Management of Asthma Based on Exhaled Nitric Oxide in Addition to Guideline-Based Treatment for Inner-City Adolescents and Young Adults: A Randomised Controlled Trial
Niya H. Wanich, MD, Michael S. Kaplan, MD
Los Angeles, CA

Szefler SJ, Mitchell H, Sorkness CA, et al. Lancet. 2008;372(9643):1065–1072

PURPOSE OF THE STUDY. To determine whether the use of exhaled nitric oxide (NO) measurements to modify asthma treatment regimens improves asthma control when used as an adjunct to management based on national asthma care guidelines.

STUDY POPULATION. A randomized, double-blind, parallel-group trial at 10 centers in the United States monitored a total of 546 inner-city subjects, 12 to 20 years of age, with poorly controlled asthma.

METHODS. Physician assessment was performed every 6 to 8 weeks for 46 weeks, during which patients were evaluated for asthma symptoms, pulmonary function, and exhaled NO, a marker of airway inflammation. At each visit, treatment was stepped up or down on the basis of the National Asthma Education and Prevention Program (NAEPP) asthma care guidelines for the control group or the NAEPP guidelines plus measurements of fraction of exhaled NO (FeNO) for the NO group.

RESULTS. There was no difference between the control group and the NO group with respect to asthma symptoms, pulmonary function, or asthma exacerbations. By the end of the study, patients in the NO group were receiving higher doses of inhaled corticosteroids (difference in fluticasone doses: 119 µg; P = .001) than were those in the control group, with a greater number receiving long-acting ?2-adrenergic receptor agonists. Adverse events did not differ between the treatment groups.

CONCLUSIONS. The addition of FeNO as an indicator of asthma control resulted in higher doses of inhaled corticosteroids, without clinically important improvements in symptomatic asthma control.

REVIEWERS COMMENTS. Because asthma symptoms and exacerbations are linked to underlying airway inflammation, it seems that using measurements of biomarkers that are indicators of airway inflammation (FeNO) to direct asthma management would improve asthma control. However, this study showed that use of current NAEPP guidelines for asthma treatment alone provided good asthma control for inner-city adolescents and young adults. The addition of FeNO measurements resulted in higher doses of inhaled corticosteroids and long-acting ?2-adrenergic receptor agonists, without producing additional improvements in asthma symptoms, lung function, or need for health care.

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Gene Therapy To Prevent Progression Of Emphysema Discovered By Researchers: “Researchers from Boston University School of Medicine (BUSM) have discovered a new gene therapy that may prevent the progression of emphysema. The study, which appears on-line in the Journal of Clinical Investigation, describes a method to express therapeutic genes in lung tissue for a lifetime after only a single treatment…”

(Via Respiratory / Asthma News From Medical News Today.)

A blood test for diagnosing heart failure

By Richard N. Fogoros, M.D., About.com

When a patient shows up in the emergency room acutely short of breath, the possibilities are many. Is the shortness of breath due to asthma, a pulmonary embolus, heart failure, emphysema, or one of several other conditions? Many times doctors can find it difficult to make the right diagnosis – especially in people who have both heart and lung disease. Often an expensive test, such an an echocardiogram, must be performed to rule out heart failure in these cases – IF an echocardiographer can be cajoled out of bed in the middle of the night.

Now a rapid blood test can tell the clinician whether heart failure is present. The test measures a protein called B Natriuretic Peptide (BNP) a substance secreted by heart muscle that is failing.

In a report in the February issue of the Journal of the American College of Cardiology, BNP levels were measured in 250 patients coming to the hospital with shortness of breath. Of the 97 patients who actually had heart failure, the blood test accurately detected heart failure in 95%.

The BNP test, rapid, inexpensive and widely available, should immediately begin helping doctors make the correct diagnosis in patients with heart failure.

More information

Pregnant women are four times more likely to be admitted to hospital if they contract swine flu than the general population, American scientists have found. An article published online in The Lancet written by the scientists at the respected Centres for Disease Control and Prevention has quantified the extra risk swine flu poses during pregnancy for the first time since the outbreak began.
The analysis included 45 deaths in America, 13 per cent of which were in pregnant women and all were relatively healthy before they contracted flu.

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