449 Usefulness of Asthma Control Test Questionnaire, FEV1 and Exhaled Nitric Oxide Level (FENO) for the Clinical Assessment of Elderly Asthma

BACKGROUND: Asthma remains a prevalent disease with significant morbidity and mortality, therefore numerous markers or measurements for the evaluation of its severity are available. Functional parameters, clinical assessment and biomarkers of inflammation are the most used. Also the diagnosis and treatment of asthma are often focused on young patients. This study was intended to determine the usefulness of patient-based questionnaire, Asthma Control Test score (ACT), forced expiratory volume in 1 second (FEV1) and exhaled nitric oxide (FeNO) for clinical assessment of elderly asthma patients. PATIENTS AND METHODS: Sixty seven (67) patients with a diagnosis of asthma more than 65 of age were enrolled. They performed spirometry, FeNO measurement and answered the ACT questionnaire. ACT is scored on a scale from 5 to 25 with higher values reflecting better control. Spirometry measures that met the American Thoracic Society criteria were included. FeNO was measured with values ≥35 ppb indicating probability of airway inflammation. Qui-square test was used for statistical analysis. RESULTS: 67 patients (15% female), mean age of 72.3 (65–89) were included. 25 patients (37.3%) were very poorly controlled, ACT ≤ 15 and mean values of FEV1 81.5+21.5 (% predicted) and mean FeNO of 41 ± 35 ppb. Thirty patients (44.8%) were not-well-controlled, ACT 16 to 19, FEV1 89% ± 16.8, FeNO of 40 ± 36 and 12 patients (17.9%) were well-controlled, ACT ≥ 20, FEV1 93.3 ± 16.8 and FeNO of 44 ± 35. FEV1 as >80% of predicted in 62.4% of patients (ACT 7–25) and 75% of patients with ACT ≥ 20 had FEV1 > 80%. The relation between ACT and FEV1 in this study was statistically significant (P = 0.014). There was no correlation when we evaluated ACT/FeNO and FEV1/FeNo variables (P = 0.45, 0.41 respectively). CONCLUSIONS: A good correlation was found between ACT and FEV1, with higher ACT scores reflecting less bronchial obstruction. FeNO values had no correlation with ACT or FEV1, indicating that this marker of inflammation had less interest for assessment of asthma control in these elderly patients. In spite of these data, we still advise that the clinical assessment of asthma should be based on a combined approach that involves clinical aspects, functional parameters and biomarkers of inflammation, because elderly patients may have reduced symptom perception and have multiple co-morbidity.