ACT scores, FEV1 and FeNO correlation and interaction in

asthma control

Dogan Ismail, Guven Kasim, Musellim Benan, Gemicioglu Bilun

Istanbul University, Faculty of Medicine Cerrahpasa, Department of Pulmonary

Diseases

.

1.1. In the past 4 weeks, how much of the time did your asthma keep you In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school or at home?from getting as much done at work, school or at home?

2.2. During the past 4 weeks, how often have you had shortness of breath?During the past 4 weeks, how often have you had shortness of breath?

3.3. During the past 4 weeks, how often did your asthma symptoms During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night, or earlier than usual in the morning?night, or earlier than usual in the morning?

4.4. During the past 4 weeks, how often have you used your rescue During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as albuterol)?inhaler or nebulizer medication (such as albuterol)?

5.5. How would you rate your asthma control during the past 4 weeks?How would you rate your asthma control during the past 4 weeks?

ScoreScore

BACKGROUND: ACT

.

BACKGROUND: FeNO

.

AIM

• To identify the correlation between ACT, FeNO levels and pulmonary functions

• To demonstrate the interactions between ACT, FeNO with several parameters.

416 persistent asthma patients on combined therapy.

All patients responded prepared demographic and comorbidities questionnaire and ACT

FeNO, PFT, Skin prick test was done in all of them.

Statistical analysis

.

METHOD

ACT: Nathan R A et al. JACI 2004

Pulmonary functions tests: ZAN 100 Flow Handy II, Germany

FeNO: NIOX Mino, Aerocrine AB, Solna Sweden

Skin prick test: ALK Abello Spain Soluprick set

Statistical analysis and correlation: SPSS 15:0

Materials

Number of patients 416

Female / male 294/122 (F: 70,7 %)

Mean age 41,8 ± 14

BMI 27,4 ± 5,1

Mean asthma years 12,3±9,5

Non-smokers (%) 74,6 %

Patients: Demographic Parameters

Control Parameters Results

Parameters Mean ± SD FEV1 (lt) 2,4 ± 0,9

FEV1 (%) 83,4 ± 19,8

ACT 19 ± 5,2

FeNO (ppb) 31,8 ± 28,5

Emergency visit 16,8 %

Hospitalization 5,8 %

ACT & %FEV1 correlation

r= 0,22p < 0,001

fev1yuzde125,00100,0075,0050,0025,00

akt

30,00

25,00

20,00

15,00

10,00

5,00

R Sq Linear = 0,05

AK

T

%FEV1 PREDİKT

FeNO & ACT correlation

r= - 0,31p= - 0,002

feno300,00250,00200,00150,00100,0050,000,00

akt

30,00

25,00

20,00

15,00

10,00

5,00

R Sq Linear = 0,093

AK

T

FeNO(ppb)

Hospitalization, Emergency Visit

ACT and FeNO values varied significantly in patients with and without emergency visit history (p<0,001, p=0,02). While ACT was statistically different in patients with and without hospitalization history (p< 0,001), no difference was observed for FeNO.

ACT & Emergency Room Visit

p < 0,001

acilbasvuruvaryok

akt

30,00

25,00

20,00

15,00

10,00

5,00

210

204

AK

T

Acil Başvuru

Yes

No

FeNO & Emergency Rooom Visit

p= - 0,02

acilbasvuruvaryok

feno

300,00

250,00

200,00

150,00

100,00

50,00

0,00

249

250

248247

246

244 245

239240237

235 234414413

FeN

O(p

pb)

Acil Başvuru

Yes

No

ACT & Hospitalization

p< 0,001

hastaneyatisvaryok

akt

30,00

25,00

20,00

15,00

10,00

5,00

117142

209204

217

AK

T

Hastane Yatışı

Yes

No

ACT & FeNO Results

ACT < 20 ACT ≥ 20

FeNO < 25 30,0 % 57,2 %

25≤FeNO<50 34,5 % 28,9 %

FeNO ≥ 50 26,5 % 13,9 %

FeNO & gender interaction

p= - 0,005

cinsiyetkadinerkek

feno

300,00

250,00

200,00

150,00

100,00

50,00

0,00

114

113249

248

111

250

247

112246

240237235

236

416234

415

233

245

244110

FeN

O(p

pb)

Cinsiyet

Female

Male

FeNO & Age correlation

r= - 0,13p= - 0,009

feno300,00250,00200,00150,00100,0050,000,00

yas

80

60

40

20R Sq Linear = 0,016

Ya

ş(yı

l)

FeNO(ppb)

FeNO & duration of asthma correlation

astimsüre6050403020100

feno

300,00

250,00

200,00

150,00

100,00

50,00

0,00

R Sq Linear = 0,023

Astım Süresi (yıl)

FeN

O(p

pb)

Duration of asthma (year)

r= -0,15p= - 0,008

Smoking History

FeNO and ACT were not different in patients with and without smoking history

Skin Prick Test Results

%

FeNO was statistically different in patients with positive and negative skin prick test (p=0,004), whereas no difference was noted for ACT (p>0,05))

FeNO & Skin Prick Test

p = 0,004

pricktestiallerjiknonallerjik

feno

200,00

150,00

100,00

50,00

0,00

114

113249

248247

112246

244

237

108

416

415

FeN

O(p

pb)

Deri (prick) testi

Allergic

Non allergic

Comorbidities

ACT was not different in patients with and without allergic rhinitis, but it was significant for FeNO (p=0,008). FeNO and ACT values were different in patients with and without allergic conjunctivitis (p=0,02, p=0,03 respectively).

FeNO & Allergic Rhinitis

p = 0,008

allrinitvaryok

feno

300,00

250,00

200,00

150,00

100,00

50,00

0,00

250

248

247

249

236

246

245 244

243

405224

398394

FeN

O(p

pb)

Allerjik Rinit

( +)

( - )

FeNO & Allergic Conjunctivitis

p = 0,02

allkonjunkvaryok

feno

300,00

250,00

200,00

150,00

100,00

50,00

0,00

250

249

247

244

248

246

238240235

236

234

414

FeN

O(p

pb)

Allerjik Konjonktivit

( +)

( - )

ACT & Allergic Conjunctivitis

p = 0,03

allkonjunkvaryok

akt

30,00

25,00

20,00

15,00

10,00

5,00

150232

117 142

209197204

AK

T

Allerjik Konjonktivit

( +)

( - )

.

CONCLUSION

• ACT and FEV1 were positively correlated whereas FEV1 and FeNO were not. FeNO measurement, in patients whose asthma was controlled according to ACT, seems to be significant in terms of treatment management.

• As possible interactions between FeNO and various parameters have been shown; each patient should be individually assessed according to his/her best FeNO value.