Biomarkers of airway inflammation: the use of exhaled nitric oxide (FeNO) in the management of adult asthma in UK primary care

Wilson, Emma Elizabeth (2013) Biomarkers of airway inflammation: the use of exhaled nitric oxide (FeNO) in the management of adult asthma in UK primary care. PhD thesis, University of Nottingham.

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Abstract

Rationale:

Current asthma guidelines recommend reducing inhaled corticosteroid (ICS) therapy dose by 50% in patients with mild to moderate asthma who have demonstrated three months of good symptom control however there is evidence to suggest that this does not occur.

Objectives:

We tested whether exhaled nitric oxide (FeNO) measurements or other clinical indices could be utilised to predict a safe reduction of ICS dose, without provoking loss of symptom control or exacerbation within 3 months. We also investigated relationships between airway inflammation and asthma symptoms in the mild to moderate asthma cohort.

Methods:

191 patients with stable asthma were recruited from primary care. Patients had their FeNO level measured at baseline and then had their inhaled corticosteroid (ICS) dose reduced by 50%. FeNO measurements were reassessed seven days later. The primary outcomes were whether baseline FeNO or a change in FeNO following ICS dose reduction could predict asthma stability at 3 months. Results: 128/191 patients (67%) completed the ICS dose reduction successfully at three months. 63/191 patients (33%) suffered from either a loss of control or an exacerbation. Baseline FeNO, or change in FeNO (post step-down minus pre step-down) were not statistically significantly different between the two groups.

Conclusion:

67% of patients with well-controlled asthma can safely reduce their ICS dose by half without suffering from a loss of control or exacerbation within three months; however neither baseline nor change in FeNO measurements or routine clinical indices can be used to predict which patients can or cannot successfully tolerate a reduction in ICS dose.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Harrison, T.
McKeever, T.
Shaw, D.E.
Keywords: Biochemical markers, Nitric oxide, Inhaled corticosteroid therapy, Dose reduction, Asthma management
Subjects: W Medicine and related subjects (NLM Classification) > WF Respiratory system
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 29710
Depositing User: Blore, Mrs Kathryn
Date Deposited: 27 Aug 2015 09:44
Last Modified: 14 Sep 2016 17:47
URI: http://eprints.nottingham.ac.uk/id/eprint/29710

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