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Improving Diagnosis and Managemento Asthma through F
eno
Measurement
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”…the new studies... …are highly suggestive o long-term benet o F
e no
infammometry in asthma man-agement. The bottom line is that F
e no
infammometry is an easy test which is helpul to target steroid treat-ment, to reduce steroids where possible, and to providesignicant benets in terms o less hyperresponsive-ness and less infammation without leading to overall need or more steroids at the group level. On the basiso these ndings, F
e no
oers more or day-to-day asthma management than any o the conventional lung unction tests.”
Editorial, Eur Respir J 2005;26:1–3
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CONTENTS Asthma Management Made Easy 3F
e
NO
Measures the Infammation – Not Just the Symptoms 4How Can F
eno
MeasurementHelp Improve Clinical Decision Making? 5-7Factors Aecting Exhaled NO Levels 8Reerences 9Guide to Interpretation o F
eno
Values inSymptomatic Steroid Naïve Patients 10Guide to Interpretation o F
eno
Values in Anti-Infammatory Treated Patients 11
What is NO?
Nitric oxide (NO) is produced in theepithelial cells o the bronchial wallas an intrinsic part o the inamma-tory process. NO production has beenshown to increase when there iseosinophilic airway inammation
1, 2
.The presence o endogenous NO inexhaled air was frst reported in 1991by Gustasson et al.
3
and in 1993 Al-ving et al. ound that NO in exhaledair was elevated in patients withasthma
4
. Since that time researchhas been directed at uncovering therole that NO plays in airway inam-mation.There has been a continuous owo research and a large body o data(nearly 1,500 publications in peerreviewed medical journals) to con-frm the clinical value o exhaledNO measurement.
Normal epithelial cells. Minimal release o NO.Activated epithelial cells during inam-mation demonstrate increased produc-tion o NO.
Epithelial cell liningin the bronchial wallNitric oxide
Asthma ManagementMade Easy
The measurement o ractional exhaled nitric oxide (F
e no
) has been validated as a way o measuring the airway inammation that underlies asthma.
3
F
e no
measurement is:
Accurate Reproducible Immediate As inormative as biopsy
F
e no
measurement oers:
Correct asthma diagnosis Rapid identifcation o non- compliance Insights into steroid eectiveness
Prediction o steroid response Steroid dose-titration that reduces cost and improves patient outcome Notifcation o loss o control Prediction o asthma relapse
The American Thoracic Society,in conjunction with the EuropeanRespiratory Society, have developedguidelines on how exhaled NOmeasurements should be perormed
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.Measurements perormed accordingto these guidelines are calledFractional Exhaled Nitric Oxide(F
eno
). The guidelines state thatexhaled NO measurements must beperormed at a controlled and stan-dardized exhalation ow rate as theF
eno
value is highly ow dependent.The F
eno
values in this brochure arevalid or the standardized 50mL/sow rate only.
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