RESUMO
We aimed to evaluate the accuracy of baseline exhaled nitric oxide fraction (F(eNO)) to recognise individuals with difficult-to-treat asthma who have the potential to achieve control with a guideline-based stepwise strategy. 102 consecutive patients with suboptimal asthma control underwent stepwise increase in the treatment with maximal fluticasone/salmeterol combination dose for 1 month. Then, those who remained uncontrolled received oral corticosteroids for an additional month. With this approach, 53 patients (52%) gained control. Those who achieved control were more likely to have positive skin results (60.4% versus 34%; p = 0.01), positive bronchodilator test (57.1% versus 35.8%; p = 0.02) and peak expiratory flow variability > or =20% (71.1% versus 49.1%; p = 0.04). Conversely, depression was more frequent in those who remained uncontrolled (18.4 % versus 43.4 %; p = 0.01). An F(eNO) value > or =30 ppb demonstrated a sensitivity of 87.5% (95% CI 73.9-94.5%) and a specificity of 90.6% (95% CI 79.7-95.9%) for the identification of responsive asthmatics. The current results suggest that F(eNO) can identify patients with difficult-to-treat asthma and the potential to respond to high doses of inhaled corticosteroids or systemic steroids.
Assuntos
Albuterol/análogos & derivados , Androstadienos/uso terapêutico , Antiasmáticos/uso terapêutico , Asma/diagnóstico , Asma/tratamento farmacológico , Testes Respiratórios/métodos , Óxido Nítrico/metabolismo , Corticosteroides/uso terapêutico , Adulto , Idoso , Albuterol/uso terapêutico , Ansiedade/diagnóstico , Asma/metabolismo , Broncodilatadores , Depressão/diagnóstico , Combinação de Medicamentos , Monitoramento de Medicamentos/métodos , Resistência a Medicamentos , Quimioterapia Combinada , Feminino , Combinação Fluticasona-Salmeterol , Humanos , Masculino , Pessoa de Meia-Idade , Pico do Fluxo Expiratório/efeitos dos fármacos , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , EspirometriaRESUMO
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Assuntos
Asma/tratamento farmacológico , Anticorpos Monoclonais/uso terapêutico , Antiasmáticos/uso terapêutico , Hospitalização/estatística & dados numéricosRESUMO
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