The utility of fractional exhaled nitric oxide suppression in the identification of nonadherence in difficult asthma.

Rationale: Nonadherence to inhaled corticosteroid therapy (ICS) is a major contributor to poor control in difficult asthma, yet it is challenging to ascertain.

Objectives: Identify a test for nonadherence using fractional exhaled nitric oxide (Fe(NO)) suppression after directly observed inhaled corticosteroid (DOICS) treatment.

Methods: Difficult asthma patients with an elevated Fe(NO) (>45 ppb) were recruited as adherent (ICS prescription filling >80%) or nonadherent (filling <50%).

The utility of cardiopulmonary exercise testing in difficult asthma.

Background: Unexplained persistent breathlessness in patients with difficult asthma despite multiple treatments is a common clinical problem. Cardiopulmonary exercise testing (CPX) may help identify the mechanism causing these symptoms, allowing appropriate management.

Methods: This was a retrospective analysis of patients attending a specialist-provided service for difficult asthma who proceeded to CPX as part of our evaluation protocol.

The safety of bisphosphonate use in pre-menopausal women on corticosteroids.

Glucocorticoid therapy, the mainstay treatment of many chronic diseases, has many complications including osteoporosis. Pre-menopausal women requiring glucocorticoids are at a significant risk of developing glucocorticoid-induced osteoporosis. Bisphosphonate therapy is a vital option in the prevention and treatment of glucocorticoid-induced osteoporosis.

Omalizumab: the evidence for its place in the treatment of allergic asthma.

Introduction: Asthma is a chronic inflammatory airways disease associated with reversible airflow obstruction and bronchial hyperresponsiveness. Asthma is prevalent worldwide and results in significant morbidity, mortality, and healthcare costs, the majority of which arise from those with severe disease. Omalizumab is a monoclonal antibody to immunoglobulin E (IgE) that has been developed for the treatment of severe persistent allergic (IgE mediated) asthma.