Exhaled nitric oxide in the management of childhood asthma: A prospective 6‐months study

Abstract

Fractional exhaled nitric oxide (FeNO) is elevated in asthma and reflects eosinophilic airway inflammation. The aim of this prospective, randomized, single-blind study was to examine whether the inclusion of repeated FeNO measurements into asthma monitoring leads to an improvement in asthma outcome. Forty-seven children with mild to moderate asthma were allocated to a FeNO group (n = 22) and to a control group (n = 25). In the FeNO group therapy was based on symptoms, beta-agonist use, lung function, and FeNO whereas in the control group therapy was based on symptoms, beta-agonist use and lung function only. Patients performed five visits in 6 weeks intervals. Frequency of respiratory symptoms, beta-agonist use, FEV(1)% predicted and the frequency of exacerbations were similar between groups. Patients in the FeNO group received higher doses of inhaled corticosteroids (ICS) (control group: median (interquartile range): 241 microg (26-607 microg); FeNo group: 316 microg (200-500 microg) and had significantly higher MEF(50)% predicted (control group: median (interquartile range): 68.5% (55.8-83.1%); FeNO group: 83.2% (62.9%-98.3%). At a cut-off point of 22.9 ppb FeNO the best predictive value for exacerbations with a sensitivity of 80% and specificity of 60% was found. Significant relationships were observed between FeNO and dose of ICS (beta = -8.77; P < 0.002), beta-agonist use 2 weeks prior to a visit (beta = 0.11; P < 0.05), asthma symptoms (beta = 0.02; P < 0.0001), and bronchial hyperresponsiveness (beta = 0.04; P = 0.02). In conclusion, FeNO was related to important markers of asthma control. A therapy regimen aimed at lowering FeNO in children with asthma improved parameters of small airway function, but was not able to improve clinical markers of asthma control.

Parent-Child Agreement in Report of Nighttime Respiratory Symptoms and Sleep Disruptions and Quality

“…Duration of asthma was not ascertained. Baseline analysis of children's exhaled nitric oxide (eNO), a well accepted biological marker of airway inflammation (American Thoracic Society, 1999;Battaglia et al, 2005;Fritsch et al, 2006;Taylor, Pijnenburg, Smith, & Jongste, 2006;Gelb, Flynn Taylor, Shinar, Gutierrez, & Zamel, 2006;Zietkowski, Bodzenta-Lukaszyk, Tomasiak, Skiepko, & Szmitkowski, 2006), confirmed appropriate group placement of children within the asthma vs. no asthma group. (See 'Sample' description for actual data.)…”

Measurement of exhaled nitric oxide concentration in asthma: a systematic review and economic evaluation of NIOX MINO, NIOX VERO and NObreath

“…There may have been some bias in terms of outcome data completeness in the remaining four studies. Fritsch et al 103 did not report the reasons for participant withdrawal or correction for missing FeNO values and there may have been missing outcome data in the study by Petsky et al, 107 but this is unknown as only a conference abstract of this study was identified. In the study by Verini et al 105 it was reported that 64 patients were recruited; however, it was unclear whether this was the total number after dropout or whether no participants dropped out.…”

Exhaled NO: Determinants and Clinical Application in Children With Allergic Airway Disease

“…48 Another study in children presented 22.9 ppb as a FeNO cutoff with a sensitivity of 80% and a specificity of 60% for predicting exacerbation. 50 Emerging information indicates that assessment of within-individual changes in FeNO may be a more accurate method for In general for children, elevated eosinophil counts in sputum may be more sensitive for predicting asthma exacerbations or loss of asthma control after steroid reduction than elevated FeNO. 49 This is because high FeNO is not always pathological, whereas induced sputum eosinophil counts >1% is abnormal.…”