Ethnic Differences in Exhaled Nitric Oxide (FeNO) Before, During, and ...

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618 Relationship Between Sputum TWEAK Levels and. Childhood Asthma. Soo Yeon Kim, Jong Deok Kim, In Suk Sol, Min Jung Kim, Mi Seon Oh,. Yun Seon ...
AB196 Abstracts

618

Relationship Between Sputum TWEAK Levels and Childhood Asthma

Soo Yeon Kim, Jong Deok Kim, In Suk Sol, Min Jung Kim, Mi Seon Oh, Yun Seon Kim, Mina Kim, Jung Yeon Hong, Young A. Park, Yoon Hee Kim, Kyung Won Kim, Myung Hyun Sohn, and Kyu-Earn Kim; Yonsei Univeresity Severance Children’s Hospital Department of Pediatrics and Institute of Allergy, Seoul, Korea, The Republic of. RATIONALE: Human Tumor Necrosis Factor-like weak inducer of apoptosis (TWEAK) has been known to play a role in the pathogenesis of various inflammatory diseases. However, there is no previous data elucidating relationships in between TWEAK and childhood asthma. METHODS: One hundred and one children with asthma and 81 control subjects aged 5 -18 years were included. Induced sputum, pulmonary function, and methacholine challenge test were performed. Patients with asthma were stratified according to four levels of asthma severity (mild intermittent, mild persistent, moderate persistent, and severe persistent). The analysis of TWEAK levels in induced sputum supernatants was performed with the use of a commercially available enzyme-linked immunosorbent assay (ELISA) kit. RESULTS: TWEAK levels in induced sputum sample were significantly higher in asthmatic children than those in controls [238.6 (36.7-559.0) pg/ mL vs. 121.4 (35.6-585.3) pg/mL, P 5 0.043]. TWEAK level was elevated in eosinophil-dominant sputum compared to non-eosinophilic sputum in asthma patients [212.2 (113.4-1183.5) pg/mL vs. 66.9 (8.3-187.5) pg/mL, P < 0.001]. In addition, atopic asthma patients showed significantly higher TWEAK levels than non-atopic asthma patients [131.4 (62.8-228.8) pg/ mL vs. 45.7 (4.8-162.3) pg/mL, P 5 0.016]. Sputum level of TWEAK increased according to severity, mild, moderate and severe, in persistent asthma group [108.6 (42.6-181.3), 170.2 (68.3-506.5), and 328.0 (60.0764.8) pg/mL, respectively]. CONCLUSIONS: TWEAK might play a role in airway inflammation of childhood asthma, especially eosinophilic asthma with atopy.

MONDAY

619

Ethnic Differences in Exhaled Nitric Oxide (FeNO) Before, During, and After an Asthma Exacerbation in Children with Asthma

Katherine McCormack, MD1, Jonathan Malka, MD, FAAAAI2, Melanie C. Gleason, MS, PA-C3, and Joseph D. Spahn, MD4; 1Children’s Hospital Colorado, Denver, CO, 2Pediatric Associates, Aventura, FL, 3The Breathing Institute, Children’s Hospital Colorado, Aurora, CO, 4Children’s Hospital Colorado, Aurora, CO. RATIONALE: Studies have found African American (AA) asthmatics to be less responsive to systemic and inhaled glucocorticoid (GC) therapy, although this finding remains controversial. METHODS: 131 children (67 Caucasians, 37 Hispanics, 27 AA’s) with moderate asthma had exhaled nitric oxide (FeNO) and spirometry measured before, during and after an acute asthma exacerbation (following a course of prednisone). RESULTS: At baseline, there was no difference in lung function between Caucasians and AA’s. AA’s were more atopic (15.561.5 vs. 9.861.1 positive SPT; p50.005), required higher dose inhaled GC (9986126 vs. 676685 mcg/d; p50.04) and had higher FeNO levels (4265 vs. 2663 ppb; 0.008). Hispanics compared to Caucasians had better lung function but similar FeNO levels. During an acute exacerbation, compared to Caucasians, AAs had the greatest increase in FeNO (7969 vs. 4966; p50.006), while there was no difference in lung function between the groups. Following prednisone therapy, AA’s had the highest FeNO levels (4065 vs. 2563;p50.01) and fewer had a positive FeNO response (level _24 ppb; 71% vs. 30%.; p50.003). Hispanics had the greatest falling to < improvement in both FEV1 and FEF25-75 following prednisone therapy. CONCLUSIONS: Compared to Caucasian children with moderate persistent asthma, AA children had higher FeNO levels at baseline, during an acute exacerbation and following a course of prednisone. In addition, fewer AA’s had a positive FeNO response to prednisone. This suggests that

J ALLERGY CLIN IMMUNOL FEBRUARY 2017

AA children have a greater degree of allergic inflammation at baseline, have a greater inflammatory response during an asthma exacerbation, and have a blunted response to prednisone therapy.

620

Measuring Exhaled Nitric Oxide (FeNO) Improves Assessment of Airway Inflammation and Guides Stepwise Treatment Decisions

Marc Massanari, PharmD1, Nicola Hanania, MD2, Eric Kassel, PharmD1, Craig LaForce, MD3, and Kathy Rickard, MD4; 1 Circassia Pharmaceuticals, Chicago, IL, 2Baylor College of Medicine, Houston, TX, 3North Carolina Clinical Research, Raleigh, NC, 4Circassia Pharmaceuticals, Raleigh, NC. RATIONALE: Assessment of patient’s symptoms and lung function frequently underestimates underlying asthma severity, airway inflammation and risk for future asthma exacerbations. We hypothesized that measurement of FeNO supports clinical assessment at the point of care and provides insights into underlying airway inflammation; thereby helping practitioners to improve asthma control by making stepwise changes in anti-inflammatory treatment. METHODS: The objective of the ASTH2MA survey was to explore the real world impact of measuring FeNO on physician’s treatment decisions. Physicians recorded their assessment of underlying airway inflammation based on patient’s clinical presentation. Patient’s FeNO was then measured using NIOXÒ device. Based on the FeNO result, physicians recorded what changes in drug therapy were made. RESULTS: Data from 337 physician practices which included 7,901 patients with asthma were available for analysis. Clinical impression matched FeNO of low and 50ppb in 33.6% (341/1016) of patients. Changes in treatment were made in 17.8% (904/5083) of patients with FeNO < 25ppb vs 68.4% (695/1016) of patients with FeNO >50ppb. Stepping up/down of inhaled corticosteroids occurred in 26.3%/47.6% when FeNO was 50ppb. CONCLUSIONS: Our results suggest that assessing airway inflammation in asthma is improved by the measurement of FeNO at the point of care and this leads to clinically relevant changes in treatment. More frequently, clinicians stepped up steroids when FeNO was high compared to stepping down when FeNO was low. Additional research is needed to understand why inhaled corticosteroid treatment is not stepped down more frequently.