Respiratory care student conducts research while earning bachelor’s degree

SAN ANTONIO (March 25, 2015) — Respiratory care student Kelli Hand recently was one of 67 students from 57 universities selected to participate in Texas Undergraduate Research Day at the Capitol in Austin.

Fellow student Amber Marquette, who contributed to the research study, also participated in the undergraduate research day at the Capitol.

Hand, who will earn her bachelor of science in respiratory care this May from The University of Texas Health Science Center at San Antonio, also presented her research titled “An Observational Study of Fractional Exhaled Nitric Oxide Levels in Elementary School Children Who Have Been Diagnosed with Asthma,” at the 2014 conference of the American Association for Respiratory Care in Las Vegas.

While participating in the Department of Respiratory Care’s 2+2 Asthma Education Program for children with asthma in local elementary schools, Hand worked in the diagnostic area with the young students. This program is supported by the McCaffree Humanitarian Award from the CHEST Foundation.

“We were measuring the Fractional exhaled Nitric Oxide or FeNO levels by having the children blow into a disposable mouthpiece attached to the Aerocrine NiOx device. When they blew into the device, the kids could see on an interfacing laptop the effect of their breath on a girl, who resembles the main character from the `Dora the Explorer’ TV show, in a hot air balloon. When they inhaled, a sun rose to the top of the screen, and when they blew out, they could see the hot air balloon move across the screen,” she said.

While the children enjoyed the colorful graphics on the laptop screen, their FeNO levels were being measured. The FeNO levels indicate the amount of inflammation in the lungs.

The FeNO test can show if their asthma is controlled, or, if is not controlled, then if the asthma will respond to inhaled corticosteroids. Inhaled corticosteroids are considered controller medications and, when used daily, will keep the airway inflammation down and exacerbations away, Hand explained.

After analyzing the findings, Hand found 37 percent of the students had either intermediately controlled or uncontrolled asthma.

“Unfortunately, these numbers were on par with what we found in current literature, when we reviewed published studies. We know this places these students at increased risk for asthmatic attacks, hospitalizations and even death,” she said. “In theory, all the children we saw should have been taking the controller medications, an inhaled corticosteroid, to best manage their asthma.”

Because the 2+2 Asthma Education Program is held after school and includes parents, the respiratory care students had the opportunity to participate with a pulmonologist discussing the importance of FeNO level findings with parents and stress the importance of the controller medication.

By showing the parents their child’s FeNO levels and explaining how to manage the disease by using the correct controller medication, she said they hope to improve the percentage of those with controlled asthma.

“We learned that sometimes families don’t have the money to buy the needed medicine,” Hand said. “We also found a lack of education about asthma as a barrier to proper management of the disease. Many do not fully grasp the gravity of the situation.”

Hand said she and faculty advisors Richard Wettstein, M.M.Ed., RRT, and Donna Gardner, M.S.H.P., RRT, FAARC, would like to see this research used to encourage physicians, including pediatric allergists and pulmonologists, to use the FeNO measurement device to test patients at each visit.

“If physicians could test FeNO levels at each visit, they could monitor the levels. This would allow them to reinforce to each patient the importance of the controller medication regimen. This could be another tool to help in the care of each patient with asthma,” she said.

Gardner said they recommend this tool be used to support asthma management and the FeNO Guidelines.

“The importance of this research is to stress the use of the device to help reinforce that asthma patients use their controller medications, which are the inhaled corticosteroid. Those with high levels demonstrate inflammation that is caused by eosinophils which are disease-fighting white blood cells, and these patients will most likely respond to inhaled corticosteroids to best manage asthma,” Gardner said. There are some phenotypes of asthma in which the inflammation is not caused by the eosinophils and will need additional medications to manage the disease, she added.

Gardner said those with asthma and their caregivers need to remember that asthma is not curable, but it is controllable with the right medications.


The University of Texas Health Science Center at San Antonio, one of the country’s leading health sciences universities, ranks in the top 13 percent of academic institutions receiving National Institutes of Health (NIH) funding. The university’s schools of medicine, nursing, dentistry, health professions and graduate biomedical sciences have produced more than 31,000 graduates. The $787.7 million operating budget supports eight campuses in San Antonio, Laredo, Harlingen and Edinburg. For more information on the many ways “We make lives better®,” visit

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