Abstract
We aimed to evaluate the accuracy of baseline exhaled nitric oxide fraction (F(eNO)) to recognise individuals with difficult-to-treat asthma who have the potential to achieve control with a guideline-based stepwise strategy. 102 consecutive patients with suboptimal asthma control underwent stepwise increase in the treatment with maximal fluticasone/salmeterol combination dose for 1 month. Then, those who remained uncontrolled received oral corticosteroids for an additional month. With this approach, 53 patients (52%) gained control. Those who achieved control were more likely to have positive skin results (60.4% versus 34%; p = 0.01), positive bronchodilator test (57.1% versus 35.8%; p = 0.02) and peak expiratory flow variability > or =20% (71.1% versus 49.1%; p = 0.04). Conversely, depression was more frequent in those who remained uncontrolled (18.4 % versus 43.4 %; p = 0.01). An F(eNO) value > or =30 ppb demonstrated a sensitivity of 87.5% (95% CI 73.9-94.5%) and a specificity of 90.6% (95% CI 79.7-95.9%) for the identification of responsive asthmatics. The current results suggest that F(eNO) can identify patients with difficult-to-treat asthma and the potential to respond to high doses of inhaled corticosteroids or systemic steroids.
Highlights
The current results suggest that FeNO can identify patients with difficult-to-treat asthma and the potential to respond to high doses of inhaled corticosteroids or systemic steroids
For the first time, that FeNO levels might be predictive of response to a stepwise approach in patients with difficult-to-treat asthma
FeNO is reduced by treatment with inhaled corticosteroids [19], but elevated levels of this biomarker were previously observed in patients with severe asthma despite corticosteroid treatment [20]
Summary
The current results suggest that FeNO can identify patients with difficult-to-treat asthma and the potential to respond to high doses of inhaled corticosteroids or systemic steroids. Escalation of tice, many patients with severe disease will not therapy to maximum doses of inhaled corticosbe optimally controlled, and asthma surveys teroids and oral corticosteroids is widely indicate that a high proportion of patients remain accepted in poorly controlled chronic asthmatics uncontrolled even while receiving adequate [4]. Despite guideline-based asthma the response to steroids and patients may be management goals, the Asthma Insights and Reality in Europe (AIRE) study of 2,803 committed to an ineffective and potentially harmful therapy [5]. Asthma specialists have been interested in looking for an easy-to-measure and reliable biomarker that could facilitate the assessment of the disease and could avoid the risk of too little or too much treatment.
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