Exhaled nitric oxide monitoring does not reduce exacerbation frequency or inhaled corticosteroid dose in paediatric asthma: a randomised controlled trial

Abstract

FENO-guided ICS titration does not appear to reduce corticosteroid usage or exacerbation frequency in paediatric outpatients with moderate to severe asthma. This may reflect limitations in FENO-driven management algorithms, as there are now concerns that FENO levels relate to atopy as much as they relate to asthma control.

Exhaled Nitric Oxide Fraction as an Add-On to ACQ-7 for Not Well Controlled Asthma Detection

“…The presence of such patients, seeming to have controlled asthma symptoms and an acceptable FEV 1 but poorly controlled airway inflammation, may result from two opposing events. As argued in a prior report, the higher FeNO values in such patients may not reflect greater airway inflammation, but be a confounding factor resulting from sustained exposure to an allergen [11]. Conversely, the increased FeNO may be an actual indicator of more intense airway inflammation, not sufficiently controlled by the current maintenance treatment.…”

“…Some studies have suggested that treated asthma patients who have high FeNO values suffer from more severe disease [5], have poorer asthma control, and are at greater risk for asthma exacerbations [6-8]. Conversely, other studies showed that the addition of FeNO measurements to the determinations usually employed to evaluate asthma control [9,10] and adjust therapy [11], such as standardized symptom questionnaires and spirometry, does not result in a better assessment of the current asthma control level nor the risk of exacerbation. A systematic review, which included a Cochrane based meta-analysis on six controlled randomized studies (two on adults and four on children/adolescents), showed data discrepancy in adults versus children and concluded that current evidence is not supportive on the use of FeNO for treatment adjustment [12].…”

A systematic review of fractional exhaled nitric oxide in the routine management of childhood asthma

“…The searches returned 5,354 unique records across all three reviews, from which seven randomised controlled trials which recruited children (plus adolescents and/or young adults) and compared FeNO‐guided management to non‐FeNO‐guided management were identified (Fig. ) . Fritsch (2006), was based in Austria; Szefler (2008), was based in the US; Verini, (2010, was based in Italy; Pijnenburg (2005), was based in Netherlands; Peirsman (2013) was based in Belgium; Petsky (2014), was based in Australia and Hong Kong; and Pike (2013) was based in the UK.…”

The Clinical Utility of Fractional Exhaled Nitric Oxide (FeNO) in Asthma Management

“…109 In adults seen in the ED, an increase in FeNO was observed in almost all patients with acute asthma. However; FeNO and its initial variation, within 2 hours, were not related to the severity of the attack (measured at presentation using a French instrument developed by Salmeron et al 110 ) or the effectiveness of bronchodilator treatment. 111 In a study of patients age 2-18 years seen in an urban ED for acute asthma exacerbation, measurement of FeNO was difficult for a large proportion of children and did not correlate with other measures of acute severity.…”