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Association of elevated fractional exhaled nitric oxide concentration and blood eosinophil count with severe asthma exacerbations

Price, David B.; Bosnic-Anticevich, Sinthia; Pavord, Ian D.; Roche, Nicolas; Halpin, David M.G.; Bjermer, Leif LU ; Usmani, Omar S.; Brusselle, Guy; Ming, Simon Wan Yau and Rastogi, Sarang (2019) In Clinical and Translational Allergy 9(1).
Abstract

Background: Blood eosinophil count (BEC) and fractional exhaled nitric oxide (FeNO) concentration are established biomarkers in asthma, associated particularly with the risk of exacerbations. We evaluated the relationship of BEC and FeNO as complementary and independent biomarkers of severe asthma exacerbations. Methods: This observational study included data from the Optimum Patient Care Research Database. Asthma patients (18-80 years) with valid continuous data for 1 year before FeNO reading, ≥ 1 inhaled corticosteroid prescription, and BEC recorded ≤ 5 years before FeNO reading were separated into cohorts. Categorisation 1 was based on the American Thoracic Society criteria for elevated FeNO concentration (high: ≥ 50 ppb; non-high:... (More)

Background: Blood eosinophil count (BEC) and fractional exhaled nitric oxide (FeNO) concentration are established biomarkers in asthma, associated particularly with the risk of exacerbations. We evaluated the relationship of BEC and FeNO as complementary and independent biomarkers of severe asthma exacerbations. Methods: This observational study included data from the Optimum Patient Care Research Database. Asthma patients (18-80 years) with valid continuous data for 1 year before FeNO reading, ≥ 1 inhaled corticosteroid prescription, and BEC recorded ≤ 5 years before FeNO reading were separated into cohorts. Categorisation 1 was based on the American Thoracic Society criteria for elevated FeNO concentration (high: ≥ 50 ppb; non-high: < 25 ppb) and BEC (high: ≥ 0.300 × 109 cells/L; non-high: < 0.300 × 109 cells/L). Categorisation 2 (FeNO concentration, high: ≥ 35 ppb; non-high: < 35 ppb) was based on prior research. Reference groups included patients with neither biomarker raised. Results: In categorisation 1, patients with either high FeNO or high BEC (n = 200) had a numerically greater exacerbation rate (unadjusted rate ratio, 1.31 [95% confidence interval: 0.97, 1.76]) compared with patients in the reference group. Combination of high FeNO and high BEC (n = 27) resulted in a significantly greater exacerbation rate (3.67 [1.49, 9.04]). Similarly, for categorisation 2, when both biomarkers were raised (n = 53), a significantly greater exacerbation rate was observed (1.72 [1.00, 2.93]). Conclusion: The combination of high FeNO and high BEC was associated with significantly increased severe exacerbation rates in the year preceding FeNO reading, suggesting that combining FeNO and BEC measurements in primary care may identify asthma patients at risk of exacerbations.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Asthma, Blood eosinophils, Exhaled airway markers, Nitric oxide
in
Clinical and Translational Allergy
volume
9
issue
1
pages
18 pages
publisher
BioMed Central
external identifiers
  • scopus:85070956142
ISSN
2045-7022
DOI
10.1186/s13601-019-0282-7
language
English
LU publication?
yes
id
a2cca8b1-d081-466d-9b70-b9992277e056
date added to LUP
2019-09-11 11:29:30
date last changed
2019-09-11 11:29:30
@article{a2cca8b1-d081-466d-9b70-b9992277e056,
  abstract     = {<p>Background: Blood eosinophil count (BEC) and fractional exhaled nitric oxide (FeNO) concentration are established biomarkers in asthma, associated particularly with the risk of exacerbations. We evaluated the relationship of BEC and FeNO as complementary and independent biomarkers of severe asthma exacerbations. Methods: This observational study included data from the Optimum Patient Care Research Database. Asthma patients (18-80 years) with valid continuous data for 1 year before FeNO reading, ≥ 1 inhaled corticosteroid prescription, and BEC recorded ≤ 5 years before FeNO reading were separated into cohorts. Categorisation 1 was based on the American Thoracic Society criteria for elevated FeNO concentration (high: ≥ 50 ppb; non-high: &lt; 25 ppb) and BEC (high: ≥ 0.300 × 10<sup>9</sup> cells/L; non-high: &lt; 0.300 × 10<sup>9</sup> cells/L). Categorisation 2 (FeNO concentration, high: ≥ 35 ppb; non-high: &lt; 35 ppb) was based on prior research. Reference groups included patients with neither biomarker raised. Results: In categorisation 1, patients with either high FeNO or high BEC (n = 200) had a numerically greater exacerbation rate (unadjusted rate ratio, 1.31 [95% confidence interval: 0.97, 1.76]) compared with patients in the reference group. Combination of high FeNO and high BEC (n = 27) resulted in a significantly greater exacerbation rate (3.67 [1.49, 9.04]). Similarly, for categorisation 2, when both biomarkers were raised (n = 53), a significantly greater exacerbation rate was observed (1.72 [1.00, 2.93]). Conclusion: The combination of high FeNO and high BEC was associated with significantly increased severe exacerbation rates in the year preceding FeNO reading, suggesting that combining FeNO and BEC measurements in primary care may identify asthma patients at risk of exacerbations.</p>},
  articleno    = {41},
  author       = {Price, David B. and Bosnic-Anticevich, Sinthia and Pavord, Ian D. and Roche, Nicolas and Halpin, David M.G. and Bjermer, Leif and Usmani, Omar S. and Brusselle, Guy and Ming, Simon Wan Yau and Rastogi, Sarang},
  issn         = {2045-7022},
  keyword      = {Asthma,Blood eosinophils,Exhaled airway markers,Nitric oxide},
  language     = {eng},
  month        = {08},
  number       = {1},
  pages        = {18},
  publisher    = {BioMed Central},
  series       = {Clinical and Translational Allergy},
  title        = {Association of elevated fractional exhaled nitric oxide concentration and blood eosinophil count with severe asthma exacerbations},
  url          = {http://dx.doi.org/10.1186/s13601-019-0282-7},
  volume       = {9},
  year         = {2019},
}