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Case Study:

Treatment Adherence

15-Year-Old Male With a History of Asthma and Allergies*

*The case study presented is for educational purposes only and does not represent a real patient case. Similar results cannot be guaranteed and should not be considered typical.

Role of FeNO

FeNO testing helped identify significant airway inflammation in this case. FeNO testing also highlighted the possibility of non-adherence, providing the opportunity to reinforce the importance of the consistent and proper use of the inhaler.

Patient Background

  • 15-year-old male with a history of asthma and mild, intermittent allergic rhinitis
  • Previous allergy skin testing showed sensitivities to mold, as well as grass, weed, and tree pollens
  • Inhaled steroid treatment of beclomethasone 4 times a day
  • Medication refill history strongly suggestive of treatment nonadherence
  • Currently not on medication for rhinitis
  • No exacerbations in previous 6 months, but patient reports periodic nighttime awakenings and symptoms with physical activity/exercise
  • Pulmonary function consistently 70-80% of predicted

NIOX-Guided Assessment

  • Evaluation of fractional exhaled nitric oxide (FeNO) showed a value of 118 ppb.
  • Pulmonary function 72% of predicted, with 18% reversibility with albuterol
  • When questioned further, patient admits <50% adherence to medication

Treatment

  • Patient counseled on the importance of consistent adherence to inhaled controller medication to bring airway inflammation into the normal range
  • Prescribed an inhaled steroid with a twice-daily dosing regimen to encourage better adherence

Follow Up

  • Repeat pulmonary function 77% of predicted and FeNO 75 ppb
  • Investigation revealed slightly improved adherence at about 67%
  • Previous counseling regarding adherence was reinforced and proper inhaler technique was reviewed
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