Exhaled nitric oxide predicts loss of asthma control in children after inhaled corticosteroids withdrawal

Abstract

Background: Exhaled nitric oxide (eNO) has been proposed for monitoring airway inflammation, diagnosis, and prediction of steroid responsiveness in asthma. However, its utility after elective suspension of asthma medication is still unclear. We aimed to determine the association between eNO values and the subsequent loss of asthma control (LAC) in asymptomatic asthmatic children after inhaled corticosteroids (ICS) withdrawal. Methods:We conducted a prospective observational cohort study. Forty-two children (23 boys), mean age 11 years, with clinically controlled asthma, according to GINA guidelines, and receiving low-dose of ICS (budesonide 200 μg/day or equivalent) were included immediately after the withdrawal of ICS. eNO, Asthma Control Test (ACT) and spirometry were monthly assessed, during 54 weeks or until the presence of at least one of the following criteria of LAC: 1) asthma exacerbation, 2) obstructive spirometric pattern, 3) ACT ≤ 19.Results: eNO baseline geometric mean (eNO b ), measured 4 weeks after discontinuation of ICS, was 23.7 ppb (SD: 1.16). An eNO b cutoff point of 21.8 ppb was determined to better discriminate between high and low eNO groups. Twenty-five subjects (71.4%) had LAC. High eNO b was associated to LAC (OR: 9.01; 95CI: 1.10-74.26). In addition, LAC occurred earlier in high eNO b than in low eNO b patients (8 vs 28 weeks, respectively; P = 0.017). Conclusions:Our findings suggest that eNO predicts loss of asthma control and may contribute for clinical follow up decisions during childhood asthma after ICS withdrawal. K E Y W O R D Sasthma, exhaled nitric oxide, inhaled corticosteroids

The treatment of allergic rhinitis in asthmatic children and adolescents: practical outcomes from the real-world “ControL’Asma” study

“…On the other hand, AIT was used only in 20% of patients. It is well known that medications do not cure the allergy, as symptoms and inflammation quickly recur after their suspension (16,17). AIT should represent the choice treatment of AR and allergic asthma as restores immunological and clinical tolerance toward the causal allergen, may prevent allergy worsening, and its effects are longlasting over time.…”

Fractional Exhaled Nitric Oxide (FENO) in the management of asthma: a position paper of the Italian Respiratory Society (SIP/IRS) and Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC)

“…The performance of FE NO as a biomarker of asthma control increases when its assessment is combined with lung function parameters [122][123], when it is used to predict the future risk of losing asthma control [124][125][126][127][128], or when its increase in a given time is considered as a marker of loss of asthma control [119].…”

Pediatric pulmonology 2019 year in review: Asthma

“…Fraction of exhaled nitric oxide (FeNO) is another biomarker that may play a role in the diagnosis and management of asthma. Chang et al 11 sought to investigate whether exhaled nitric oxide could identify children whose asthma symptoms would become uncontrolled after elective discontinuation of inhaled corticosteroids. The investigators established a cutoff value for exhaled nitric oxide, 21.8 parts per billion; those with a FeNO value higher than this threshold when measured four weeks after discontinuation of inhaled corticosteroids were more likely to have loss of asthma control.…”