PURPOSE OF THE STUDY.
The ability to predict asthma exacerbations would be useful because it might be possible to intensify therapy and prevent the exacerbation. One proposed tool to predict asthma exacerbations is exhaled nitric oxide (FeNO). The study evaluated whether measurements of FeNO predict subsequent asthma exacerbations.
The study included 103 children aged 6 to 16 years with asthma on daily inhaled corticosteroid controller therapy. At a scheduled follow-up visit, a single FeNO measurement was made (baseline). The children were then followed prospectively for 12 months for asthma exacerbations requiring systemic corticosteroids.
Ten patients (9.7%) had asthma exacerbations. The baseline FeNO was higher in children who went on to have exacerbations (median 41 ppb, interquartile range 33–71 ppb) than in those who did not (median 13, interquartile range 9–21 ppb, P < .001). However, there was complete overlap of FeNO values between groups.
The authors concluded that FeNO measurements are “useless in predicting asthma exacerbations.”
Although the current study evaluated only a single FeNO measurement as a predictor of subsequent asthma exacerbations, many other studies have assessed using serial FeNO measurements to tailor asthma therapy. A meta-analysis published in 2012 (Petsky et al. Thorax 2012;67:199–208. doi: 10.1136/thx.2010.135574) concluded that “tailoring of asthma treatment based on FeNO levels has not been shown to be effective in improving asthma outcomes in children … there is insufficient justification to advocate the routine use of … FeNO in everyday clinical practice.” I believe FeNO has yet to prove itself to be a useful clinical tool.
- Copyright © 2012 by the American Academy of Pediatrics