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Exhaled nitric oxide measurement reflects asthma control

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WESTPORT, CT (Reuters Health) – Measurement of exhaled nitric oxide (eNO) is useful in assessing asthma control, and it is easier to perform than other airway inflammation tests, according to a report by investigators from New Zealand.

Dr. D. Robin Taylor and colleagues from the University of Otago in Dunedin measured the eNO levels of 78 asthmatic patients who stopped their inhaled steroid therapy until loss of control occurred, or for a maximum of 6 weeks. For comparison purposes, patients' airway hyperresponsiveness to hypertonic saline and sputum eosinophil levels were also determined.

Sixty patients experienced a loss of asthma control. Patients who lost control experienced a significantly greater (p < 0.008) increase in eNO levels than patients who did not, the researchers report in the September issue of the American Journal of Respiratory and Critical Care Medicine.

Increased eNO levels were strongly associated with a decrease in FEV1 (p < 0.002), an increase in sputum eosinophils (p < 0.0002), and an increase in airway hyperresponsiveness (p < 0.0002), the investigators note. The positive predictive values of single and repeat eNO measurements for diagnosing loss of control ranged from 80% to 90%, comparable with those of AHR and sputum analysis.

"This is the largest longitudinal study to date in which the utility of eNO measurement in asthma management has been assessed," the researchers state. "Our results document the usefulness of eNO for predicting and diagnosing poorly controlled asthma compared with other currently used markers of airway inflammation and clinical parameters."

Previous findings have shown that clinical outcomes are improved when anti-inflammatory therapy is adjusted to improve airway hyperresponsiveness, Dr. Taylor's team notes. The current results suggest that the same may hold true when therapy is tailored according to eNO levels. However, "further studies are needed to confirm that the clinical application of eNO measurement is worthwhile in optimizing asthma management," the authors conclude.

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