February 2009

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FENO Falls Shorts in Managing Mild to Moderate Asthma …
Dutch researchers publishing in the January issue of the American Journal of Respiratory and Critical Care Medicine find no advantage to adding daily measurement of the fractional exhaled nitric oxide (FENO) to symptom monitoring when calibrating medications in children with mild to moderate asthma. The results are based on a study of 151 children from 15 centers who were randomly assigned to either the symptom only or symptom plus FENO group. FENO was assessed via telemonitoring. Symptom control improved for both groups by the end of the 30 week study, and inhaled steroid doses were reduced by about 50% for all. The authors speculate that daily supervision and frequent phone contacts produced improvements that could not be augmented by the addition of FENO monitoring. They believe more study is needed, however, to determine the role of FENO in children with severe asthma. READ PRESS RELEASE—READ ABSTRACT

… But Comes Out on Top in British Study
While Dutch researchers found no advantage to adding FENO monitoring to daily measurement of symptoms in their study (see previous article), British investigators found measuring FENO via a hand-held monitor was both effective and cost-effective in a study comparing FENO for asthma diagnosis and management with standard care. For diagnosis, FENO was compared to lung function measurements and reversibility testing, bronchial provocation, and sputum eosinophil count. For management, it was compared to symptom monitoring and lung function measurements in standard care. Results showed asthma diagnosis and management using FENO was less costly, but equally effective, to standard care. The study was published in the January 29 Epub edition of Allergy. READ ABSTRACT

Simulator Testing Improves Accuracy of DLco Devices
A new study out of Salt Lake City, UT, finds regular simulator testing of single-breath diffusing capacity of the lung for carbon monoxide (DLco) devices helps maintain the accuracy of DLco measurements and can reduce variability across laboratories participating in multicenter clinical trials. The research involved 125 labs taking part in a large study on inhaled insulin. All used a DLco simulator to validate and monitor the accuracy of their DLco measuring device. Devices were considered to have failed testing if they measured a simulated DLco different from target by >3 mL.min(-1).mmHg(-1). At the beginning of the study, 25% of the labs had a device that failed testing. After these devices were repaired or replaced, 99% of the labs had devices that passed testing, and the percentage of failed tests significantly decreased over time. Differences in geographical region, device type, breath-hold time, temperature, and pressure were not associated with meaningful differences in DLco device accuracy. The findings were published in the January 7 Epub edition of the European Respiratory Journal. READ ABSTRACT

Lung Function at Age 30 in People with Alpha-1
Between 1972 and 1974, all newborns in Sweden were screened for alpha-1-antitrypsin (AAT) deficiency, and those identified with the condition have been followed on a regular basis over the years. A new study looked at standard lung function measurements in these individuals when they reached the age of 30, comparing them with those obtained from age-matched controls. Among the group, 60 were diagnosed with severe AAT deficiency, while 19 were considered to have moderate deficiency. Results showed normal lung function in both groups, but smokers in the severe deficiency group demonstrated lung function changes that may be early signs of emphysema. The study appeared in the January 30 Epub edition of Respiratory Medicine. READ ABSTRACT