Moderate Persistent Asthma Research Articles

Inhaled corticosteroids in children with persistent asthma: dose-response effects on growth.

Background Inhaled corticosteroids (ICS) are the first-line treatment for children with persistent asthma. Their potential for growth suppression remains a matter of concern for parents and physicians. Objectives To assess whether increasing the dose of ICS is associated with slower linear growth, weight gain and skeletal maturation in children with asthma. Search methods We searched the Cochrane Airways Group Specialised Register of trials (CAGR) and the ClinicalTrials.gov website up to March 2014. Selection criteria Studies were eligible if they were parallel-group randomised trials evaluating the impact of different doses of the same ICS using the same device in both groups for a minimum of three months in children one to 17 years of age with persistent asthma. Data collection and analysis Two review authors ascertained methodological quality independently using the Cochrane Risk of bias tool. The primary outcome was linear growth velocity. Secondary outcomes included change over time in growth velocity, height, weight, body mass index and skeletal maturation. Main results Among 22 eligible trials, 17 pairs of groups comparisons were derived from 10 trials (3394 children with mild to moderate asthma), measured growth and contributed data to the meta-analysis. Trials used ICS (beclomethasone, budesonide, ciclesonide, fluticasone or mometasone) as monotherapy or as combination therapy with a long-acting beta2-agonist and generally compared low (50 to 100 μg) versus low to medium (200 μg) doses of hydrofluoroalkane (HFA)-beclomethasone equivalent over 12 to 52 weeks. In the four comparisons reporting linear growth over 12 months, a significant group difference was observed, clearly indicating lower growth velocity in the higher ICS dose group of 5.74 cm/y compared with 5.94 cm/y on lower-dose ICS (N = 728 school-aged children; mean difference (MD)0.20 cm/y, 95% confidence interval (CI) 0.02 to 0.39; high-quality evidence): No statistically significant heterogeneity was noted between trials contributing data. The ICS molecules (ciclesonide, fluticasone, mometasone) used in these four comparisons did not significantly influence the magnitude of effect (X2 = 2.19 (2 df), P value 0.33). Subgroup analyses on age, baseline severity of airway obstruction, ICS dose and concomitant use of non-steroidal antiasthmatic drugs were not performed because of similarity across trials or inadequate reporting. A statistically significant group difference was noted in unadjusted change in height from zero to three months (nine comparisons; N = 944 children; MD 0.15, 95% CI -0.28 to -0.02; moderate-quality evidence) in favour of a higher ICS dose. No statistically significant group differences in change in height were observed at other time points, nor were such differences in weight, body mass index and skeletal maturation reported with low quality of evidence due to imprecision. Authors' conclusions In prepubescent school-aged children with mild to moderate persistent asthma, a small but statistically significant group difference in growth velocity was observed between low doses of ICS and low to medium doses of HFA-beclomethasone equivalent, favouring the use of low-dose ICS. No apparent difference in the magnitude of effect was associated with three molecules reporting one-year growth velocity, namely, mometasone, ciclesonide and fluticasone. In view of prevailing parents’ and physicians’ concerns about the growth suppressive effect of ICS, lack of or incomplete reporting of growth velocity in more than 86% (19/22) of eligible paediatric trials, including those using beclomethasone and budesonide, is a matter of concern. All future paediatric trials comparing different doses of ICS with or without placebo should systematically document growth. Findings support use of the minimal effective ICS dose in children with asthma.

Inhaled corticosteroids in children with persistent asthma: effects on growth.

Inhaled corticosteroids in children with persistent asthma: effects on growth.

Evaluation of angiopoietin 1 and 2, vascular endothelial growth factor, and tumor necrosis factor alpha levels in asthmatic children.

Asthma is characterized by chronic airway inflammation that is associated with structural changes termed airway remodeling. Recently, cytokines/mediators that augment inflammation have been attracting attention in this field. The aim of this study was to evaluate serum angiopoietin (Ang)-1, Ang-2, vascular endothelial growth factor (VEGF), and tumor necrosis factor (TNF) alpha values, which have important roles in inflammation, angiogenesis, and remodeling in asthmatic children. We also documented correlations between demographic features, duration of asthma, and pulmonary function test (PFT) parameters. Randomly selected 40 children (20 male and 20 female children, aged 6-16 years) with mild or moderate persistent asthma and 32 healthy children (15 male and 17 female children, aged 6-16 years) enrolled in the study. All asthmatic children had been using inhaled corticosteroids at least for the last 3 months. Serum Ang-1 levels were significantly lower in asthmatic children than those in normal controls. The Ang-1/Ang-2 ratio was also significantly lower in asthmatic children compared with those in normal controls (p < 0.01). However, serum Ang-2, VEGF, and TNF-alpha levels were similar in the two groups. A significant positive correlation was found between VEGF and duration of asthma. No correlation between serum Ang-1, Ang-2, VEGF values, and PFT parameters was obtained. On the other hand, significant negative correlation was detected between serum TNF-alpha and forced expiratory volume in 1 second. We have shown that serum Ang-1 levels and Ang-1/Ang-2 ratio were significantly reduced and balance was toward Ang-2 in asthmatics children. This process may lead to inflammation, destabilization of blood vessels, and trigger remodeling.

PRS7 - Impact of Omalizumab on Poor Asthma Control Events and Medication Utilisation in Patients With Moderate or Severe Persistent Asthma

PRS7 - Impact of Omalizumab on Poor Asthma Control Events and Medication Utilisation in Patients With Moderate or Severe Persistent Asthma

PRS63 - Impact of Omalizumab On All-Cause and Asthma-Related Health Care Resource Utilisation in Patients With Moderate or Severe Persistent Asthma

PRS63 - Impact of Omalizumab On All-Cause and Asthma-Related Health Care Resource Utilisation in Patients With Moderate or Severe Persistent Asthma

PO-1003 Characteristics Of The Immune Response To Influenza Vaccine In Children With Allergic Diseases

<h3>Background</h3> Patients with chronic diseases, including atopic bronchial asthma (BA), should be vaccinated annually against influenza. Purpose. To determine the impact of vaccination against influenza in the state of immune response in children with atopic BA. <h3>Object</h3> Studied immune status of 39 children with moderate persistent BA in children from 7 to 14 years, which annually for three years were vaccinated influenza subunit vaccine. <h3>Methods</h3> Compared the levels of serum markers of activation of apoptosis and immune cells before and one month after vaccination. Results. After the vaccination was determined by the tendency to increase of level of IFNγ and IL12 in the serum. Also demonstrated increased in 1.3 times sCD25 (p &lt; 0.05), in 1.6 times IL8 (p &lt; 0.001), reduction in 1.5 times IL4 (p &lt; 0.001), in 1,3 times TNFα (p &lt; 0.05). In vaccinated children was revealed a tendency to increase sCD25 and the reduction of sCD30, sCD95 (p &lt; 0.05), with the all of the listed indicators were significantly rejected from the reference levels. Reliable dynamics of the content of eotaxin, soluble ligands markers of apoptosis sFASL, TRAIL (Apo-2L), the enzyme Caspase-1/ICE and protein Annexin V have been identified. <h3>Conclusions</h3> The data show a pronounced inflammatory process in children with atopic bronchial asthma. At the same time, the observed dynamics of the studied indicators can be interpreted as evidence of an absence of negative impact of vaccination on the various links of the immune response in children with atopic bronchial asthma, including on the processes of activation and apoptosis.

Correlation between FeNO value and asthma severity

Objective. The purpose of this study is to assess the correlation between the FeNO (fractional exhaled nitric oxide) value and asthma severity. Material and method. A prospective study including 48 children aged 5 to 18 years, who have been diagnosed with asthma in „Victor Gomoiu” Children Clinical Hospital between May 2012 – November 2013, has been initiated. In the first stage of the study both the diagnosis and the degree of severity of asthma, using GINA 2008 guideline criteria, have been established, and the FeNO value has been measured before beginning any controller therapy. For the persistent asthma forms the controller therapy has been initiated, adapted to provide the controlled asthma status. In the next stage, after GINA 2014 guideline was published, a second classification of asthma, based on the degree of severity, has been performed, by taking into account the treatment step necessary to maintain the controlled asthma status, according to this new guide. Finally the correlation between FeNO value and the degree of asthma severity has been assessed, using first the asthma classification from GINA 2008 guideline and then the asthma classification from GINA 2014 guideline. Results. Among those 48 children included in the study 29 had normal FeNO value and 19 elevated FeNO value. According to GINA 2008 guideline criteria they have been included in the following severity asthma forms: 6 patients intermittent asthma, 27 patients mild persistent asthma, 14 patients moderate persistent asthma and 1 patient severe persistent asthma. According to GINA 2014 guideline criteria 25 patients have been labeled as mild asthma, 22 as moderate asthma and 1 as severe asthma. The statistic assessment of the correlation between asthma severity form according to GINA 2008 guideline and FeNO value provided a value of p = 0,278 and for the correlation between FeNO value and asthma severity form according to GINA 2014 guideline provided a value of p = 0,0468. Conclusion. FeNO value is not correlated with asthma severity as resulted from GINA 2008 guideline classification, but is correlated with asthma severity as resulted from GINA 2014 guideline classification.

Study of effect of inhaled versus oral corticosteroids on sputum granzyme B in patients with moderate persistent bronchial asthma

BackgroundAsthma is a major public health problem with a high economic burden. It involves several inflammatory cells and multiple mediators. Granzyme B is an inflammatory mediator expressed and secreted by both immune and non immune cells. Recently it was found to play a role in the pathogenesis of asthma. The aim of this workwas to evaluate the effect of both inhaled and oral corticosteroids on sputum granzyme B in asthmatic patients with moderate severity. MethodsThe study included 25 patients with moderate persistent asthma plus 15 healthy subjects as a control group. Granzyme B was measured before treatment with corticosteroids then after inhalation therapy and oral therapy. ResultsIt was found that expected pulmonary function parameters were significantly lower in asthmatic patients than in controls. Sputum granzyme B levels were significantly higher in asthmatic patients than in controls. Sputum granzyme B levels were significantly lower after treatment with inhaled corticosteroids than basal levels. Oral corticosteroids further significantly lowered granzyme B, but the lowering effect of inhaled steroids was significantly higher than that of oral drugs. There was no statistically significant correlation between granzyme B and PFTs in asthmatic patients. ConclusionGranzyme B levels are elevated in bronchial asthma. Granzyme B could play a role in the pathogenesis of bronchial asthma. Both inhaled and oral corticosteroids lowered granzyme B levels significantly. The lowering effect of inhaled corticosteroids on sputum granzyme B is more than that of the oral corticosteroids.

Neutrophil-like low-density granulocytes are elevated in patients with moderate to severe persistent asthma

BackgroundElevations in neutrophil-like low-density granulocytes (LDGs) are observed in association with disease severity in some autoimmune and other disorders. This study evaluated whether a similar association with disease severity is observed in asthma. ObjectiveTo determine LDG levels in peripheral blood mononuclear cells of subjects with intermittent or mild persistent asthma, subjects with moderate persistent or severe persistent (SP) asthma, and control subjects without a history or allergy or asthma. MethodsA brief medical history and physical examination, spirometry, and measurement of fraction of exhaled nitric oxide were performed. The LDGs were quantified by polychromatic flow cytometry. ResultsThe LDGs displaying the same phenotype as those described previously for LDGs in other diseases were significantly elevated in peripheral blood mononuclear cells of subjects with moderate persistent or SP asthma. The LDGs comprised up to 39% of peripheral blood mononuclear cells, with elevated LDG levels most prevalent in subjects with SP asthma. The highest LDG levels were observed in 4 subjects with SP asthma. Fraction of exhaled nitric oxide levels and body mass were significantly increased in subjects with low LDG levels compared with control subjects, whereas fraction of exhaled nitric oxide levels and body mass were not elevated in subjects with moderate persistent or SP asthma and high LDG levels compared with control subjects. ConclusionThese findings identify a previously unrecognized association between LDG levels and asthma severity. Identification of the factor(s) responsible for the increased LDG levels in moderate persistent or SP asthma may provide a serum biomarker to aid in the identification of neutrophil-associated phenotypes of severe asthma.

Evaluation of Th17-related cytokines and IFNγ production from blood mononuclear cells of moderate and severe asthmatic children reveals methylprednisolone does not decrease IL-22 levels

Objective: The aim of this study was to correlate IL-6, IL-17A, IFNγ, and IL-22 production with asthma disease severity and to evaluate if methylprednisolone downregulated cytokine production in peripheral blood mononuclear cells (PBMCs). Methods: Forty-two children with chronic persistent asthma and 34 non-asthmatic children were selected. Cytokines were quantified by ELISA from serum or PBMCs supernatants, after the PMA and Ionomycin stimulation, with or without methylprednisolone at 100 µM. Results: Our data showed undetectable levels of serum cytokines in most patients and controls. In the PBMCs, we have observed a higher production of IL-17A than IL-22 among asthmatics and controls, although it is not statistically significant. IL-6, IFNγ, and IL-17A levels were significantly reduced after methylprednisolone treatment (p = 0.02, 0.03, and 0.03, respectively) in Severe Persistent Asthma (SPA) and in Moderate Persistent Asthma (MPA), (p = 0.007, 0.01, and 0.007, respectively). However, IL-22 levels were unaffected (SPA, p = 0.12 and MPA, p = 0.93). Conclusion: Methylprednisolone downregulated IL-6, IL17A, and IFNγ, but not IL-22, in stimulated PBMCs from asthmatic children indicating that methylprednisolone has no effect on IL-22 production by PBMCs.

Sensitivity to Five Types of House Dust Mite in a Group of Allergic Egyptian Children.

Background: The published data on house dust mite (HDM) sensitization from Egypt are scanty. We sought to investigate the sensitization to five different types of HDM among a group of allergic children in a trial to outline the most frequent sensitizing strains in the Cairo Province. Methods: We consecutively enrolled 100 asthmatic patients, aged 1-7 years, of whom 22 had concomitant skin allergy. Skin prick testing was performed using allergen extracts of Dermatophagoides pteronyssinus, Dermatophagoides farinae, Lepidoglyphus destructor, Tyrophagus putrescentiae, and Acarus siro. Results: Twenty-four patients (24%) were sensitized to one or more strains of HDM. Sensitization to one strain was revealed in 12% of the studied sample, while sensitization to two or three strains was detected in 8% and 4% respectively. Twelve percent of the enrolled children were sensitive to D. pteronyssinus, 11% to D. farinae, 7% to L. destructor, 6% to T. putrescentiae, and 4% to A. siro. Eight out of the 12 (66%) children sensitive to one strain had mild intermittent asthma, while five out of eight (62.5%) sensitive to two strains had moderate persistent asthma. All children sensitized to three strains of HDM had persistent rather than intermittent asthma. HDM sensitization did not correlate significantly to the history of sun exposure, bed mattresses and pillows, living in farms, or exposure to stored grains. The co-existence of atopic dermatitis tended to have a higher rate of HDM sensitization. Conclusion:D. pteronyssinus and D. farinae represent the most common sensitizing strains in the studied sample. Wider-scale population-based studies are needed to assess the prevalence of HDM allergy and its clinical correlates in our country.

The effects of vitamin D supplementation on airway functions in mild to moderate persistent asthma

BackgroundVitamin D is hypothesized to have some roles in innate and adaptive immunity, inflammation reduction, and remodeling; therefore, it is supposed to affect the asthma phenotype, severity, and response to inhaled corticosteroid (ICS). ObjectiveTo explore the synergistic effects of vitamin D supplementation in addition to asthma controllers (ICS or ICS plus long-acting β-agonist) on airway functions. MethodsA randomized clinical trial was conducted in 130 individuals aged 10 to 50 years who lived in Tehran during a 24-week period. Data on age, sex, body mass index, stage of asthma, serum total IgE, history of allergic rhinitis, atopic dermatitis, food allergy, and urticaria were collected. Spirometric parameters (forced expiratory volume in 1 second [FEV1] and ratio of FEV1 to forced vital capacity) and serum vitamin D measurement were obtained before and 8 and 24 weeks after the intervention. Patients were divided in 2 groups randomly. Both groups received asthma controllers (budesonide or budesonide plus formoterol) according to their stage, but the intervention group received vitamin D supplementation (100,000-U bolus intramuscularly plus 50,000 U orally weekly) in addition to asthma controllers. ResultsFEV1 improved significantly in both groups after 8 weeks, but no significant difference was found between the 2 groups at baseline (P = .20) or after 8 weeks (P = .99); however, a significant improvement was seen in the intervention group in the last 16 weeks, and FEV1 was significantly better in the intervention group than the other group after 24 weeks (P < .001). ConclusionVitamin D supplementation associated with asthma controllers could significantly improve FEV1 in mild to moderate persistent asthma after 24 weeks. Trial Registrationirct.ir Identifier: IRCT201302079608N1.

House dust mite sublingual immunotherapy is safe and appears to be effective in moderate, persistent asthma.

The efficacy and safety of sublingual immunotherapy in house dust mite-induced asthma have yet to be firmly established. We report the results of a double-blind, placebo-controlled, randomized clinical trial performed in mainland China. After a three-month baseline period, 484 asthmatic adults were randomized 2:1 to 12months of daily treatment with either an aqueous, standardized, 300 index of reactivity mixture of Dermatophagoides pteronyssinus and Dermatophagoides farinae extracts or a placebo. The primary efficacy criterion was well-controlled asthma for at least 16 of the last 20weeks of treatment. In the active (n=308) and placebo (n=157) groups, well-controlled asthma was achieved by 85.4% and 81.5% of the patients, respectively (P=0.244). A subsequent post hoc analysis by asthma severity revealed significant clinical benefits in actively treated subjects with moderate, persistent asthma at baseline [401-800μg budesonide/day (n=175)], with greater achievement of well-controlled asthma (80.5% and 66.1% for the active treatment and placebo groups, respectively; P=0.021) and totally controlled asthma (54.0% and 33.9%, respectively, P=0.008), a higher percentage of patients with an asthma control questionnaire score <0.75 (56.6% and 40.0%, respectively; P=0.039) and a greater mean reduction in inhaled corticosteroid use (218.5μg and 126.2μg, respectively; P=0.004). The active vs placebo differences in disease control and corticosteroid use were not significant for mild, persistent asthma. No treatment-related serious adverse events were reported. Sublingual mite allergen immunotherapy was well tolerated in adult asthmatics and effectively controlled disease in patients with moderate (but not mild) persistent asthma (ClinicalTrials.gov: NCT00660452).

The Editor takes a closer look at some of this month's articles

The Editor takes a closer look at some of this month's articles

Inhaled corticosteroids in children with persistent asthma: dose-response effects on growth.

Inhaled corticosteroids (ICS) are the first-line treatment for children with persistent asthma. Their potential for growth suppression remains a matter of concern for parents and physicians. To assess whether increasing the dose of ICS is associated with slower linear growth, weight gain and skeletal maturation in children with asthma. We searched the Cochrane Airways Group Specialised Register of trials (CAGR) and the ClinicalTrials.gov website up to March 2014. Studies were eligible if they were parallel-group randomised trials evaluating the impact of different doses of the same ICS using the same device in both groups for a minimum of three months in children one to 17 years of age with persistent asthma. Two review authors ascertained methodological quality independently using the Cochrane Risk of bias tool. The primary outcome was linear growth velocity. Secondary outcomes included change over time in growth velocity, height, weight, body mass index and skeletal maturation. Among 22 eligible trials, 17 group comparisons were derived from 10 trials (3394 children with mild to moderate asthma), measured growth and contributed data to the meta-analysis. Trials used ICS (beclomethasone, budesonide, ciclesonide, fluticasone or mometasone) as monotherapy or as combination therapy with a long-acting beta2-agonist and generally compared low (50 to 100 μg) versus low to medium (200 μg) doses of hydrofluoroalkane (HFA)-beclomethasone equivalent over 12 to 52 weeks. In the four comparisons reporting linear growth over 12 months, a significant group difference was observed, clearly indicating lower growth velocity in the higher ICS dose group of 5.74 cm/y compared with 5.94 cm/y on lower-dose ICS (N = 728 school-aged children; mean difference (MD)0.20 cm/y, 95% confidence interval (CI) 0.02 to 0.39; high-quality evidence): No statistically significant heterogeneity was noted between trials contributing data. The ICS molecules (ciclesonide, fluticasone, mometasone) used in these four comparisons did not significantly influence the magnitude of effect (X(2) = 2.19 (2 df), P value 0.33). Subgroup analyses on age, baseline severity of airway obstruction, ICS dose and concomitant use of non-steroidal antiasthmatic drugs were not performed because of similarity across trials or inadequate reporting. A statistically significant group difference was noted in unadjusted change in height from zero to three months (nine comparisons; N = 944 children; MD 0.15, 95% CI -0.28 to -0.02; moderate-quality evidence) in favour of a higher ICS dose. No statistically significant group differences in change in height were observed at other time points, nor were such differences in weight, bone mass index and skeletal maturation reported with low quality of evidence due to imprecision. In prepubescent school-aged children with mild to moderate persistent asthma, a small but statistically significant group difference in growth velocity was observed between low doses of ICS and low to medium doses of HFA-beclomethasone equivalent, favouring the use of low-dose ICS. No apparent difference in the magnitude of effect was associated with three molecules reporting one-year growth velocity, namely, mometasone, ciclesonide and fluticasone. In view of prevailing parents' and physicians' concerns about the growth suppressive effect of ICS, lack of or incomplete reporting of growth velocity in more than 86% (19/22) of eligible paediatric trials, including those using beclomethasone and budesonide, is a matter of concern. All future paediatric trials comparing different doses of ICS with or without placebo should systematically document growth. Findings support use of the minimal effective ICS dose in children with asthma.

Inhaled corticosteroids in children with persistent asthma: effects on growth.

Inhaled corticosteroids in children with persistent asthma: effects on growth.

Heightened response of eosinophilic asthmatic patients to the CRTH2 antagonist OC000459.

The CRTH2 antagonist OC000459 has previously been demonstrated to reduce airway inflammation and improve lung function in moderate persistent asthma. A study was conducted to determine the effect of lower once daily doses of OC000459 and to define the phenotype of subjects most responsive to treatment. Adult subjects (percentage of predicted forced expiratory volume in 1s (FEV1 ) 60-85%) were randomized to OC000459 at three dose levels (25mg once daily, 200mg once daily or 100mg twice daily) or placebo for 12weeks (n=117-125 per group, full analysis set). The primary endpoint was the change from baseline in prebronchodilator FEV1 , and secondary endpoints included Asthma Control Questionnaire (ACQ) and Standardised Asthma Quality of Life Questionnaire [AQLQ(S)], and incidence of exacerbations and respiratory tract infections. OC459 caused a significant improvement in FEV1 compared with placebo at a dose of 25mg once daily (P=0.028). A similar increase was observed in the other dose groups, and the mean change in FEV1 in the pooled dose groups at endpoint was 95ml greater than placebo (P=0.024). In a post hoc analysis of atopic eosinophilic subjects with uncontrolled asthma, a mean increase in FEV1 of 220ml was observed compared with placebo (P=0.005). The mean increase in FEV1 was more marked in younger subjects in this group: for subjects aged ≤40years, there was a mean increase of 355ml compared with placebo (P=0.007). Improvements in ACQ and AQLQ(S) were observed in both the full analysis set and the atopic eosinophilic subgroup. There was a lower incidence of exacerbations and respiratory infections in subjects treated with OC000459. There were no drug-related serious adverse events. OC000459 is a safe and effective oral anti-inflammatory agent, which achieved clinically meaningful improvements in lung function and asthma control in allergic asthmatics with an eosinophil-dominant form of the disease. A dose of 25mg given once daily was as effective as the higher doses studied.

The chitinase-like protein YKL-40 is not a useful biomarker for severe persistent asthma in children

BackgroundThe chitinase-like protein YKL-40 is thought to play a role in inflammation and tissue remodeling. In adults with severe asthma, YKL-40 is expressed in the airway and YKL-40 levels are elevated in the serum. ObjectiveTo compare YKL-40 levels in children with severe persistent asthma with those in adults with severe persistent asthma and to determine whether YKL-40 levels correlate with increasing asthma severity in childhood asthma. MethodsIn this prospective, cross-sectional study, 23 adults and 19 children with severe persistent asthma, 23 children with moderate persistent asthma, and 19 children with mild persistent asthma were enrolled. The following data were collected on each patient: spirometry, exhaled nitric oxide, percutaneous skin testing results to aeroallergens, peripheral eosinophils, serum IgE levels, and serum YKL-40 levels. ResultsCompared with adults, children with severe persistent asthma had significantly lower YKL-40 levels, higher values for forced vital capacity and forced expiration volume in 1 second, higher serum IgE levels, and higher exhaled nitric oxide levels. YKL-40 levels did not correlate with increasing asthma severity in the pediatric cohort. ConclusionSevere persistent asthma in childhood is not associated with elevated YKL-40 levels, unlike in adults with severe persistent asthma. YKL-40 is not a useful biomarker for asthma severity in childhood asthma.

117: Association Between Fraction of Exhaled Nitrous Oxide (FeNO), Parameters of Asthma Control and Inhaled Corticosteroid Type in a Regional Paediatric Asthma Center

FeNO is a known marker of airway inflammation, and is a topic of recent investigation for asthma control in children. To investigate the relationship between FeNO and known parameters of asthma control in a regional paediatric asthma center. A secondary objective was to investigate the correlation between different types of inhaled corticosteroids (ICS) and FeNO concentration. We conducted a retrospective chart review of children tested with both spirometry and FeNO over a one-year period. Collected data included age, anthropometrics, ICS type, equivalent dose, and duration of use, recent oral steroid use, asthma severity score, season, smoking status of family, and the presence or absence of; eczema, allergic rhinitis and respiratory tract infection. Data was analyzed by descriptive statistics and stepwise linear regression. A univariate generalized linear model was built to evaluate FeNO by ICS type, while correcting for statistically significant covariates. A total of 183 children were included. Mean (± SD) age was 12.8±2.8 years. Fluticasone was used most commonly (n=66, 36.1%) followed by ciclesonide (n=50 [27.3%]). Most children had moderate-persistent asthma (n=73 [39.9%]). FeNO level was associated with percent-change in FEV1 while adjusting for allergic rhinitis, parental smoking and ICS type (B=0.08 [95% CI 0.04 to 0.12]; P<0.001). Likewise, FeNO was associated with percent-change in FEF 25–75 while adjusting for parental smoking and ICS type (B=0.13 [95% CI 0.01 to 0.24]; P=0.03). However, FeNO accounted for only 16% and 9% of the variability in FEV1 and FEF 25–75, respectively. FeNO level differed by ICS type, while adjusting for equivalent dosing, allergic rhinitis and weight. Mean adjusted FeNO was lowest in fluticasone users compared to no ICS (mean difference ppb = 18.3 (95% CI 4.5 to 32.1]) and there was no difference in adjusted FeNO level between ciclesonide and no ICS (6.1 [95% CI −5.9 to 18.2]). FeNO levels correlate with known parameters of asthma control in a regional pediatric asthma center. However, FeNO accounts for only 16% and 9% of the variability in FEV1 and FeF 25–75. Mean adjusted FeNO varied by ICS type suggesting there is a difference in relative efficacy between inhaled corticosteroids beyond their dose equivalents.

Influence of Demographic Status on Pulmonary Function, Quality of Life, and Symptom Scores in Patients with Mild to Moderate Persistent Asthma

The association of patient factors such as age, sex, smoking status, asthma duration, and literacy with pulmonary function, quality of life, and symptom scores was examined. Two hundred and forty-two patients were included in this study. Pulmonary function was measured by spirometry and data on the patients' health-related quality of life and asthma symptom scores were obtained from questionnaires. After the drug treatment, younger asthmatics, particularly male patients showed statistically significant ( p p p