High exhaled nitric oxide levels correlate with nonadherence in acute asthmatic children

doi:10.1016/j.anai.2017.01.031

中山醫學大學機構典藏 CSMUIR > 醫學院 > 醫學系 > 期刊論文 > Item 310902500/21027

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Title:	High exhaled nitric oxide levels correlate with nonadherence in acute asthmatic children
Authors:	Tsai, Yi-Giien Sun, Hai-Lun Chien, Jien-Wen Chen, hun-Yu Lin, Ching-Hsiung Lin, Ching-Yuang
Contributors:	醫學系
Date:	2017-04-01
Issue Date:	2020-08-10T03:04:18Z (UTC)
Publisher:	Letters
Abstract:	Nonadherence to asthma controller medication is associated with an increased number of acute exacerbations, increased asthma-related emergency department visits and childhood hospitalizations, and high health care costs.1 The average medication adherence rate in children with asthma tends to be poor (<50%). Improving patient adherence is essential to achieving optimal outcomes.2 Measurement of fractional exhaled nitric oxide (FeNO) has been suggested as a sensitive, noninvasive indicator for monitoring T-helper cell type 2 (TH2)-mediated airway inflammation in children with asthma.3, 4 Nonadherence to daily use of inhaled corticosteroids (ICSs) has been implicated as a key contributor to acute asthma exacerbation.5 Using the FeNO measurement in clinical practice is beneficial to predict future exacerbations and can be used to identify poor adherence to anti-inflammatory therapy in patients with allergic asthma.6 Feedback of FeNO findings during an acute asthma exacerbation offers a chance of improving parental knowledge of ICS characteristics by health providers. However, the feasibility and usefulness of FeNO as a diagnostic tool for identifying nonadherence to ICS in children with acute asthma exacerbation has not been established. Identifying nonadherent patients with asthma is difficult and electronic monitoring is the only reliable method to assess ICS adherence, but this is not routinely available in clinical practice.5 The Hill-Bone Medication Adherence Scale (HBMAS) is a well-validated instrument for determining adherence to hypertension medications.7 In this study, a modified short-form HBMAS for asthma control was administered to assess the behavioral domains of asthma control treatment, taking medication, and keeping appointments. The availability of short screening tools can increase awareness and identify barriers of adherence to asthma control medication.8 The characteristics of the 102 subjects are shown in the eMethods section and eTable 1. Their median Childhood Asthma Control Test scores4 were 19.0 (18.4–20.1) and 30% had a previous emergency department visit, including 22% with a history of hospitalization in the past year. For asthma control treatment, 68% were prescribed an ICS, 13% were prescribed an ICS and a long-acting β2-adrenergic agonist, and 80% were prescribed leukotriene modifiers. The HBMAS was used to dichotomize the responses as “perfect adherence” (9 points) and “imperfect adherence” (>9 points; Table 1), and only 32 patients (31%) with asthma reported perfect adherence (eTable 1).
URI:	https://ir.csmu.edu.tw:8080/ir/handle/310902500/21027
Relation:	Letters / Ann Allergy Asthma Immunol 118 (2017) 505e523
Appears in Collections:	[醫學系] 期刊論文

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