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Different techniques have been proposed to measure antibiotic levels within the lung parenchyma; however, their use is limited because they are invasive and associated with adverse effects. We explore whether beta-lactam antibiotics could be measured in exhaled breath condensate collected from heat and moisture exchange filters (HMEFs) and correlated with the concentration of antibiotics measured from bronchoalveolar lavage (BAL). We designed an observational study in patients undergoing mechanical ventilation, which required a BAL to confirm or discard the diagnosis of pneumonia. We measured and correlated the concentration of beta-lactam antibiotics in plasma, epithelial lining fluid (ELF), and exhaled breath condensate collected from HMEFs. We studied 12 patients, and we detected the presence of antibiotics in plasma, ELF, and HMEFs from every patient studied. The concentrations of antibiotics were very heterogeneous over the population studied. The mean antibiotic concentration was 293.5 (715) ng/mL in plasma, 12.3 (31) ng/mL in ELF, and 0.5 (0.9) ng/mL in HMEF. We found no significant correlation between the concentration of antibiotics in plasma and ELF (R2 = 0.02, p = 0.64), between plasma and HMEF (R2 = 0.02, p = 0.63), or between ELF and HMEF (R2 = 0.02, p = 0.66). We conclude that beta-lactam antibiotics can be detected and measured from the exhaled breath condensate accumulated in the HMEF from mechanically ventilated patients. However, no correlations were observed between the antibiotic concentrations in HMEF with either plasma or ELF.
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The quarrying is considered a precarious occupation with high toxicity, is an informal economic activity that employs low technology, limited protection, and poses a risk to workers and their families. In quarrying, silica dust is generated and there is also occupational exposure to significant mixtures of pneumotoxic pollutants, including mineral dust (crystalline silica, carbon or cement, polycyclic aromatic hydrocarbons (PAHs), solvents, and others, which are aggravated by the lack of use of protective equipment, causing irreversible damage to the worker's respiratory health. Thus, the objective of this work focused on the evaluation of the respiratory health of artisan stonemasons in San Luis Potosí, Mexico through the study of exhaled breath condensate (EBC) (pH, pro-inflammatory cytokines) as well as the study of the exposure to pollutants present in the work area (PAHs, toluene, and 2.5 µm particulate matter) through biomarkers of exposure (hippuric acid and hydroxylated metabolites of PAHs). The results show the presence of crystalline SiO2 in 100% of the samples analyzed; the PM2.5 concentrations were 5 to 10 times the permitted levels. Regarding exposure to PAHs, all the stonemasons presented urine concentrations of at least 5 of the OH-PAHs evaluated; 9-OH-FLU occurred at higher concentrations of 171.2 (122.7-279.4) µg L-1; hippuric acid, which was present in 100% of the workers evaluated in concentrations of 283.4 (27.72-1119) mg L-1, 100% of which were above the values established for occupational scenarios. The pH values obtained for the EBC samples were presented at an average of 7.07 (6.33-7.66). Pro-inflammatory cytokines were present in 86.1% of the study population. The cytokine that was found in higher concentrations was IL-2, with a mean of 178.01 pg mL-1 and 3124.01 pg mL-1 for the pH < 7 and pH > 7 groups, respectively. Some correlations between the cytokines and the exposure biomarkers were presented. Stonemasons are highly exposed to pneumotoxic pollutants and markers of inflammation at the pulmonary level; in addition, a high risk of developing silicosis. Quarrying should be addressed as a carcinogenic activity, which would imply the design of monitoring and control strategies for these pollutants that our country currently lacks, particularly in precarious occupations. It is necessary to develop strategies to protect the health of precarious workers.
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Contaminantes Ambientales , Exposición Profesional , Hidrocarburos Policíclicos Aromáticos , Biomarcadores/metabolismo , Citocinas , Polvo , Monitoreo del Ambiente/métodos , Humanos , Exposición Profesional/análisis , Hidrocarburos Policíclicos Aromáticos/análisis , Dióxido de SilicioRESUMEN
Tuberculosis (TB) is one of the highest infectious burdens worldwide. An excess of inflammation and inadequate antioxidant defense mechanisms are believed to lead to chronic inflammation and lung damage in tuberculosis (TB). However, circulating metabolites do not always replicate lung-associated biomarkers that define the pathobiology of the disease. The objective of this study was to determine the utility of exhaled breath condensate (EBC), a non-invasive and straightforward sample, to evaluate alveolar space-derived metabolites of redox state and inflammation. We assessed the levels of exhaled oxidant/antioxidant parameters (8-isoprostane, MDA, GSH), inflammatory markers, such as nucleosomes, cytokines (IL-2, IL-4, IL-6 and IL-8, IL-10, GM-CSF, TNF-α, and IFN-γ) and lipid mediators (PGE2, LTB4, RvD1, and Mar1), in patients with recently diagnosed pulmonary TB and healthy controls' EBC and serum. The TB patients showed 36% lower GSH levels, and 2-, 1.4-, 1.1-, and 50-fold higher levels of 8-isoprostanes, nucleosomes, IL-6, and LTB4, respectively, in EBC. There was no correlation between EBC and serum, highlighting the importance of measuring local biomarkers. Quantitation of local inflammatory molecules and redox states in EBC would help find biomarkers useful for pharmacological and follow-up studies in pulmonary tuberculosis.
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We demonstrate the formation of stable spatially-ordered states in auniformand alsotrappedquasi-two-dimensional (quasi-2D) Rashba or Dresselhaus spin-orbit (SO) coupled pseudo spin-1/2 Bose-Einstein condensate using the mean-field Gross-Pitaevskii equation. For weak SO coupling, one can have a circularly-symmetric (0, +1)- or (0, -1)-type multi-ring state with intrinsic vorticity, for Rashba or Dresselhaus SO coupling, respectively, where the numbers in the parentheses denote the net angular momentum projection in the two components, in addition to a circularly-asymmetric degenerate state with zero net angular momentum projection. For intermediate SO couplings, in addition to the above two types, one can also have states with stripe pattern in component densities with no periodic modulation in total density. The stripe state continues to exist for large SO coupling. In addition, a new spatially-periodic state appears in the uniform system: asuperlatticestate, possessing some properties of asupersolid, with a square-lattice pattern in component densities and also in total density. In a trapped system the superlattice state is slightly different with multi-ring pattern in component density and a square-lattice pattern in total density. For an equal mixture of Rashba and Dresselhaus SO couplings, in both uniform and trapped systems, only stripe states are found for all strengths of SO couplings. In a uniform system all these states are quasi-2D solitonic states.
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We study supersolid-like states in a quasi-two-dimensional trapped Rashba and Dresselhaus spin-orbit (SO) coupled spin-1 condensate. For small strengths of SO couplingγ(γ⪠0.75), in the ferromagnetic phase, circularly-symmetric (0, ±1, ±2)- and (∓1, 0, ±1)-type states are formed where the numbers in the parentheses denote the angular momentum of the vortex at the center of the components and where the upper (lower) sign correspond to Rashba (Dresselhaus) coupling; in the antiferromagnetic phase, only (∓1, 0, ±1)-type states are formed. For large strengths of SO coupling, supersolid-like superlattice and superstripe states are formed in the ferromagnetic phase. In the antiferromagnetic phase, for large strengths of SO coupling, supersolid-like superstripe and multi-ring states are formed. For an equal mixture of Rashba and Dresselhaus SO couplings, only a superstripe state is found. All these states are found to be dynamically stable and hence accessible in an experiment and will enhance the fundamental understanding of crystallization onto radially periodic states in solids.
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PURPOSE: The purpose of this study was to compare pulmonary and plasma markers of oxidative stress and inflammation after concentric and eccentric cycling bouts in individuals with chronic obstructive pulmonary disease (COPD). METHODS: Ten patients with moderate COPD level (68.3 ± 9.1 years; forced expiratory volume in 1 s = 68.6 ± 20.4% of predicted) performed 30 min of moderate-intensity concentric (CONC-M: 50% maximum concentric cycling power output; POmax) and eccentric cycling (ECC-M: 50% POmax), and high-intensity eccentric cycling (ECC-H: 100% POmax) in a randomised order. Cardiometabolic demand was monitored during cycling. Indirect markers of muscle damage were assessed before, immediately after, 24 and 48 h after cycling (muscle strength, muscle soreness and creatine kinase activity). Plasma oxidative stress (malondialdehyde: MDA), antioxidant (glutathione peroxidase activity: GPx) and inflammatory markers (IL-6, TNF-α) were measured before and 5 min after cycling. Exhaled breath condensate (EBC) samples were collected before and 15 min after cycling and analysed for hydrogen peroxide (H2O2), nitrites (NO2-) and pH. RESULTS: Cardiometabolic demand was 40-50% lesser for ECC-M than CONC-M and ECC-H. Greater muscle damage was induced after ECC-H than ECC-M and CONC-M. MDA decreased immediately after CONC-M (- 28%), ECC-M (- 14%), and ECC-H (- 17%), while GPx remained unchanged. IL-6 increased only after ECC-H (28%), while TNF-α remained unchanged after exercise. Pulmonary H2O2, NO2- and pH remained unchanged after exercise. CONCLUSION: These results suggest that only moderate muscle damage and inflammation were induced after high-intensity eccentric cycling, which did not induce pulmonary or plasmatic increases in markers of oxidative stress. TRIAL REGISTRATION NUMBER: Trial registration number: DRKS00009755.
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Biomarcadores/metabolismo , Ergometría , Inflamación/metabolismo , Estrés Oxidativo/fisiología , Enfermedad Pulmonar Obstructiva Crónica/metabolismo , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Anciano , Ingestión de Energía/fisiología , Femenino , Humanos , Peróxido de Hidrógeno/metabolismo , Concentración de Iones de Hidrógeno , Masculino , Fuerza Muscular/fisiología , Nitritos/metabolismo , Consumo de Oxígeno/fisiología , Encuestas y CuestionariosRESUMEN
Quantum turbulence deals with the phenomenon of turbulence in quantum fluids, such as superfluid helium and trapped Bose-Einstein condensates (BECs). Although much progress has been made in understanding quantum turbulence, several fundamental questions remain to be answered. In this work, we investigated the entropy of a trapped BEC in several regimes, including equilibrium, small excitations, the onset of turbulence, and a turbulent state. We considered the time evolution when the system is perturbed and let to evolve after the external excitation is turned off. We derived an expression for the entropy consistent with the accessible experimental data, which is, using the assumption that the momentum distribution is well-known. We related the excitation amplitude to different stages of the perturbed system, and we found distinct features of the entropy in each of them. In particular, we observed a sudden increase in the entropy following the establishment of a particle cascade. We argue that entropy and related quantities can be used to investigate and characterize quantum turbulence.
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PURPOSE: The respiratory redox-state of swimmers can be affected by chronic exposures to chlorinated pools, and the effects of different exercises on it are unknown. Our aim was to compare two exercises performed at high-intensity and under habitual environmental conditions (swimming indoor vs. running outdoor) on the production of pro-oxidants (hydrogen peroxide and nitrite) and pH in exhaled breath condensate (EBC) and spirometry parameters in competitive swimmers chronically exposed to chlorinated pools. METHODS: Seventeen men and women (mean age ± SD = 21 ± 2 years) swam 3.5 km in an indoor pool treated with Cl2, and after 2-weeks, they ran 10 km outdoors. The pHEBC, [H2O2]EBC, [NO2-]EBC, [NO2-]EBC/[NO2-]Plasma and spirometry parameters were analyzed pre-exercise and 20 min and 24 h after exercise ended. RESULTS: Two mixed models were applied to compare EBC parameters between swimming and running. Lower levels of [H2O2]EBC and [NO2-]EBC (p = 0.008 and p = 0.018, respectively) were found 24-h post-swimming, and the same trend was observed for [NO2-]EBC/[NO2-]Plasma (p = 0.062). Correlations were found in both exercises between pre-exercise levels of pHEBC, [H2O2]EBC, [NO2-]EBC, and [NO2-]EBC/[NO2-]Plasma and their changes (Δ) after 24-h as well as between [H2O2]EBC and [NO2-]EBC for basal levels and for changes after 24 h. A relationship was also found for running exercise between pulmonary ventilation and changes after 24 h in [H2O2]EBC. Spirometry data were unaffected in both types of exercise. CONCLUSION: In competitive swimmers, at 24-h acute post-exercise follow-up, swimming decreased and running increased pro-oxidant biomarkers of pulmonary origin, without changes in lung function.
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Peróxido de Hidrógeno/análisis , Especies Reactivas de Oxígeno/análisis , Carrera/fisiología , Natación/fisiología , Pruebas Respiratorias , Femenino , Humanos , Concentración de Iones de Hidrógeno , Masculino , Estrés Oxidativo/fisiología , Adulto JovenRESUMEN
ETHNOPHARMACOLOGICAL RELEVANCE: Vernonia condensata Baker (Asteraceae) is traditionally used in South American Countries as an anti-inflammatory, analgesic and hepatoprotective. AIM OF THE STUDY: This study aimed to investigate the in vivo hepatoprotective and antioxidant, and the in vitro anti-inflammatory activities of the ethyl acetate partition (EAP) from the ethanolic extract of this medicinal plant leaves. MATERIALS AND METHODS: For the in vivo hepatoprotective activity, rats were pretreated orally for seven days with vehicle, silymarin 100mg/kg or EAP 50, 100 and 200mg/kg. Then, acetaminophen 3g/kg was also orally administrated. Animals were euthanatized 24h after the damage inducement. The levels of the serum enzymes ALT, AST and ALP were determined, as well as the triglycerides, total cholesterol and fractions. The antioxidant activity was evaluated by TBARS assay and by the measurement of glutathione reductase, superoxide dismutase and catalase activities in the rats liver tissue. The in vitro anti-inflammatory assay using Raw 264.7 cell line induced by lipopolysaccharide was conducted to verify EAP ability to inhibit pro-inflammatory cytokines. RESULTS: EAP was able to inhibit all the acute biochemical alterations caused by acetaminophen overdose. EAP inhibited malondialdehyde formation, maintained the catalase and increased the glutathione reductase activities. Also, EAP decreased NO, IL-6 and TNF-α levels at concentrations from 10 to 20µg/mL. 1,5-dicaffeoylquinic acid was isolated and identified as the major compound in EAP. Apigenin, luteolin, chlorogenic acid were also identified. EAP anti-inflammatory action may be due to its antioxidant activity or its capacity to inhibit the pro-inflammatory cytokines. CONCLUSION: These results strongly suggested that V. condensata may be useful as a possible therapy against liver damage.
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Antiinflamatorios/farmacología , Antioxidantes/farmacología , Enfermedad Hepática Inducida por Sustancias y Drogas/prevención & control , Extractos Vegetales/farmacología , Vernonia/química , Acetaminofén/administración & dosificación , Acetaminofén/toxicidad , Animales , Antiinflamatorios/administración & dosificación , Antiinflamatorios/aislamiento & purificación , Anticolesterolemiantes/administración & dosificación , Anticolesterolemiantes/aislamiento & purificación , Anticolesterolemiantes/farmacología , Antioxidantes/administración & dosificación , Antioxidantes/aislamiento & purificación , Línea Celular , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Citocinas/metabolismo , Relación Dosis-Respuesta a Droga , Sobredosis de Droga , Macrófagos/efectos de los fármacos , Macrófagos/metabolismo , Masculino , Ratones , Extractos Vegetales/administración & dosificación , Hojas de la Planta , Ratas , Ratas Wistar , Silimarina/farmacologíaRESUMEN
AIM: To set up and test the feasibility of a handmade apparatus adapted for exhaled breath condensate (EBC) collection in medium-sized animals. MATERIALS AND METHODS: The apparatus was produced using an 18-mm thick u-shaped borosilicate glass. The u-shaped tube body is 25 cm in diameter, and the horizontal portions are 12 cm in diameter. The base consists of a tube joint 14/20 or 14 mm thick by 20 cm in diameter, and has a length of 5 cm. This has a hole that is plugged for condensate flow to a 1.5 mL polypropylene microtube that stores the condensate during collection. Was placed inside a styrofoam box and immersed in crushed ice and salt to ensure cooling. The temperature was monitored and maintained throughout the collection at -10°C. One of the outputs of the u-shaped tube was connected to the expiratory limb of the ventilator. RESULTS: An experimental model of ALI, induced by oleic acid (OA) was adopted to determine the concentration of biomarkers of oxidative stress: malondialdehyde (MDA), glutathione (GSH), and nitrite/nitrate (NOx). The proposed model allows measurement of NOx, MDA, and GSH. However, the NOx and MDA levels in the EBC were not significant. It was only possible to observe an upward trend, which suggests a temporal evolution of the presence of these markers in the EBC. CONCLUSION: The EBC collection method adapted is effective to generate sufficient content that allows to determine the levels of different biomarkers, such as NOx, MDA, and GSH, that are involved in oxidative and inflammatory stress processes during respiratory diseases.
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Lesión Pulmonar Aguda/metabolismo , Modelos Animales de Enfermedad , Animales , Biomarcadores/análisis , Pruebas Respiratorias/instrumentación , Estudios de Factibilidad , Ácido Oléico , ConejosRESUMEN
OBJECTIVE: The aim of the present study was to assess nasal mucociliary clearance, mucus properties and inflammation in smokers and subjects enrolled in a Smoking Cessation Program (referred to as quitters). METHOD: A total of 33 subjects with a median (IQR) smoking history of 34 (20-58) pack years were examined for nasal mucociliary clearance using a saccharine transit test, mucus properties using contact angle and sneeze clearability tests, and quantification of inflammatory and epithelial cells, IL-6 and IL-8 concentrations in nasal lavage fluid. Twenty quitters (mean age: 51 years, 9 male) were assessed at baseline, 1 month, 3 months and 12 months after smoking cessation, and 13 smokers (mean age: 52 years, 6 male) were assessed at baseline and after 12 months. Clinicaltrials.gov: NCT02136550. RESULTS: Smokers and quitters showed similar demographic characteristics and morbidities. At baseline, all subjects showed impaired nasal mucociliary clearance (mean 17.6 min), although 63% and 85% of the quitters demonstrated significant nasal mucociliary clearance improvement at 1 month and 12 months, respectively. At 12 months, quitters also showed mucus sneeze clearability improvement (∼26%), an increased number of macrophages (2-fold) and no changes in mucus contact angle or cytokine concentrations. CONCLUSION: This study showed that smoking cessation induced early improvements in nasal mucociliary clearance independent of mucus properties and inflammation. Changes in mucus properties were observed after only 12 months of smoking cessation.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Fumar/efectos adversos , Cese del Hábito de Fumar , Moco/química , Factores de Tiempo , Monóxido de Carbono/análisis , Fumar/metabolismo , Recuento de Células , Depuración Mucociliar , Estudios Longitudinales , Interleucina-8/metabolismo , Interleucina-6/metabolismo , Líquido del Lavado Nasal/química , Cotinina/análisis , Inflamación/patología , Mucosa Nasal/patologíaRESUMEN
Exercise promotes pulmonary oxidative imbalance. In this regard, some evidence has been obtained from the study of exhaled breath condensate (EBC) during urban races, in which the factors involved in the occurrence of this process are still not characterized. In this paper, under laboratory conditions, both the role of time of exercise on the generation of pro-oxidants (H2O2, NO2 (-)) and pH have been assessed in EBC of 16 under-trained subjects who completed three tests of cycloergometric exercise at low intensity (30 % of VO2 max) with a duration of 10, 30, and 90 min. Samples were obtained as follows: immediately before and at 80 min post exertion in each test. In the 90-min test, an increase in H2O2, NO2 (-) concentration in EBC at 80 min post exertion with no changes in the pH was observed. Total O2 consumption and total ventilation weakly correlated with the changes in H2O2 and NO2 (-). In conclusion, the concentration of pro-oxidants in the EBC depends on the duration of the exercise when it is performed at low intensity under laboratory conditions.
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Ejercicio Físico , Pulmón/metabolismo , Oxidantes/metabolismo , Mucosa Respiratoria/metabolismo , Adolescente , Adulto , Ciclismo , Pruebas Respiratorias , Prueba de Esfuerzo , Frecuencia Cardíaca , Humanos , Peróxido de Hidrógeno/metabolismo , Concentración de Iones de Hidrógeno , Masculino , Nitritos/metabolismo , Consumo de Oxígeno , Eliminación Pulmonar , Frecuencia Respiratoria , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: To utilize low-cost and simple methods to assess airway and lung inflammation biomarkers related to air pollution. METHODS: A total of 87 male, non-smoking, healthy subjects working as street traffic-controllers or office-workers were examined to determine carbon monoxide in exhaled breath and to measure the pH in nasal lavage fluid and exhaled breath condensate. Air pollution exposure was measured by particulate matter concentration, and data were obtained from fixed monitoring stations (8-h work intervals per day, during the 5 consecutive days prior to the study). RESULTS: Exhaled carbon monoxide was two-fold greater in traffic-controllers than in office-workers. The mean pH values were 8.12 in exhaled breath condensate and 7.99 in nasal lavage fluid in office-workers; these values were lower in traffic-controllers (7.80 and 7.30, respectively). Both groups presented similar cytokines concentrations in both substrates, however, IL-1β and IL-8 were elevated in nasal lavage fluid compared with exhaled breath condensate. The particulate matter concentration was greater at the workplace of traffic-controllers compared with that of office-workers. CONCLUSION: The pH values of nasal lavage fluid and exhaled breath condensate are important, robust, easy to measure and reproducible biomarkers that can be used to monitor occupational exposure to air pollution. Additionally, traffic-controllers are at an increased risk of airway and lung inflammation during their occupational activities compared with office-workers. .
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Adolescente , Adulto , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Contaminación del Aire/efectos adversos , Espiración , Lavado Nasal (Proceso)/métodos , Exposición Profesional/efectos adversos , Neumonía/inducido químicamente , Neumonía/diagnóstico , Biomarcadores , Pruebas Respiratorias , Estudios Transversales , Monóxido de Carbono/análisis , Citocinas/sangre , Concentración de Iones de Hidrógeno , Material Particulado/análisis , Reproducibilidad de los Resultados , Factores de RiesgoRESUMEN
OBJETIVOS: Revisar o papel da avaliação clínica, da qualidade de vida, da espirometria, do teste de broncoprovocação e dos marcadores inflamatórios na avaliação da asma. FONTES DOS DADOS: Pesquisa nas bases MEDLINE e LILACS. SÍNTESE DOS DADOS: A avaliação clínica auxilia na avaliação do controle da asma e é amplamente preconizada. No entanto, os pacientes podem apresentar obstrução e inflamação das vias aéreas a despeito da normalidade clínica. A espirometria quantifica o grau de obstrução das vias aéreas e auxilia no diagnóstico, enquanto a broncoprovocação pode ser indicada na suspeita de asma com espirometria normal. Já os marcadores inflamatórios do condensado do ar exalado, do escarro induzido e do lavado broncoalveolar, além dos fragmentos da biópsia brônquica, encontram-se alterados na asma e são métodos complexos, quase sempre restritos às pesquisas. A fração exalada de óxido nítrico (FeNO) é elevada nos pacientes com asma, reprodutível e não invasiva, reduzindo-se com o tratamento. O uso da FeNO como auxiliar no ajuste de doses do corticoide inalatório tem sido estudado, mas as vantagens ainda não estão claras. CONCLUSÕES: Vários métodos são necessários para avaliar de forma acurada o controle da asma, e todos têm vantagens e limitações. A avaliação clínico-funcional é útil para o diagnóstico de asma, porém limitada para avaliar de forma precisa a intensidade do processo inflamatório nas vias aéreas. É necessário que mais estudos controlados, randomizados, com adequado poder estatístico sobre a utilidade dos marcadores inflamatórios não invasivos, especialmente a FeNO, no manejo da asma, sejam realizados para determinar sua utilidade clínica.
OBJECTIVES: To review the role of clinical assessment, quality of life assessment, spirometry, bronchial responsiveness test and inflammatory markers for asthma assessment. SOURCES: Search run on MEDLINE and LILACS. SUMMARY OF THE FINDINGS: Clinical assessment aids with assessing asthma control and is widely recommended. However, patients may have airway inflammation and obstruction despite normal clinical findings. Spirometry quantifies the degree of airway obstruction and helps with diagnosis, while the bronchial responsiveness test may be indicated for when asthma is suspected but spirometry is normal. The results of assaying the inflammatory markers in exhaled breath condensate, induced sputum, bronchoalveolar lavage and bronchial biopsy specimens are abnormal in asthma patients, but these are complex techniques almost always restricted to research. Fractional exhaled nitric oxide (FeNO) is elevated in patients with asthma, is reproducible and noninvasive and reduces with treatment. Studies have investigated using FeNO to help with adjusting inhaled corticoid dosages, but the benefits are not clear. CONCLUSIONS: A range of different methods are needed to accurately assess disease control, all with their advantages and limitations. Clinical and functional assessment is useful for diagnosing asthma, but is of limited use for precisely evaluating the intensity of the inflammatory process in the airways. More randomized and controlled studies with adequate statistical power should be carried out to investigate the true utility of noninvasive inflammatory markers, especially FeNO, for asthma management.