1. Asthma control test (ACT) scores and FeNO correlation
Yıldırım BZ, Doğan İ, S Serbest, Güven K, Gemicioğlu B.

2. Aim
To evaluate the correlation of ACT and FeNO in asthma control in asthmatics

3. GINA 2006 and Consept of Control
Characteristic
Controlled (all of the following)
Partly controlled (any measure present in any week
Uncontrolled
Daytime symptoms
None (twice or less/week)
More than twice/week
Three or more features of partly controlled asthma present in any week
Limitation of activities
None
Any
Nocturnal symptoms
Need for rescue treatment
Lung function (FEV1 or PEF)
Normal
<80%predicted or personal best
Exacerbations
One or more/year
One in any week

4. Asthma Control Test (ACT)
ACT is a validated, practical instrument to evaluate asthma control
ACT measures the quality of asthma control objectively by using simple numerical values as the target of treatment
It is reliable, valid and sensitive to fluctuations in asthma control over time

6. FeNO
NO is a noninvasive marker of inflammation
It reveals the eosinophilic inflammation and response to corticosteroids in asthmatic patients.

7. Evaluation of FeNO in Patients Receiving Antiinflamatory Treatment
Low
Normal
Medium
High
Eosinophilic inflammation
Unlikely
Present but mild
Prominent
FeNO ppb
<5
5-25
25-50
>50
Consider smoker
Symptom+
reconsider diagnosis:
Neutrophilic asthma
Anxiety
Rhinosinusitis
GERD
Symptom-
full compliance
Infection
Contact with allergen
Combine ICS with another drug
Increase ICS
Do not change the treatment
İnsufficient treatment
-İncompliance to treatment
-technical difficulties
-İnsufficient ICS
-continous contact with allergens
Kharitonov et al., Eur Respir J :433-8

8. Method
ACT, pulmonary functions and FeNO were measured in 71 cases who were diagnosed as persistent asthma and were receiving combined therapy

9. Epidemiological and Functional Characteristics of Our Cases
Female/male
48(%67)/23(%33)
Mean age
41± 13,5
Smoking history
22 (%28,6)
+allergic rhinitis
63 (%88,7)
Mean FEV1
2,4±1 lt (%80,7 ±19)
Emergency visit
16 (%22,5)
Hospitalization
6 (%8,5)

10. Findings
Mean AST score
19 ± 6
Mean FeNO (ppb)
38 ± 38

11. Mean ACT Scores

12. Mean FeNO

13. ACT-FeNO ACT<20 ACT>20 NO<25 ppb 10 (%14) 20 (%28)
23 (%32)
18 (%25)

14. ACT-FEV1 AKT<20 AKT>20 FEV1>%80 14 (%20) 30 (%42)
9 (%13)
7 (%10)
FEV1<%60
2 (%3)

15. FEV1-FeNO NO<25 ppb NO>25 ppb FEV1>%80 21(%30) 23 (%32)
3 (%4)
13 (%18)
FEV1<%60
6 (%8)
5 (%7)

16. ACT-FeNO
ACT scores were found to be negatively correlated with FeNO (by using Pearson correlation test r=-0,342; p=0,004).

17. ACT-FeNO Correlation

18. Conclusions ACT and NO are negatively correlated
In patients whose ACT scores mean controlled, anti-inflammatory therapy yet may be insufficient.
ACT is useful in symptomatic and functional follow-up in asthmatic patients but may not be sufficient in evaluating the inflammation

19. Conclusions
Routine NO measurement combined with ACT may be helpful in adjusting the antiinflammatory treatment in patients who are considered controlled according to ACT only