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Sputum Tests and Exhaled NO in the Diagnosis and Monitoring of Asthma

  • Myron Zitt
Part of the Allergy Frontiers book series (ALLERGY, volume 4)

Optimal control of asthma has yet to be achieved globally, as costs of care continue to mount, patient quality of life remains inadequate and mortality rates are unacceptably high. While prevalence rates are rising, asthma continues to be under-diagnosed and under-treated. Because of disease heterogeneity, it is difficult to determine the type and dose of medication that will afford patients the best risk/benefit ratio and to determine which patients will or will not develop irreversible airflow limitation. Poor patient compliance/adherence can negatively impact outcomes and must also be assessed.

While inflammation is an essential component of asthma, current practice parameters do not include its measurement in the diagnosis or management of disease. Studies employing surrogate markers of inflammation to orchestrate therapy, including induced sputum for eosinophils and methacholine sensitivity, a measure of airways hyper-reactivity, have revealed improved asthma outcomes. While these studies are less invasive than the direct assessment of inflammation with bronchial biopsy and/or evaluation of BAL washings, they are still time consuming and labor intensive and impractical for routine asthma management.

Inducible nitric oxide synthase (iNOS) is produced predominantly by airway epithelial cells and is up-regulated as part of the inflammatory process resulting in elevated levels of fractional exhaled nitric oxide (FENO) in patients with asthma. As there is a positive correlation between airway hyper-reactivity, sputum eosinophilia and FENO, this surrogate marker of eosinophilic inflammation, which is non-invasive and is quickly and easily measured, has significant potential as an “inflammometer” in the management of asthma. Despite some controversy, studies indicate that the evaluation of FENO, which is more sensitive, but correlates poorly with pulmonary function, should prove to be a valuable adjunct to current guideline recommendations.

Although further studies are needed to understand the scope and potential impact of measuring FENO, it appears to fulfill an unmet need by providing a simple, non-invasive well-tolerated, standardized and reproducible test that is a surrogate measure of eosinophilic airway inflammation in patients with asthma. When used to complement standard monitoring tools, improved asthma outcomes appear likely.

Keywords

Nitric Oxide Airway Inflammation Fluticasone Propionate Asthma Control Allergy Clin Immunol 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer 2009

Authors and Affiliations

  • Myron Zitt
    • 1
  1. 1.Medicine, State University of New York, Stony Brook Medical CenterWoodburyUSA

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