act scores, fev1 and feno correlation and interaction in asthma control
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ACT scores, FEV1 and FeNO correlation and interaction in
asthma control
Dogan Ismail, Guven Kasim, Musellim Benan, Gemicioglu Bilun
Istanbul University, Faculty of Medicine Cerrahpasa, Department of Pulmonary
Diseases
.
1.1. In the past 4 weeks, how much of the time did your asthma keep you In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school or at home?from getting as much done at work, school or at home?
2.2. During the past 4 weeks, how often have you had shortness of breath?During the past 4 weeks, how often have you had shortness of breath?
3.3. During the past 4 weeks, how often did your asthma symptoms During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night, or earlier than usual in the morning?night, or earlier than usual in the morning?
4.4. During the past 4 weeks, how often have you used your rescue During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as albuterol)?inhaler or nebulizer medication (such as albuterol)?
5.5. How would you rate your asthma control during the past 4 weeks?How would you rate your asthma control during the past 4 weeks?
ScoreScore
BACKGROUND: ACT
.
BACKGROUND: FeNO
.
AIM
• To identify the correlation between ACT, FeNO levels and pulmonary functions
• To demonstrate the interactions between ACT, FeNO with several parameters.
416 persistent asthma patients on combined therapy.
All patients responded prepared demographic and comorbidities questionnaire and ACT
FeNO, PFT, Skin prick test was done in all of them.
Statistical analysis
.
METHOD
ACT: Nathan R A et al. JACI 2004
Pulmonary functions tests: ZAN 100 Flow Handy II, Germany
FeNO: NIOX Mino, Aerocrine AB, Solna Sweden
Skin prick test: ALK Abello Spain Soluprick set
Statistical analysis and correlation: SPSS 15:0
Materials
Number of patients 416
Female / male 294/122 (F: 70,7 %)
Mean age 41,8 ± 14
BMI 27,4 ± 5,1
Mean asthma years 12,3±9,5
Non-smokers (%) 74,6 %
Patients: Demographic Parameters
Control Parameters Results
Parameters Mean ± SD FEV1 (lt) 2,4 ± 0,9
FEV1 (%) 83,4 ± 19,8
ACT 19 ± 5,2
FeNO (ppb) 31,8 ± 28,5
Emergency visit 16,8 %
Hospitalization 5,8 %
ACT & %FEV1 correlation
r= 0,22p < 0,001
fev1yuzde125,00100,0075,0050,0025,00
akt
30,00
25,00
20,00
15,00
10,00
5,00
R Sq Linear = 0,05
AK
T
%FEV1 PREDİKT
FeNO & ACT correlation
r= - 0,31p= - 0,002
feno300,00250,00200,00150,00100,0050,000,00
akt
30,00
25,00
20,00
15,00
10,00
5,00
R Sq Linear = 0,093
AK
T
FeNO(ppb)
Hospitalization, Emergency Visit
ACT and FeNO values varied significantly in patients with and without emergency visit history (p<0,001, p=0,02). While ACT was statistically different in patients with and without hospitalization history (p< 0,001), no difference was observed for FeNO.
ACT & Emergency Room Visit
p < 0,001
acilbasvuruvaryok
akt
30,00
25,00
20,00
15,00
10,00
5,00
210
204
AK
T
Acil Başvuru
Yes
No
FeNO & Emergency Rooom Visit
p= - 0,02
acilbasvuruvaryok
feno
300,00
250,00
200,00
150,00
100,00
50,00
0,00
249
250
248247
246
244 245
239240237
235 234414413
FeN
O(p
pb)
Acil Başvuru
Yes
No
ACT & Hospitalization
p< 0,001
hastaneyatisvaryok
akt
30,00
25,00
20,00
15,00
10,00
5,00
117142
209204
217
AK
T
Hastane Yatışı
Yes
No
ACT & FeNO Results
ACT < 20 ACT ≥ 20
FeNO < 25 30,0 % 57,2 %
25≤FeNO<50 34,5 % 28,9 %
FeNO ≥ 50 26,5 % 13,9 %
FeNO & gender interaction
p= - 0,005
cinsiyetkadinerkek
feno
300,00
250,00
200,00
150,00
100,00
50,00
0,00
114
113249
248
111
250
247
112246
240237235
236
416234
415
233
245
244110
FeN
O(p
pb)
Cinsiyet
Female
Male
FeNO & Age correlation
r= - 0,13p= - 0,009
feno300,00250,00200,00150,00100,0050,000,00
yas
80
60
40
20R Sq Linear = 0,016
Ya
ş(yı
l)
FeNO(ppb)
FeNO & duration of asthma correlation
astimsüre6050403020100
feno
300,00
250,00
200,00
150,00
100,00
50,00
0,00
R Sq Linear = 0,023
Astım Süresi (yıl)
FeN
O(p
pb)
Duration of asthma (year)
r= -0,15p= - 0,008
Smoking History
FeNO and ACT were not different in patients with and without smoking history
Skin Prick Test Results
%
FeNO was statistically different in patients with positive and negative skin prick test (p=0,004), whereas no difference was noted for ACT (p>0,05))
FeNO & Skin Prick Test
p = 0,004
pricktestiallerjiknonallerjik
feno
200,00
150,00
100,00
50,00
0,00
114
113249
248247
112246
244
237
108
416
415
FeN
O(p
pb)
Deri (prick) testi
Allergic
Non allergic
Comorbidities
ACT was not different in patients with and without allergic rhinitis, but it was significant for FeNO (p=0,008). FeNO and ACT values were different in patients with and without allergic conjunctivitis (p=0,02, p=0,03 respectively).
FeNO & Allergic Rhinitis
p = 0,008
allrinitvaryok
feno
300,00
250,00
200,00
150,00
100,00
50,00
0,00
250
248
247
249
236
246
245 244
243
405224
398394
FeN
O(p
pb)
Allerjik Rinit
( +)
( - )
FeNO & Allergic Conjunctivitis
p = 0,02
allkonjunkvaryok
feno
300,00
250,00
200,00
150,00
100,00
50,00
0,00
250
249
247
244
248
246
238240235
236
234
414
FeN
O(p
pb)
Allerjik Konjonktivit
( +)
( - )
ACT & Allergic Conjunctivitis
p = 0,03
allkonjunkvaryok
akt
30,00
25,00
20,00
15,00
10,00
5,00
150232
117 142
209197204
AK
T
Allerjik Konjonktivit
( +)
( - )
.
CONCLUSION
• ACT and FEV1 were positively correlated whereas FEV1 and FeNO were not. FeNO measurement, in patients whose asthma was controlled according to ACT, seems to be significant in terms of treatment management.
• As possible interactions between FeNO and various parameters have been shown; each patient should be individually assessed according to his/her best FeNO value.
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