Fractional exhaled nitric oxide for identification of uncontrolled asthma in children

Meena, Raj Kumar; Raj, Dinesh; Lodha, Rakesh; Kabra, S. K.

doi:10.1007/s13312-016-0842-z

Cited by 12 publications

(19 citation statements)

References 18 publications

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“…We found that 78% of the children had uncontrolled disease, defined by an increase of at least 12% of the FEV 1 after salbutamol or respiratory symptoms with exhaled NO level above than 35 ppb. This figure is fairly similar to other studies that reported about 75% uncontrolled asthma between 5 and 18 years of age …”

Section: Discussionsupporting

confidence: 92%

“…This figure is fairly similar to other studies that reported about 75% uncontrolled asthma between 5 and 18 years of age. 10,23,30,31 In our study, the ratio of exhaled NO/FEF 25%-75% arises as the best to assess asthma control, while the exhaled NO adjusted for FEV 1 as A moderate-to-strong agreement between spirometry-adjusted fraction of exhaled NO cut-off levels and those from the ATS 3 was ob- is probably due to growth-related increase in the airway area producing NO. Therefore, the spirometry adjustment could be regarded as a way to normalize this growth effect.…”

Section: Discussionmentioning

confidence: 50%

“…Exhaled NO also proved to be a useful tool that distinguishes asthma severity and asthma control in children when FEV 1 fails to do it as well as when its defined by a clinical evaluation . Nevertheless, there is also evidence against the use of exhaled NO in the assessment of asthma control in children: it does not have enough discriminatory value in children under ICS treatment and disagrees among common measures of asthma control such as the C‐ACT …”

Section: Discussionmentioning

confidence: 99%

“…However, no significant advantage was seen with the specific use of exhaled NO‐driven protocols to guide asthma treatment compared with other methods, and according to GINA guidelines, treatment of asthmatic children usually relies on symptoms reported by the child and/or guardians. Furthermore, correlations between airway inflammation and symptoms, asthma control and asthma severity are weak or absent . In steroid‐naïve patients, high exhaled NO levels predict a good response to inhaled corticosteroids (ICS) treatment, and a low level of exhaled NO in adults in ICS treatment is associated with reduced likelihood ratio of exacerbation .…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, correlations between airway inflammation and symptoms, asthma control and asthma severity are weak or absent. 1,[9][10][11] In steroid-naïve patients, high exhaled NO levels predict a good response to inhaled corticosteroids (ICS) treatment, and a low level of exhaled NO in adults in ICS treatment is associated with reduced likelihood ratio of exacerbation. 12 Until now, it is not possible to provide clear recommendations for the utility of the exhaled NO in asthma management, as studies failed to show an overall benefit in the rate of exacerbations as well as in asthma control, lung function and use of oral corticosteroids during exacerbations.…”

mentioning

confidence: 99%

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Spirometry‐adjusted fraction of exhaled nitric oxide increases accuracy for assessment of asthma control in children

Martins

Silva

Severo

et al. 2017

Pediatric Allergy Immunology

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Spirometry and exhaled nitric oxide are two important complimentary tools to identify and assess asthma control in children. We aimed to determine the ability of a new suggested spirometry-adjusted fraction of exhaled nitric oxide (NO) index in doing that. A random sample of 1602 schoolchildren were screened by a health questionnaire, skin prick tests, spirometry with bronchodilation and exhaled NO. A total of 662 children were included with median (IQR) exhaled NO 11(14) ppb. Receiver operating characteristic (ROC) curves using exhaled NO equations from Malmberg, Kovesi and Buchvald, and spirometry-adjusted fraction of exhaled NO values were applied to identify asthmatic children and uncontrolled asthma. Receiver operating characteristic (ROC) curves failed to identify asthmatic children (all AUC < 0.700). Spirometry-adjusted fraction of exhaled NO/FEV (AUC = 0.712; P = .010) and NO/FEF (AUC = 0.735 P = .004) had a fair and increased ability to identify uncontrolled disease compared with exhaled NO (AUC = 0.707; P = .011) or the Malmberg equation (AUC = 0.701; P = .014). Sensitivity and specificity identifying non-controlled asthma were 59% and 81%, respectively, for the cut-off value of 9.7 ppb/L for exhaled NO/FEV , and 40% and 100% for 15.7 ppb/L/s for exhaled NO/FEF . Exhaled NO did not allow to identify childhood asthma. Spirometry-adjusted fraction of exhaled NO performed better-assessing asthma control in children. Thus, although more validation studies are needed, we suggest its use in epidemiological studies to assess asthma control.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Spirometry‐adjusted fraction of exhaled nitric oxide increases accuracy for assessment of asthma control in children

Martins

Silva

Severo

et al. 2017

Pediatric Allergy Immunology

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Long‐term predictors of loss of asthma control in school‐aged well‐controlled children with mild to moderate asthma: A 5‐year follow‐up

Hauerslev

Garpvall

Marckmann

et al. 2021

Pediatric Pulmonology

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Background: Long-term follow-up studies establishing risk factors for loss of asthma control in well-controlled children with mild to moderate disease are lacking and are of importance for improving patient quality of life and utilization of health-care resources.Methods: Loss of asthma control was assessed in 146 school-aged children with well-controlled mild to moderate asthma from a Danish pediatric asthma outpatient clinic based on hospital admissions, emergency department (ED), or outpatient management of exacerbations, oral corticosteroid (OCS) use, or step-up of regular asthma treatment according to Global Initiative for Asthma (GINA) guidelines through a 5-year follow-up period. Risk factors included sex, ethnicity, age, body mass index (BMI), atopic comorbidity and predisposition, lung function, fractional exhaled nitric oxide (FeNO) level, exercise challenge test results, regular physical activity, GINA treatment step at baseline, and adherence to controller therapy.Results: A total of 27 (18%) children experienced 56 acute events defined by hospital admission, ED, or outpatient management. Risk of experiencing any acute event was increased with female sex (adjusted odds ratio, aOR = 2.4 (1.0-5.9), p = 0.047) and higher baseline GINA treatment step (aOR = 1.6 (1.1-2.5), p = 0.03). Furthermore, female sex (aOR = 6.1 (1.4-42.2), p = 0.01) and higher FeNO (aOR = 1.8(1.0-3.2), p = 0.04) were associated with OCS prescriptions, whereas no risk factors were identified for GINA treatment step-up during the 5-year follow-up.Conclusions: Female sex, higher FeNO, and higher baseline GINA treatment step increase the risk of long-term loss of control including acute events and OCS use in well-controlled children with mild to moderate asthma. These findings are important for primary physicians and clinicians in asthma outpatient clinics to identify seemingly well-controlled children at risk to plan more frequent follow-ups.

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Nitric Oxide as a Diagnostic and Therapeutic Tool in Respiratory Diseases

Gulati

Thokchom²,

Ray³

2023

Nitric Oxide: From Research to Therapeutics

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Fractional exhaled nitric oxide for identification of uncontrolled asthma in children

Abstract: FENO, in itself, does not have good discriminatory value in assessment of controlled and uncontrolled asthma in children on asthma therapy.

Cited by 12 publications

References 18 publications

Spirometry‐adjusted fraction of exhaled nitric oxide increases accuracy for assessment of asthma control in children

Spirometry‐adjusted fraction of exhaled nitric oxide increases accuracy for assessment of asthma control in children

Long‐term predictors of loss of asthma control in school‐aged well‐controlled children with mild to moderate asthma: A 5‐year follow‐up

Nitric Oxide as a Diagnostic and Therapeutic Tool in Respiratory Diseases

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