Original Articles: Asthma, Lower Airway DiseasesDiscrepancy between clinical asthma control assessment tools and fractional exhaled nitric oxide
Section snippets
INTRODUCTION
Airway inflammation is central to the pathogenesis of asthma and can lead to airway remodeling and irreversible impairment of lung function.1 Asthma control guidelines stress the importance of anti-inflammatory medications, particularly inhaled corticosteroids (ICS), as first-line treatment.2 In assessing asthma control, it would be prudent to include markers of airway inflammation.
Current asthma control evaluation tools are primarily clinical parameters (eg, daytime and nocturnal
Study Population
Patients (scheduled and walk-ins) who were presenting to an allergy and asthma clinic were enrolled in the study. Patients 6 years or older with specialist-diagnosed asthma were eligible for participation. Patients were excluded if they had any of the following: respiratory tract infection within the preceding 14 days, tobacco smoking during the preceding 30 days, or atopic dermatitis. Respiratory tract infections18 and atopic dermatitis19 have been shown to increase FeNO, whereas tobacco
Patient Demographics
One hundred patients 6 to 86 years old (15 patients ≤12 years) were enrolled; 65% were white and 34% were African American (Table 3). Twenty-six percent of patients were ex-smokers, with a mean (SD) smoke-free duration of 18 (13) years. A positive skin prick test result to 1 or more aeroallergens was noted in 93.7%, and allergic rhinitis was diagnosed in 59%. Most patients (81%) were taking ICS either as monotherapy or in combination with long-acting β2-agonists and/or leukotriene antagonists.
Correlation Between FeNO and Clinical Evaluation Tools
DISCUSSION
This study indicates that commonly used asthma control evaluation tools do not accurately reflect the status of airway inflammation as reflected by FeNO. Use of such tools may lead to inappropriate clinical decision making and result in suboptimal short-term and long-term care.
Several studies showed that asthma control cannot be optimally evaluated by any single parameter, particularly the patient's perception.26 Other parameters viewed as objective, such as asthma exacerbations and SABA use,
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Improving Asthma Outcomes During Pregnancy in Underserved Communities
2023, Immunology and Allergy Clinics of North AmericaCitation Excerpt :Poor attendance at office visits may be further exacerbated by poor symptom self-perception, as nearly 10% of pregnant women with uncontrolled asthma misclassify their asthma as mild.25 In other underserved, albeit nonpregnant populations, subjective symptoms have been shown to poorly correlate with objective measurements of asthma control, which may further support difficulty in self-perception of asthma severity as a contributing barrier to optimal asthma management.29,30 Thus, patient outreach outside the office setting may have promise in improving asthma care in underserved communities.31
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Disclosures: Dr Boggs is performing research studies supported by Aerocrine Inc and Apieron.