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 the following) Partly controlled (any measure present in any week Uncontrolled 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 Need for rescue treatment Lung function (FEV1 or PEF) Normal <80%predicted or personal best Exacerbations 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 inflammation Unlikely Present but mild Prominent FeNO ppb <5 5-25 25-50 >50 Consider smoker Symptom+ reconsider diagnosis: Neutrophilic asthma Anxiety Rhinosinusitis GERD Symptom- full compliance Infection Contact with allergen Combine ICS with another drug Increase ICS Do not change the treatment İnsufficient treatment -İncompliance to treatment -technical difficulties -İnsufficient ICS -continous contact with allergens 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

Mean FeNO

ACT-FeNO ACT<20 ACT>20 NO<25 ppb 10 (%14) 20 (%28) 23 (%32) 18 (%25)

ACT-FEV1 AKT<20 AKT>20 FEV1>%80 14 (%20) 30 (%42) 9 (%13) 7 (%10) FEV1<%60 2 (%3)

FEV1-FeNO NO<25 ppb NO>25 ppb FEV1>%80 21(%30) 23 (%32) 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

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