Exhaled nitric oxide fraction as an add-on to ACQ-7 for not well controlled asthma detection

• Published in: PloS one Vol. 8; no. 10; p. e77085
• Main Authors: Plaza, Vicente, Ramos-Barbón, David, Muñoz, Ana María, Fortuna, Ana María, Crespo, Astrid, Murio, Cristina, Palomino, Rosa
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 25.10.2013; Public Library of Science (PLoS)
• Subjects: Adult; Anti-Asthmatic Agents - therapeutic use; Appraisals; Asthma; Asthma - diagnosis; Asthma - drug therapy; Asthma - physiopathology; Breath Tests - methods; Clinical medicine; Control methods; Exhalation; Female; Follow-Up Studies; Humans; Inflammation; Maintenance; Male; Middle Aged; Nitric oxide; Nitric Oxide - analysis; Outcome Assessment, Health Care - methods; Prospective Studies; Questionnaires; Reproducibility of Results; Respiratory Function Tests; Respiratory tract; Respiratory tract diseases; Sensitivity and Specificity; Studies; Surveys and Questionnaires; Systematic review; Therapy; Time Factors; Tuberculosis; Spain
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0077085

The measurement of fractional nitric oxide concentration in exhaled breath (FeNO), a noninvasive indicator of airway inflammation, remains controversial as a tool to assess asthma control. Guidelines currently limit asthma control assessment to symptom and spirometry based appraisals such as the Asthma Control Questionnaire-7 (ACQ-7). We aimed at determining whether adding FeNO to ACQ-7 improves current asthma clinical control assessment, through enhanced detection of not well controlled asthma. Asthmatic subjects, classified as not well controlled as per ACQ-7 on regular clinical practice, were included in a prospective, multicenter fashion, and had their maintenance treatment adjusted on visit 1. On follow-up (visit 2) four weeks later, the subjects were reevaluated as controlled or not well controlled using ACQ-7 versus a combination of FeNO and ACQ-7. Out of 381 subjects enrolled, 225 (59.1%) had not well controlled asthma on visit 2 as determined by ACQ-7, and 264 (69.3%) as per combined FeNO and ACQ-7. The combination of FeNO to ACQ-7 increased by 14.8% the detection of not well controlled asthma following maintenance therapy adjustment. The addition of FeNO to ACQ-7 increased the detectability of not well controlled asthma upon adjustment of maintenance therapy. Adding a measure of airway inflammation to usual symptom and spirometry based scores increases the efficacy of current asthma clinical control assessment.