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Concordance between bronchial hyperresponsiveness, fractional exhaled nitric oxide, and asthma control in children
Author(s) -
Thomas Biju,
Chay Oh Moh,
Allen John C.,
Chiang Andrea Shu Xian,
Pugalenthi Arun,
Goh Anne,
Wong Petrina,
Teo Ai Huay,
Tan Soh Gin,
Teoh Oon Hoe
Publication year - 2016
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.23426
Subject(s) - exhaled nitric oxide , medicine , asthma , bronchial hyperresponsiveness , spirometry , concordance , bronchoconstriction , context (archaeology) , airway hyperresponsiveness , pediatrics , respiratory disease , lung , paleontology , biology
Summary Background Previous studies on association between level of asthma control, markers of airway inflammation and the degree of bronchial hyperresponsiveness (BHR) have yielded conflicting results. Our aim was to determine the presence and severity of BHR and the concordance between BHR, asthma control, and fractional exhaled nitric oxide (FeNO) in children with asthma on therapy. Methods In this cross‐sectional observational study, children (aged 6–18 years) with asthma on British Thoracic Society (BTS) treatment steps 2 or 3, underwent comprehensive assessment of their asthma control (clinical assessment, spirometry, asthma control test [ACT], Pediatric Asthma Quality of Life Questionnaire [PAQLQ]), measurement of FeNO and BHR (using mannitol dry powder bronchial challenge test [MCT], Aridol™, Pharmaxis, Australia). Results Fifty‐seven children (63% male) were studied. Twenty‐seven children were on BTS treatment step 2 and 30 were on step 3. Overall, 25 out of 57 (43.8%) children had positive MCT. Of note, 9 out of 27 (33.3%) children with clinically controlled asthma had positive MCT. Analyses of pair‐wise agreement between MCT (positive or negative), FeNO (>25 or ≤25 ppb) and clinical assessment of asthma control (controlled or partially controlled/uncontrolled) showed poor agreement between these measures. Conclusions A substantial proportion of children with asthma have persistent BHR despite good clinical control. The concordance between clinical assessment of asthma control, BHR and FeNO was observed to be poor. Our findings raise concerns in the context of emerging evidence for the role of bronchoconstriction in inducing epithelial stress that may drive airway remodeling in asthma. Pediatr Pulmonol. 2016;51:1004–1009. © 2016 Wiley Periodicals, Inc.