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      Nasal Airflow Measured by Rhinomanometry Correlates with FeNO in Children with Asthma

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          Abstract

          Background

          Rhinitis and asthma share similar immunopathological features. Rhinomanometry is an important test used to assess nasal function and spirometry is an important tool used in asthmatic children. The degree to which the readouts of these tests are correlated has yet to be established. We sought to clarify the relationship between rhinomanometry measurements, fractional exhaled nitric oxide (FeNO), and spirometric measurements in asthmatic children.

          Methods

          Patients’ inclusion criteria: age between 5 and 18 years, history of asthma with nasal symptoms, and no anatomical deformities. All participants underwent rhinomanometric evaluations and pulmonary function and FeNO tests.

          Results

          Total 84 children were enrolled. By rhinomanometry, the degree of nasal obstruction was characterized as follows: (1) no obstruction in 33 children, (2) slight obstruction in 29 children, and (3) moderate obstruction in 22 children. FeNO was significantly lower in patients without obstruction than those with slight or moderate obstruction. Dividing patients according to ATS Clinical Practice Guidelines regarding FeNO, patients < 12 years with FeNO > 20 ppb had a lower total nasal airflow rate than those with FeNO < 20 ppb. Patients ≥ 12 years with FeNO > 25 ppb had a lower total nasal airflow rate than those with FeNO < 25 ppb.

          Conclusions

          Higher FeNO was associated with a lower nasal airflow and higher nasal resistance. This supports a relationship between upper and lower airway inflammation, as assessed by rhinomanometry and FeNO. The results suggest that rhinomanometry may be integrated as part of the functional assessment of asthma.

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          Most cited references34

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          Can guideline-defined asthma control be achieved? The Gaining Optimal Asthma ControL study.

          For most patients, asthma is not controlled as defined by guidelines; whether this is achievable has not been prospectively studied. A 1-year, randomized, stratified, double-blind, parallel-group study of 3,421 patients with uncontrolled asthma compared fluticasone propionate and salmeterol/fluticasone in achieving two rigorous, composite, guideline-based measures of control: totally and well-controlled asthma. Treatment was stepped-up until total control was achieved (or maximum 500 microg corticosteroid twice a day). Significantly more patients in each stratum (previously corticosteroid-free, low- and moderate-dose corticosteroid users) achieved control with salmeterol/fluticasone than fluticasone. Total control was achieved across all strata: 520 (31%) versus 326 (19%) patients after dose escalation (p < 0.001) and 690 (41%) versus 468 (28%) at 1 year for salmeterol/fluticasone and fluticasone, respectively. Asthma became well controlled in 1,071 (63%) versus 846 (50%) after dose escalation (p < 0.001) and 1,204 (71%) versus 988 (59%) at 1 year. Control was achieved more rapidly and at a lower corticosteroid dose with salmeterol/fluticasone versus fluticasone. Across all strata, 68% and 76% of the patients receiving salmeterol/fluticasone and fluticasone, respectively, were on the highest dose at the end of treatment. Exacerbation rates (0.07-0.27 per patient per year) and improvement in health status were significantly better with salmeterol/fluticasone. This study confirms that the goal of guideline-derived asthma control was achieved in a majority of the patients.
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            International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods.

            The aetiology of asthma and allergic disease remains poorly understood, despite considerable research. The International Study of Asthma and Allergies in Childhood (ISAAC), was founded to maximize the value of epidemiological research into asthma and allergic disease, by establishing a standardized methodology and facilitating international collaboration. Its specific aims are: 1) to describe the prevalence and severity of asthma, rhinitis and eczema in children living in different centres, and to make comparisons within and between countries; 2) to obtain baseline measures for assessment of future trends in the prevalence and severity of these diseases; and 3) to provide a framework for further aetiological research into genetic, lifestyle, environmental, and medical care factors affecting these diseases. The ISAAC design comprises three phases. Phase 1 uses core questionnaires designed to assess the prevalence and severity of asthma and allergic disease in defined populations. Phase 2 will investigate possible aetiological factors, particularly those suggested by the findings of Phase 1. Phase 3 will be a repetition of Phase 1 to assess trends in prevalence.
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              Recommendations for standardized procedures for the on-line and off-line measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide in adults and children-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999.

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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                28 October 2016
                2016
                : 11
                : 10
                : e0165440
                Affiliations
                [1 ]Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
                [2 ]Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
                [3 ]Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
                National and Kapodistrian University of Athens, GREECE
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: IC ZD.

                • Data curation: YTL.

                • Formal analysis: JW ZD.

                • Funding acquisition: IC.

                • Investigation: YCL.

                • Methodology: YTL JH.

                • Resources: ZD IC.

                • Validation: IC YTL.

                • Visualization: YCL JW.

                • Writing – original draft: IC YTL.

                • Writing – review & editing: JW ZD YCL.

                Article
                PONE-D-16-35442
                10.1371/journal.pone.0165440
                5085031
                27792747
                dc52abfd-ada9-4731-97b0-f3a18a9c5899
                © 2016 Chen et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 3 September 2016
                : 11 October 2016
                Page count
                Figures: 0, Tables: 6, Pages: 11
                Funding
                Funded by: Kaohsiung medical university hospital
                Award ID: KMUH-2M30
                Award Recipient :
                This research was supported by the grant from the Kaohsiung Medical University Hospital, Taiwan (KMUH-2M30). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Pulmonology
                Asthma
                Medicine and Health Sciences
                Clinical Medicine
                Clinical Immunology
                Allergies
                Allergic Diseases
                Allergic Rhinitis
                Biology and Life Sciences
                Immunology
                Clinical Immunology
                Allergies
                Allergic Diseases
                Allergic Rhinitis
                Medicine and Health Sciences
                Immunology
                Clinical Immunology
                Allergies
                Allergic Diseases
                Allergic Rhinitis
                Medicine and Health Sciences
                Otorhinolaryngology
                Rhinology
                Nasal Diseases
                Rhinitis
                Allergic Rhinitis
                Research and Analysis Methods
                Bioassays and Physiological Analysis
                Respiratory Analysis
                Spirometry
                Medicine and Health Sciences
                Otorhinolaryngology
                Rhinology
                Nasal Diseases
                Rhinitis
                Biology and Life Sciences
                Biochemistry
                Neurochemistry
                Neurochemicals
                Nitric Oxide
                Biology and Life Sciences
                Neuroscience
                Neurochemistry
                Neurochemicals
                Nitric Oxide
                Medicine and Health Sciences
                Clinical Medicine
                Clinical Immunology
                Allergies
                Biology and Life Sciences
                Immunology
                Clinical Immunology
                Allergies
                Medicine and Health Sciences
                Immunology
                Clinical Immunology
                Allergies
                Biology and Life Sciences
                Anatomy
                Respiratory System
                Nasal Cavity
                Medicine and Health Sciences
                Anatomy
                Respiratory System
                Nasal Cavity
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Body Mass Index
                Medicine and Health Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Body Mass Index
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