Is fractional exhaled nitric oxide (FeNO) associated with asthma control in children?

Visitsunthorn, Nualanong; Prottasan, P.; Jirapongsananuruk, Orathai; Maneechotesuwan, Kittipong

doi:10.12932/ap0362.32.3.2014

Cited by 11 publications

(16 citation statements)

References 27 publications

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“…Some studies have reported significant differences in exhaled NO levels between controlled and uncontrolled asthmatic children and showed that children with levels below 20 ppb had significantly higher scores in Asthma Control Test (ACT) and child‐ACT (C‐ACT) . Additionally, exhaled NO levels correlated with poor asthma control status in inhaled corticosteroids (ICS) untreated cases . 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 .…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…FeNO levels also differed significantly between the controlled and uncontrolled subgroups (8.5 ppb vs. 26.4 ppb, p-0.03). 91 Another cross sectional study recruited children with stable asthma (majority were on ICS, majority were allergic defined by a radio-allergosorbent test class 2 or higher or a positive skin test). 92 Children with insufficient, acceptable, or good control of asthma had FeNO levels of 28 ppb, 15 ppb, 11ppb; respectively (p<0.01).…”

Section: Children (Ages 5 To 18)mentioning

confidence: 99%

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

Wang¹,

Pianosi²,

Keogh³

et al. 2017

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“…A study conducted in Thailand showed that FeNO levels increased in inhaled corticosteroid (ICS)‐treated asthmatic patients with poor asthma control . Information regarding FeNO levels in the prediction of asthma exacerbation (AE) in children is insufficient.…”

Section: Introductionmentioning

confidence: 99%

Association between levels of fractional exhaled nitric oxide and asthma exacerbations in Thai children

2016

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Background and objective: Fractional exhaled nitric oxide (FeNO) has been used as a marker for airway inflammation. We evaluated the association between FeNO levels and asthma exacerbations (AEs) in Thai children and young adults. Methods: This was a prospective cohort study in patients with atopic asthma aged 7-20 years. Asthma control level and management were evaluated every 3 months for 1 year. Spirometry and FeNO measurements were performed at baseline, and 6 and 12 months. Results: In all, 70 patients (median age: 12.6 (7.2-19.8) years) were enrolled, of whom 18% had an AE during the study period. Median FeNO levels were significantly higher in patients with an AE than in those without an AE (35.6 ppb vs 16.5 ppb; P = 0.012). FeNO of 31 ppb provided optimal sensitivity (92.3%) and specificity (75.4%) for AE prediction. Sensitivity and specificity of FeNO levels were higher than those of forced expiratory volume in 1 s and forced expiratory flow at 25-75% of forced vital capacity bronchodilator reversibility for the prediction of an AE, but the difference was not significant (P = 0.121). None of the patients with FeNO level of 0-20 ppb had an AE within 12 months. Percentage of patients with FeNO of 21-40 ppb who suffered an AE was 20% and 30% at 6 and 12 months, respectively. Conclusion: The optimal cut-off point of FeNO level for the prediction of AE is 31 ppb. AE within the next 12 months was significantly more common in patients with higher FeNO levels and in patients with a higher rate of previous 12-month exacerbations.

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Is fractional exhaled nitric oxide (FeNO) associated with asthma control in children?

Abstract: FeNO levels were increased in ICS-treated asthmatic patients with less asthma control, albeit with no statistically significance. However, FeNO levels correlated with poor asthma control status in ICS untreated cases.

Cited by 11 publications

References 27 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

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

Association between levels of fractional exhaled nitric oxide and asthma exacerbations in Thai children

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