Which asthma patient has allergic airway inflammation? Controlling Allergic Asthma

Several underlying diseases can present symptoms similar to asthma. Therefore, a correct diagnos­s relies on establishing i whether or not the patient is characterized by allergic airway inflammation. Until recently, diagnostic devices have not been able to convey a complete clinical over­ iew and clearly identify the v underlying cause of the symptoms. Consequently, patients that are not suffering from asthma have received unnecessary or inadequate treatment.1 Patients with asthma symptoms due to allergic inflammation will respond favorably to inhaled corticosteroids, while those who are suffering...

1 NIOX MINO® instantly reveals allergic inflammation of the airways 4 Chronic cough Cardiac disease Patient with chronic cough or symptoms suggestive of asthma Vocal Cord Dysfunction Bronchitis History, symptoms, FENO measurement Normal FENO Consider: Diagnosis other than (allergic) asthma Elevated FENO Strong predictor of allergic asthma (or eosinophilic bronchitis) ICS responsiveness likely

2 NIOX MINO® instantly reveals if the patient is compliant with anti-inflammatory therapy 5 In the clinical workup of the asthma patient there are several questions that must be answered; • Is the airway inflammation under control? • Is the patient responding to the therapy? • Does the patient take the medication? • Is the patient using correct inhalation technique? In clinical practice NIOX MINO will immediately identify the non-compliant patient or the patient with an inadequate drug delivery technique. It will also confirm uncontrolled airway inflammation. NIOX MINO is the device of choice...

Continuous follow-up and evaluation Symptoms + NO measurement = An objective measurement of: Therapy response Patient compliance to therapy Drug delivery = Inflammation control ”Control of inflammation is needed in asthma to reduce exacerbation frequency.” M. Thomas et al. High-dose inhaled corticosteroids versus add-on long-acting betaagonists in asthma: an observational study. J Allergy Clin Immunol. 2009;123(1):116-121.

3 NIOX MINO® reveals changes in allergen exposure 6 Anti-inflammatory treatment can become ineffective for patients who are highly exposed to household and work-place allergens, especially if they are subjected to continuous expo­ sure. Despite optimal anti-inflammatory therapy, the rapid onset of allergic rhinitis and conjunctivitis, or continued respiratory symptoms, can indicate significant exposure to unidentified allergens. High NO values indicate the presence of inflammation and alert the physician and patient to these conditions, suggesting the need for a change in therapy.

NIOX MINO® – maintenance and calibration free NO-measurement • The only calibration and maintenance-free NO device • All NO values quality assured • Individualized data management for the practice and the patient Maintenance and calibration free Exhale to empty the lungs Inhale deeply through the d ­ isposable filter Exhale through the filter View results on screen The procedure can be followed by e ­ ither the audio or visual feed-back. When the procedure is finished, measurement results are available within a couple of minutes.

Connectivity with individualized Data Management • Electronic storage and display of patient data • Prepared for direct communication to patient Electronic Medical ­Record (EMR). • Convert patient data into a PDF report. • Visual Incentive Program • Practice and patient specific information material

Visual Incentive Cable (USB) or wireless (Bluetooth) connection to a PC makes it possible to follow the procedure on the PC screen. Nasal research application • With the NIOX MINO Nasal Application nasal NO concentration can be measured in gas aspirated from a nostril using passive sampling. Additional parts are needed to run this application.

Guide to interpretation of quality ­ ssured a values from NIOX MINO® in patients with airway disease LOW Allergic airway inflammation NORMAL Unlikely INTERMEDIATE Present, but mild HIGH Significant ADULTS FENO value >50 (or a rise of > 60% since previous measurement) (Fractional Exhaled Nitric Oxide) CHILDREN < 12 years FENO value >35 (or a rise of > 60% since previous measurement) (Fractional Exhaled Nitric Oxide) * Adapted from Taylor DR, Pijnenburg MW, Smith AD, De Jongste JC. Exhaled nitric oxide measurements: clinical application and interpretation. Thorax 2006; 61: 817-27. References 1....

Aerocrine is continuously developing and documenting NO measurement as a valuable tool in the management of airway disease. More than 4 ­ illion tests in clinical practice m prove its efficacy. Continuous ground-breaking development • Aerocrine developed the first instrument for measurement of exhaled NO • Aerocrine instruments will remain the Gold Standard for FENO measurement • Aerocrine has close collaboration with the world’s leading NO scientists • Aerocrine will continue to lead the development of NO as a marker of airway inflammation The International Space Station is using the NIOX MINO...