhaled Nitric Oxide Levels during Acute Asthma ExacerbationACADEMIC EMERGENCY MEDICINE, Issue 7 2005Michelle Gill MD Abstract Objectives: Fractional exhaled nitric oxide (FENO) has been shown in laboratory settings and trials of patients with stable asthma to correlate with the degree of airway inflammation. The authors hypothesized that the technique of measuring FENO would be reproducible in the setting of acute asthma in the emergency department (ED) and that the FENO results during ED visits would potentially predict disposition, predict relapse following discharge, and correlate with the National Institutes of Health (NIH) asthma severity scale and peak expiratory flow measurements. Methods: The authors prospectively measured FENO in a convenience sample of ED patients with acute exacerbations of asthma, both at the earliest possible opportunity and then one hour later. Each assessment point included triplicate measurements to assess reproducibility. The authors also performed spirometry and classified asthma severity using the NIH asthma severity scale. Discharged patients were contacted in 72 hours to determine whether their asthma had relapsed. Results: The authors discontinued the trial (n= 53) after a planned interim analysis demonstrated reproducibility (coefficient of variation, 15%) substantially worse than our a priori threshold for precision (4%). There was no association between FENO response and corresponding changes in spirometry or clinical scores. Areas under the receiver operating characteristic curves for the prediction of hospitalization and relapse were poor (0.579 and 0.713, respectively). Conclusions: FENO measurements in ED patients with acute asthma exacerbations were poorly reproducible and did not correlate with standard measures of asthma severity. These results suggest that using existing technology, FENO is not a useful marker for assessing severity, response to treatment, or disposition of acute asthmatic patients in the ED. [source] Measurement of nitric oxide and 8-isoprostane in exhaled breath of children with atopic eczemaCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 5 2009C. Zinelli Summary Background., Children with atopic eczema (AE) are at risk of developing asthma. Airway inflammation has been shown to be present before the onset of clinical asthma. Increased exhalation (forced expiration; FE) of nitric oxide (FENO) and 8-isoprostane seems to be a feature of bronchial inflammation in people with asthma. Aim., To determine whether the exhalation of these two molecules is increased in children with eczema, even in the absence of overt asthma. Methods., In total, 21 children with AE were recruited and compared with healthy controls. A questionnaire was completed to identify respiratory symptoms compatible with asthma. The severity of AE was graded clinically. Spirometry, FENO measurements and exhaled breath condensate collection for 8-isoprostane were performed. Results., The mean level of 8-isoprostane was similar for children with AE (2.33 ± 4.76 pg/mL) and controls (3.37 ± 3.43). FENO was increased in children with AE (mean 64.97 parts per billion) compared with the normal range, even in the absence of respiratory symptoms and in the presence of normal lung function. Conclusions., FENO but not 8-isoprostane levels in exhaled breath condensate are higher in children with AE without asthma. Our finding may indicate a predictive role for FENO for the development of asthma. [source] Comparability of a hand-held nitric oxide analyser with online and offline chemiluminescence-based nitric oxide measurementPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 7 2009Barbara Schiller Practicability is crucial for successful implementation of fractional exhaled nitric oxide (FeNO) measurement into asthma management. The study aimed at comparing a conventional chemiluminescence NO analyser (EcoMedics®) with a hand-held device (NIOX MINO®) and offline FeNO measurement using a commercially available system in an unselected cohort of children aged 6,16 yr. A secondary objective was to confirm FeNO stability over time in 15 samples from adult volunteers obtained using the offline system. Sixty-six children (mean ± s.d. age 11.8 ± 3.0 yr) underwent single breath FeNO measurement in triplets with each device. Offline collected FeNO was measured after offline breath collection into a Mylar balloon and subsequent analysis using the chemiluminescence NO analyser. Variability and between-method agreement were assessed, and stability over time within the Mylar balloons was tested by repeated hourly measurements. FeNO levels ranged from 2 to 113 p.p.b. Intra-class correlation was excellent (r = 0.98, p < 0.001 for each pair). Bland,Altman plots and back-transformation of logarithmic mean differences revealed fair agreement between methods. Stability over time was confirmed over 10 h both at room temperature and when stored under cooling conditions. FeNO values obtained using the chemiluminescence NO analyser, the portable NIOX MINO® system and the offline collection technique show between-method agreement within clinically acceptable range. [source] Asthma Control Test correlates well with the treatment decisions made by asthma specialistsRESPIROLOGY, Issue 4 2009Fanny W.S. KO ABSTRACT Background and objective: Poor assessment of asthma control results in suboptimal treatment. Identifying parameters that accurately assess control will benefit treatment decisions. The Asthma Control Test (ACT) is a five-item questionnaire for the assessment of asthma control. This study evaluated its correlation with the treatment decisions made by asthma specialists in an outpatient clinic setting, and compared its performance with other conventional parameters including spirometry, PEF rate (PEFR), fractional exhaled nitric oxide (FeNO) and BHR. Methods: The 383 (122 men) study subjects completed a 1-month diary on symptoms and PEFR before the assessment. All subjects then completed the ACT together with same-day spirometry and FeNO measurement. BHR to methacholine was performed in 73 subjects in the week before assessment. Asthma specialists, blinded to the results of the ACT, FeNO and BHR (but not spirometry and PEFR), assessed the patients' level of control according to the 2006 version of the Global Initiative for Asthma guidelines and made appropriate treatment decision. Results: The group mean (SD) age was 46.1 (13.4) years with pre-bronchodilator FEV1 84.72 (20.81) % predicted. Receiver operating characteristic (ROC) curve analysis found that an ACT score of ,20 best correlated with uncontrolled asthma (area under curve (AUC) = 0.76) with a sensitivity of 70.5%, specificity 76.0%, positive predictive value 76.2% and negative predictive value 70.2% for predicting step-up of asthma therapy. On ROC analysis, the ACT score had the highest AUC (0.81 (P < 0.001)) for changing asthma therapy when compared with FeNO, spirometry, PEFR and BHR parameters Conclusions: The ACT correlated better with treatment decisions made by asthma specialists than spirometry, PEFR and FeNO. [source] Reliability of a new hand-held device for the measurement of exhaled nitric oxideALLERGY, Issue 10 2007B. Khalili Background:, Given the importance of airway inflammation in asthma, there has been an effort to incorporate inflammatory markers into its management. Measurement of fractional exhaled nitric oxide (FeNO) is a noninvasive marker of airway inflammation; however, the use of the available FeNO analyzer is limited by several factors including its cost and lack of transportability. The aim of this study was to compare the performance of a new hand-held FeNO measuring device (NIOX MINO) to the current clinical standard , the chemiluminescence FeNO analyzer (NIOX). Methods:, Subjects 6 years and older presenting to an allergy and asthma clinic underwent FeNO evaluation by NIOX and each of three NIOX MINOs. The mean of two acceptable measurements from the NIOX and the first approved measurement from each NIOX MINO were used for analysis. Results:, One hundred ten patients aged 6,86 years completed the study. Intrasubject FeNO levels obtained by each of the three NIOX MINOs revealed no significant difference between the measurements (P = 0.59). There was a very strong correlation between FeNO measurements by NIOX and by NIOX MINO (r = 0.98, P < 0.0001). The mean intrasubject FeNO difference between NIOX and NIOX MINO was ,0.5 p.p.b. which was not statistically significantly different from zero (P = 0.21). Conclusions:, Fractional exhaled nitric oxide measurements by the NIOX MINO showed a strong correlation and a high degree of agreement with the current standard stationary device. The NIOX MINO may be reliably used in clinical practice. [source] Non-invasive markers of airway inflammation and remodeling in childhood asthmaPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 8 2009Rosalia Gagliardo To evaluate the relationship between pro-inflammatory and pro-remodeling mediators and severity and control of asthma in children, the levels of IL-8, MMP-9, TIMP-1 in induced sputum supernatants, the number of sputum eosinophils, as well as FeNO, were investigated in 35 asthmatic children, 12 with intermittent (IA) and 23 with moderate asthma (MA), and 9 controls (C). The patients with asthma were followed for 1 yr and sputum was obtained twice during the follow-up. Biomarker levels were correlated with the number of exacerbations. We found that IL-8, MMP-9, TIMP-1 and the numbers of eosinophils in induced sputum, as well as FeNO, were increased in children with IA and MA in comparison to C. The ongoing inflammation was confirmed by increased nuclear p65 NF-,B subunit localization in sputum cells. In MA, FeNO measurements, sputum eosinophils and IL-8 levels, positively correlated with the occurrence of disease exacerbations during a 1-yr follow-up. According to FeNO, sputum eosinophils and IL-8 sputum concentrations, and the number of exacerbations, two distinct phenotypes of MA were identified. This study shows that the presence of bronchial inflammation is detectable in the airways of some IA, as well as in the airways of MA, despite the regular ICS treatment. This study also proposes the need to perform large prospective studies to confirm the importance of measuring specific biomarkers in induced sputum, concomitantly to FeNO analyses, to assess sub-clinical airway inflammation and disease control in children with asthma. [source] | ||||||||||