http://repub.eur.nl/res/aut/52137/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/37365/ 2012-10-03T00:00:00Z Respiratory disease is frequently present in childhood. It can be divided into upper airway disease and lower airway or lung disease. Two important lung diseases in childhood are cystic fibrosis (CF) and asthma. They are important because CF is the most common lethal genetic disease in the Caucasian population and asthma is one of the most frequent chronic diseases of childhood, with a prevalence of approximately 10% of children in the Western world. In both lung diseases the small airways, located in the periphery of the lung, are frequently affected. To provide optimal care for patients with lung disease it is important to accurately measure the severity of lung disease and to effectively treat the affected airways. http://repub.eur.nl/res/pub/33991/ 2011-12-01T00:00:00Z Better treatment of obstructed small airways is needed in cystic fibrosis. This study investigated whether efficient deposition of dornase alfa in the small airways improves small airway obstruction. In a multicentre, double-blind, randomised controlled clinical trial, cystic fibrosis patients on maintenance treatment with 2.5 mL dornase alfa once daily were switched to a smart nebuliser and randomised to small airway deposition (n=24) or large airway deposition (n=25) for 4 weeks. The primary outcome parameter was forced expiratory flow at 75% of forced vital capacity (FEF75%). FEF75% increased significantly by 0.7 SD (5.2% predicted) in the large airways group and 1.2 SD (8.8%pred) in the small airways group. Intention-to-treat analysis did not showa significant difference in treatment effect between groups. Per-protocol analysis, excluding patients not completing the trial or with adherence <70%, showed a trend (p=0.06) in FEF75% Z-score and a significant difference (p=0.04) between groups in absolute FEF75% (L·s-1) favouring small airway deposition. Improved delivery of dornase alfa using a smart nebuliser that aids patients in correct inhalation technique resulted in significant improvement of FEF75% in children with stable cystic fibrosis. Adherent children showed a larger treatment response for small airway deposition. Copyright http://repub.eur.nl/res/pub/13852/ 2005-10-01T00:00:00Z RATIONALE: Corticosteroids are the antiinflammatory treatment of choice in asthma. Treatment guidelines are mainly symptom-driven but symptoms are not closely related to airway inflammation. The fraction of nitric oxide in exhaled air (FENO) is a marker of airway inflammation in asthma. OBJECTIVE: We evaluated whether titrating steroids on FENO improved asthma management in children. METHODS: Eighty-five children with atopic asthma, using inhaled steroids, were allocated to a FENO group (n=39) in which treatment decisions were made on both FENO and symptoms, or to a symptom group (n=46) treated on symptoms only. Children were seen every 3 months over a 1-year period. MEASUREMENTS: Symptoms were scored during 2 weeks before visits and 4 weeks before the final visit. FeNO was measured at all visits, and airway hyperresponsiveness and FEV1 were measured at the start and end of the study. Primary endpoint was cumulative steroid dose. RESULTS: Changes in steroid dose from baseline did not differ between groups. In the FENO group, hyperresponsiveness improved more than in the symptom group (2.5 vs. 1.1 doubling dose, p=0.04). FEV1 in the FENO group improved, and the change in FEV1 was not significantly different between groups. The FENO group had 8 severe exacerbations versus 18 in the symptom group. The change in symptom scores did not differ between groups. FENO increased in the symptom group; the change in FENO from baseline differed between groups (p=0.02). CONCLUSION: In children with asthma, 1 year of steroid titration on FENO did not result in higher steroid doses and did improve airway hyperresponsiveness and inflammation.