Transcript Asthma control test (ACT) scores and FeNO correlation

Asthma control test
(ACT) scores and
FeNO correlation
Yıldırım BZ, Doğan İ, S Serbest,
Güven K, Gemicioğlu B.
Aim
 To evaluate the correlation of ACT and
FeNO in asthma control in asthmatics
GINA 2006 and Consept of Control
Characteristic
Controlled (all of Partly controlled Uncontrolled
(any measure present
the following)
in any week
Daytime
symptoms
None (twice or
less/week)
More than
twice/week
Three or more
features of
partly controlled
asthma present
in any week
Limitation of
activities
None
Any
Nocturnal
symptoms
None
Any
Need for
rescue
treatment
None (twice or
less/week)
More than
twice/week
Lung function
(FEV1 or PEF)
Normal
<80%predicted or
personal best
Exacerbations
None
One or more/year One in any
week
Asthma Control Test (ACT)
 ACT is a validated, practical instrument
to evaluate asthma control
 ACT measures the quality of asthma
control objectively by using simple
numerical values as the target of
treatment
 It is reliable, valid and sensitive to
fluctuations in asthma control over time
FeNO
 NO is a noninvasive marker of
inflammation
 It reveals the eosinophilic inflammation
and response to corticosteroids in
asthmatic patients.
Evaluation of FeNO in Patients Receiving
Antiinflamatory Treatment
Low
Normal
Medium High
Eosinophilic Unlikely
inflammation
Unlikely
Present but
mild
Prominent
FeNO ppb
<5
5-25
25-50
>50
Consider
smoker
Symptom+
Symptom+
Symptom+
reconsider
diagnosis:
Neutrophilic
asthma
Anxiety
Rhinosinusitis
GERD
Infection
Contact with
allergen
Combine ICS
with another
drug
Increase ICS
SymptomDo not change
the treatment
İnsufficient
treatment
-İncompliance to
Symptomfull
compliance
treatment
-technical
difficulties
-İnsufficient ICS
-continous
contact with
allergens
Symptom-
Kharitonov et al., Eur Respir J 2003 21:433-8
Method
 ACT, pulmonary functions and FeNO
were measured in 71 cases who were
diagnosed as persistent asthma and
were receiving combined therapy
Epidemiological and Functional
Characteristics of Our Cases
Female/male
48(%67)/23(%33)
Mean age
41± 13,5
Smoking history
22 (%28,6)
+allergic rhinitis
63 (%88,7)
Mean FEV1
2,4±1 lt (%80,7 ±19)
Emergency visit
16 (%22,5)
Hospitalization
6 (%8,5)
Findings
Mean AST score
19 ± 6
Mean FeNO (ppb)
38 ± 38
Mean ACT Scores
14
ACT>20
10<ACT<20
31
55
ACT<10
Mean FeNO
24%
45%
<25
25-50
>50
31%
ACT-FeNO
ACT<20
ACT>20
NO<25 ppb
10 (%14)
20 (%28)
NO>25 ppb
23 (%32)
18 (%25)
ACT-FEV1
FEV1>%80
AKT<20
AKT>20
14 (%20)
30 (%42)
60<FEV1<80 9 (%13)
7 (%10)
FEV1<%60
2 (%3)
9 (%13)
FEV1-FeNO
NO<25 ppb
NO>25 ppb
FEV1>%80
21(%30)
23 (%32)
60<FEV1<80
3 (%4)
13 (%18)
FEV1<%60
6 (%8)
5 (%7)
ACT-FeNO
 ACT scores were found to be negatively
correlated with FeNO (by using Pearson
correlation test r=-0,342; p=0,004).
ACT-FeNO Correlation
400
300
200
FENO
100
0
0
AKT
10
20
30
Conclusions
 ACT and NO are negatively correlated
 In patients whose ACT scores mean controlled,
anti-inflammatory therapy yet may be
insufficient.
 ACT is useful in symptomatic and functional
follow-up in asthmatic patients but may not be
sufficient in evaluating the inflammation
Conclusions
 Routine NO measurement combined with ACT
may be helpful in adjusting the
antiinflammatory treatment in patients who are
considered controlled according to ACT only