Application of fractional exhaled nitric oxide and nasal nitric oxide in control evaluation of bronchial asthma and diagnosis of allergic rhinitis in children / 中国当代儿科杂志

OBJECTIVES@#To study the association of fractional exhaled nitric oxide (FeNO) and nasal nitric oxide (nNO) with asthma control and their value in the diagnosis of allergic rhinitis in children.@*METHODS@#A total of 186 children aged 5-12 years, who attended the outpatient service of the Department of Respiration, Shanghai Children's Hospital due to bronchial asthma and/or allergic rhinitis or who underwent physical examination, were enrolled as subjects, with 52 children in the asthma group, 60 children in the asthma+allergic rhinitis group, 36 children in the allergic rhinitis group, and 38 children in the control group. FeNO, nNO, and pulmonary function were compared between groups.@*RESULTS@#The asthma+allergic rhinitis, asthma, and allergic rhinitis groups had a significantly higher level of FeNO than the control group (P<0.05). The asthma+allergic rhinitis and allergic rhinitis groups had a significantly higher level of nNO than the asthma and control groups (P<0.05). The uncontrolled asthma and partially controlled asthma groups had significantly higher levels of FeNO and nNO than the completely controlled asthma group (P<0.05). The receiver operating characteristic (ROC) curve analysis showed that nNO had an area under the ROC curve of 0.91, with a sensitivity of 80.0% and a specificity of 89.5% in the diagnosis of allergic rhinitis in children with asthma (P<0.05).@*CONCLUSIONS@#The combined measurement of nNO and FeNO can be used to evaluate the control of asthma, and the measurement of nNO can help with the diagnosis of allergic rhinitis in children with bronchial asthma.

Clinical application of childhood asthma control test / 中华实用儿科临床杂志

Objective To evaluate the childhood asthma control test(C-ACT) on the assessment of asthma by exploring the correlations among C-ACT,disease severity,the control level of pediatric asthma,disease partition and the changes in the pulmonary function as well as the score range,and to evaluate the feasibility and effectiveness of C-ACT's application to guide children's asthma control.Methods Two hundred and five children with asthma in the Pediatric Asthma Outpatient of Xiamen Hospital of Fujian University of Traditional Chinese Medicine from October 2011 to October 2015 were enrolled and randomly divided into control group and experimental group by random number table.The patients in the experimental group were monitored by the C-ACT with corresponding guidance,while patients in control group were treated without the monthly guidance of C-ACT after C-ACT involvement at the first time.C-ACT questionnaire score surveys were completed by all patients and their parents under the guidance of asthmatic specialists or nurses.Pulmonary function,disease severity and disease partition and the control level of pediatric asthma were detected and evaluated by doctors before and after treatment.The correlation between the results of C-ACT and the changes in the clinical indicators was assessed,and the improvement of lung function and the control rate of asthma were evaluated in 2 groups after 1 year.Results (1) There was no significant difference in gender,age and disease severity distribution based on the results of pulmonary function assessment between the control group and the experimental group (all P ＞ 0.05).(2) The C-ACT scores in normal,slight abnormal,moderately abnormal and severely abnormal pulmonary function were (24.79-± 2.20) scores,(21.67 ± 1.93) scores,(17.07-± 2.01) scores and (12.67 ± 1.81)scores,respectively,which showed the pulmonary function had a positive correlation with C-ACT scores (F =314.0,P ＜ 0.000 1).(3)Assessment of the reliability of C-ACT:the α value of Cronbach's coefficient for the scale was 0.867,which showed the high reliability.The correlation coefficients between the C-ACT score and the percentage of predicted value of forced expiratory volume in one second(FEV1％),the percentage of peak expiratory flow in the predicted value (PEF％) were 0.683 and 0.712,respectively,which also showed the strong reliability.(4) C-ACT scores in intermittent attacks of asthma,slight persistent asthma,moderate persistent asthma,severe persistent asthma were (24.47 ± 2.26) scores,(22.17 ± 1.86) scores,(17.42 ± 2.52) scores and (13.27 ± 2.11) scores,respectively,which showed the severity of asthma was positively associated with C-ACT scores (F =244.0,P ＜ 0.000 1).(5) C-ACT scores in controlled,partly controlled and uncontrolled asthma were (24.32 ± 2.34) scores,(18.87 ± 1.95)scores and (14.03 ± 1.32) scores,which showed the control levels of asthma had a positive association with C-ACT scores(F =394.0,P ＜ 0.000 1).(6)C-ACT scores in different disease partitions of green,yellow and red area were (24.72 ± 2.04) scores,(18.17 ± 2.03) scores and (15.06 ± 1.93) scores,which showed the diseases partition had an association with C-ACT scores (F =367.2,P ＜ 0.000 1).(7) After treatment of 3 months,6 months and 12 months,the control rates in the control group were 28.71％,67.33％,81.19％,but they were 44.23％,79.81％,95.19％ in the experimental group respectively.The control rates were higher in the experimental group than those in the control group,and the differences were significant (x2 =5.318,4.114,9.722,all P ＜ 0.05).Conclusion The C-ACT is highly correlated with pulmonary function,and our study show the C-ACT score range can help to make a quick assessment of disease severity,disease partition and the control level of children asthma.The application of C-ACT for the treatment of asthma has a good effect and it can be recommended and applied to childhood suitable for the promotion and application of children asthma clinics and community medical institutions at all levels of hospitals.

Assessment of control of bronchial asthma in children using Childhood Asthma Control Test.

Background. The use of Childhood Asthma Control Test (C-ACT) has been advised for monitoring asthma control by the Global Initiative for Asthma (GINA) guidelines. Objective. To validate the tool C-ACT for the assessment of control of asthma and to examine the correlation between C-ACT score and lung function assessed by forced expiratory volume in one second (FEV1). Methods. This was a prospective observational study conducted between January 2010 to January 2011. Children diagnosed to have bronchial asthma and aged 5 to 14 years, were enrolled in the study. Asthma severity and control status were classified according to the National Asthma Education and Prevention Programme (NAEPP) and GINA guidelines, respectively. Patients were followed-up at three and six months and C-ACT and spirometric measurements were obtained. Results. Significant positive correlations were found between C-ACT score and FEV1 at enrollment (r=0.772) (p<0.001), three months (r=0.815) (p<0.001) and at six months follow-up (r=0.908) (p<0.001). Baseline C-ACT score was useful for predicting the levels of control of asthma upto three months (0.004), but not at six months follow-up (0.787). A cut-off C-ACT value of >19 had a sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) 98.5%, 89.1%, 94.9%, 96.6%, 0.717, respectively for the control of asthma. Conclusion. C-ACT is a simple and feasible tool to assess and predict the levels of control in children with bronchial asthma upto three months.