FeNO is a reasonably robust estimate of the presence of eosinophilic airway inflammation across a wide range of patients differing in diagnosis (294). Information on what constitutes a clinically relevant change in sputum neutrophils is required. Juniper EF, Price DB, Stampone PA, Creemers JPHM, Mol SJM, Fireman P. Clinically important improvements in asthma-specific quality of life, but no difference in conventional clinical indexes in patients changed from conventional beclomethasone dipropionate to approximately half the dose of extrafine beclomethasone dipropionate. Expired nitric oxide levels during treatment of acute asthma. As regards time off school, and consequent parental costs, more work is needed to clarify what influences need for school absence, which may not always reflect loss of asthma control alone (i.e., it may also be influenced by other socioeconomic factors). To provide consensus recommendations on standardized measures of asthma control and exacerbations that can be obtained retrospectively from existing clinical trial data, to maximize the potential for pooling of data, and making comparisons between clinical trials. A reasonable estimate of the between- and within-subject standard deviation (in log 10 units) of the sputum differential eosinophil count in asthma is 0.75 and 0.4, respectively. Hargreave FE, Ryan G, Thomson NC, O'Byrne PM, Latimer K, Juniper EF, Dolovich J. In patients with asthma, the sputum differential eosinophil count tends to be right-skewed. The protocols for sputum induction differ mainly in the output of the ultrasonic nebulizer used, and sputum processing (sputum plugs or whole sample selection). However, airway resistance tests have some disadvantages, including equipment costs, few validation studies, the need for trained technologists, and the lower signal–noise ratio compared with FEV1 measurements (181). Asthma control is best considered as a scale or continuum; that is, one should not refer to “achieving asthma control” to imply achieving good control (6). Chanez P, Wenzel SE, Anderson GP, Anto JM, Bel EH, Boulet L-P, Brightling CE, Busse WW, Castro M, Dahlen B. Buhl R. Omalizumab (Xolair) improves quality of life in adult patients with allergic asthma: a review.

To provide a summary of the interval between infrequent clinic visits, composite scores may be recorded in a diary. Its methodology has been carefully standardized, and its measurement allows comparison of the study population with most other studies, as it has been by far the most commonly reported outcome variable in asthma studies to date. Measurement of post-BD FEV1 over many years is recommended for monitoring growth and decline in lung function, because it is less affected by variability in smooth muscle tone. Reference values for percent predicted FEV1 and/or FVC are primarily used for inclusion or exclusion criteria for clinical trials (139), and to characterize the study population.

They will not be considered further. For any pediatric QOL instrument, the study protocol should specify whether the carer or the child should answer the QOL measure. Effect of deep inspiration on airway caliber in children with asthma. The present Task Force was established in response to a symposium at the European Respiratory Society (ERS) Congress in Vienna in September 2003. High fractional concentration of nitric oxide in exhaled air despite steroid treatment in asthmatic children. Validity of the scale was demonstrated by confirmation of expected group differences, and the retest reproducibility was 0.948. Seven Working Groups of three to five members provided detailed reports about: exacerbations, diary data, physiologic measures, composite scores, biomarkers, indirect measures, and quality-of-life questionnaires. Asthma severity is defined as the difficulty in controlling asthma with treatment.

However, clinical trials in asthma have often focused on outcomes that are primarily of importance to the clinician, such as symptom scores or lung function. What are minimal important changes for asthma measures in a clinical trial? For closely consecutive courses of corticosteroids, some studies count two courses separated by at least 1 week as separate severe exacerbations; this lacks firm evidence, but there are advantages in a standardized approach.

Michils A, Baldassarre S, Van Muylem A. Exhaled nitric oxide and asthma control: a longitudinal study in unselected patients. Ahole, je l’utilise pour exprimer la compréhension, «ah ok » ou « ok ». Simeoni M-C, Schmidt S, Muehlan H, Debensason D, Bullinger M, Disabkids Group. Kips JC, Pauwels RA. Comparison of the forced oscillation technique and the interrupter technique for assessing airway obstruction and its reversibility in children. With electronic spirometric monitoring, significant between-group differences can be seen even in very mild asthma, where no differences in symptoms are detectable (121). Several HRQOL instruments have been developed and validated, with an estimate of an MID in HRQOL score provided for some of these.

FeNO is a prototype for the application of biomarkers in children with asthma, and may be helpful in decisions on starting and stopping ICS, and perhaps monitoring medication effects. Three community-based studies have assessed induced sputum inflammatory cell counts in normal subjects, producing very similar estimates of normal ranges, with the upper limit of normal for sputum eosinophil differential count being 1.9% (Table E2) (267–269). The most appropriate spirometry outcome variable is pre-BD FEV1, adjusted for baseline. Compliance with peak expiratory flow monitoring in home management of asthma. The relative utility of electronic PEF monitoring and spirometry in the diagnosis and monitoring of asthma in the community needs to be evaluated more fully. Their use in clinical trials enables numeric comparisons of treatment effects to be made. In selecting criteria to prospectively define severe exacerbations, one must balance specificity against safety. Timonen KL, Randell JT, Salonen RO, Pekkanen J. Reddel HK, Belousova EG, Marks GB, Jenkins CR. Threshold values for each of these outcome variables, which are usually derived from goals of treatment in asthma guidelines (8, 9, 238), are mostly arbitrary. More information is required on the utility of FeNO measurement as a tool for monitoring asthma control. In a meta-analysis, paper- and computer-administered versions of patient-reported outcomes were found to be equivalent (91). Kharitonov SA, Yates D, Robbins RA, Logan-Sinclair R, Shinebourne EA, Barnes PJ. Juniper and colleagues developed and validated a daily diary from the Asthma Control Questionnaire (ACQ), and found that its measurement properties over a single week were similar to those of the ACQ itself, recorded at the end of the same week (82). Woolcock A, Rubinfeld AR, Seale JP, Landau LL, Antic R, Mitchell C, Rea HH, Zimmerman P. Thoracic Society of Australia and New Zealand. To standardize the measurement of “on-treatment” FEV1, it should be performed after withholding SABA appropriately. Repeatability of spirometry in 18,000 adult patients. Cooling of expired air condenses exhaled breath, which contains water vapor, respiratory droplets, and particles. Symptom-free days is a useful endpoint for pediatric asthma studies, and easier to record than symptom scores. Ambulatory lung function is highly responsive to ICS or LABA treatment, with morning PEF more responsive than evening PEF (118, 119), and morning and evening PEF more responsive than morning and evening FEV1 (26). *“Predictors” are modifiable factors that have been observed to be associated with increased risk of adverse asthma outcomes in the future (such as exacerbations, future poor asthma control, and accelerated decline in lung function, or side effects of treatment), and that can be used as surrogate measures in studies in which the adverse outcomes cannot be directly measured.

Currently, the most frequently used indirect stimuli, which involve multiple cellular pathways, are hypertonic saline, adenosine monophosphate (AMP), and mannitol (182, 183, 185). Les discussions entre Ivoiriens sont souvent ponctuées de hanhan, han, djooo, tchié, etc.

A shortcoming of the ACQ is the observation that most patients' scores are less than or equal to 2.5, with scores of greater than or equal to 4 only occurring with severe exacerbations. Inflammatory cell counts can also be expressed as total count (i.e., total cell count × proportion of that inflammatory cell). Cluster analysis has demonstrated that with sputum-guided therapy, the majority of benefit in reducing exacerbations occurs in patients with inflammation-predominant asthma, whereas the majority of benefit in reducing ICS dose is seen in patients with predominant symptoms and little inflammation (288). Composite scores have the potential to be used as primary or coprimary endpoints in clinical trials. Achi : cécé (Je ne te crois pas ), Kouadio : Je ne blague pas, c’est sur The present Task Force has provided a redefinition of the concepts of asthma control and severity (6), so that the rationale behind the assessment of asthma may be improved.

Massaro AF, Gaston B, Kita D, Fanta C, Stamler JS, Drazen JM. Effect of inhaled formoterol and budesonide on exacerbations of asthma. Change in FEV1 is also moderately associated with change in PEF (174). There is no current standard method of reporting systemic corticosteroid usage and no documented “normal” range. Wallenstein GV, Carranza-Rosenzweig J, Kosinski M, Blaisdell-Gross B, Gajria K, Jhingran P. A psychometric comparison of three patient-based measures of asthma control. Task Force members were asked to refer where possible to published guidelines or recommendations about methodology relevant to their Working Group, and to identify additional papers that evaluated measurement properties or clinical associations for the nominated outcome variables from further literature searches. Validation of symptom and reliever diaries. Values within these limits are indicative of acceptable biological and technical variability.

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