There are no significant improvements in context of calibrating medications based on daily monitoring of the fractional exhaled nitric oxide (FENO) and symptoms in asthmatic children over medicating based on daily symptom monitoring alone, as per a multi-center prospective study.
The results appeared in an issue of the American Journal of Respiratory and Critical Care Medicine, which is a publication of the American Thoracic Society.
From News-Medical.Net:
Still, in light of these findings, it is clear that FENO monitoring should only be applied to those who stand to gain the most. “There can be no doubt that adding frequent assessments of FENO to management plans of most children and adults with asthma will add unjustifiable costs without providing clinical benefit. Whether there is a role for monitoring FENO to aid management of severe asthma is untested,” wrote Stephen Stick, Ph.D., of the Princess Margaret Hospital for Children in Perth, Australia and Peter Franklin, Ph.D., of the Centre for Asthma, Allergy and Respiratory Research at the University of Western Australia in Perth in an editorial that accompanied the article.
“We did not address other possible applications of frequent FENO monitoring, such as prediction of steroid effect. Loss of control, prediction and prevention of exacerbations, and tapering of steroids in symptom-free children who wheezed in the past,” noted Dr. de Jongste. “We think there is good reason to study these potential applications.”
Furthermore, as D. Robin Taylor, M.D., of the Dunedin School of Medicine at the University of Otago, in New Zealand, pointed out in separate editorial, “FENO measurements shed complementary light on the underlying inflammatory phenotype and, more importantly, on the potential response to anti-inflammatory treatment. Historically, this has been assessed either by empiric “trials of steroid” or, even more imperfectly. With reference to before/after changes in spirometry, serial or repeated FENO measurements in individual patients may provide additional diagnostic as well as prognostic insights.”
This randomized study involved 151 children from 15 academic centers and hospitals with mild to moderate asthma to a 30-week monitoring course and was led by Johan C. de Jongste, M.D., Ph.D., at the Erasmus University Medical Center-Sophia Children’s Hospital in the Netherlands, and colleagues.
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