Optimized asthma therapy for symptom-free patients
Case study: 13-year-old asthmatic Lina
Diagnosis: exercise-induced asthma
Living a normal life despite illness
Lina is now 13 years old. Her doctor first diagnosed her with exercise-induced asthma while she was still in elementary school. She was also found to have allergies to cat fur, dust mites, and hay fever. As treatment, he first prescribed an on-demand and a low-dose ICS spray.
He subsequently adjusted her medication based on the progression of the disease and evidence of inflammation. The pulmonologist based his diagnosis and therapy decision to a large degree on FeNO home measurement. Lina has since been largely symptom-free and can pursue her hobby of artistic gymnastics.
Specialist Dr. Speidel on the benefits of FeNO home measurement
Dr. Speidel, MD, talks about the benefits of FeNO measurement in an interview.
Trust is good, control is better!
FeNO home measurement supports asthma monitoring
Dr. med. Frieder Speidel is a pediatric pulmonologist and Lina’s family doctor. He regularly determines her FeNO value at his office. In addition, the teenager uses the Vivatmo me from Bosch about once a week. The breath analyzer for patients measures the inflammatory marker fractional exhaled nitric oxide (FeNO). This value increases as a result of inflammatory processes in the mucous membrane of the airways. Lina can operate the portable device independently at home and documents her measured values in the accompanying asthma diary app. This allows both her parents and her doctor to view the readings in a monthly overview and check her compliance.
“I want my young patients to have a life that is as symptom-free as possible and a good long-term prognosis. FeNO home measurement provides me with additional insights that I take into account in my therapy planning.”
Indications for adjusting the therapy
Symptoms and high FeNO values
Although Lina’s asthma had been well managed for some time, she increasingly complained of asthma symptoms in winter. She could only manage school sports and gymnastics if she additionally took her on-demand spray. Lina noticed a clear deterioration – especially the “wheezing” sound when she exhaled unsettled her. She and her parents decided to consult the pediatric pulmonologist. Together they searched for the cause of the deterioration. They were immediately able to rule out a lack of compliance with therapy because Lina always used her ICS spray conscientiously. A temporary deterioration due to the cold winter air was also a possibility. But that alone would not have been a compelling reason to change her treatment. So they looked at the FeNO values that Lina had regularly measured and documented at home.
According to ATS/ERS recommendations, FeNO levels in children should typically be below 20 parts per billion (ppb). A FeNO value above 35 ppb already indicates an acute allergic inflammatory event in the lungs. In Lina’s case, the values had regularly risen to over 120 ppb and were thus significantly above her individual normal values. It thus became clear to all involved that the inflammation was permanently too high due to Lina’s asthma. For her doctor, this in combination with her symptoms was a clear sign that he needed to adjust her medication: He prescribed Lina a higher-dose ICS, which she has been using twice a day ever since. Her FeNO levels dropped significantly to her normal range within a few days, and her symptoms disappeared.
“In the beginning, we were concerned about the cortisone. But the FeNO values clearly showed that Lina has an inflammation in her lungs that needs to be treated. We could really see the levels going down. That shows me that the medication is helping.”
Summary
Case study: 13-year-old asthmatic Lina
The case of teenager Lina shows that there are many factors that can influence asthma symptoms. Environmental factors like cold air in winter and pollen count in spring. Or patient behavior such as physical stress, adherence and much more. On the basis of a good medical history and using conventional measuring methods such as peak flow, an experienced physician can determine the current state of an asthma patient’s illness relatively well, and adjust the therapy accordingly. However, FeNO measurement can help them develop a more holistic understanding of the course of the disease, adherence, and therapy success. Especially if patients also measure regularly at home and record their FeNO values and possible influencing factors in an asthma diary.
Lina had documented an inflammation over a longer period of time with the help of FeNO home measurement and the Vivatmo app. The progression data supported her pulmonologist in his decision to adjust her medication. The course of the measured values allows conclusions to be drawn about the inflammatory process in the bronchial tubes. After the intervention, the FeNO values enable all parties involved to understand the patient’s compliance and the response to ICS therapy. In this way, it was also possible to convince Lina’s parents that an increased dose of ICS spray is meaningful and necessary.
