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Fractional exhaled nitric oxide for identification of uncontrolled asthma in children

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Abstract

Objectives

To determine the utility of Fractional Exhaled Nitric Oxide (FENO) in the identification of uncontrolled asthma in children on therapy, and to identify its cut-off value for determining asthma control.

Methods

207 children (age 5–15 y) with physician-diagnosed asthma on therapy with at least 12 months follow up were enrolled. Spirometry and FENO measurements were performed. Asthma control was assessed as per GINA guidelines. Sensitivity and specificity of various cut-off values of FENO (15 ppb, 20 ppb, 25 ppb, 30 ppb) for identification of status of control of asthma were calculated.

Results

156 (75%) children had uncontrolled or partly controlled asthma and 51 children were assessed to have controlled asthma. Median (IQR) FENO in children with controlled and uncontrolled asthma was 16 (11–23) ppb and 13 (11–25) ppb, respectively (P=0.26). No FENO cut-off had a reasonable combination of sensitivity and specificity to discriminate between controlled and uncontrolled asthma.

Conclusion

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

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References

  1. From the Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2015. Available from: http://www.ginasthma.org/. Accessed 13.10.2015

  2. Dweik RA, Boggs PB, Erzurum SC, Irvin CG, Leigh MW, Lundberg JO, et al., on behalf of ATS Committee on Interpretation of Exhaled Nitric Oxide (FENO) for Clinical Application. An official ATS Clinical Practice Guideline: Interpretation of Exhaled Nitric Oxide Levels (FENO) for clinical applications. Am J Respir Crit Care Med 2011;184:602–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Kharitonov SA, Donnelly LE, Montuschi P, Corradi M, Collins JV, Barnes PJ. Dose-dependent onset and cessation of action of inhaled budesonide on exhaled nitric oxide and symptoms in mild asthma. Thorax. 2002;57:889–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Jones SL, Herbison P, Cowan JO, Flannery EM, Hancox RJ, McLachlan CR, et al. Exhaled NO and assessment of anti-inflammatory effects of inhaled steroid: dose-response relationship. Eur Respir J. 2002;20:601–8.

    Article  CAS  PubMed  Google Scholar 

  5. Jatakanon A, Lim S, Kharitonov SA, Chung KF, Barnes PJ. Correlation between exhaled nitric oxide, sputum eosinophils, and methacholine responsiveness in patients with mild asthma. Thorax. 1998;53:91–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Visitsunthorn N, Prottasan P, Jirapongsananuruk O, Maneechotesuwan K. Is fractional exhaled nitric oxide (FeNO) associated with asthma control in children? Asian Pac J Allergy Immunol. 2014;32:218–25.

    CAS  PubMed  Google Scholar 

  7. Khalili B, Boggs PB, Shi R, Bahna SL. Discrepancy between clinical asthma control assessment tools and fractional exhaled nitric oxide. Ann Allergy Asthma Immunol. 2008;101:124–9.

    Article  PubMed  Google Scholar 

  8. Waibel V, Ulmer H, Horak E. Assessing asthma control: symptom scores, GINA levels of asthma control, lung function, and exhaled nitric oxide. Pediatr Pulmonol. 2012;47:113–8.

    Article  PubMed  Google Scholar 

  9. Raj D, Lodha R, Mukherjee A, Sethi T, Agrawal A, Kabra WHAT IS ALREADY KNOWN? • Asthma control can be objectively documented with Fractional exhaled nitric oxide (FENO) values WHAT THIS STUDY ADDS? • FENO values do not have discriminatory value for identification of asthma control using GINA guidelines for assessment of asthma. SK. Fractional exhaled nitric oxide in children with acute exacerbation of asthma. Indian Pediatr. 2014;51:105–11.

    PubMed  Google Scholar 

  10. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–38.

    Article  CAS  PubMed  Google Scholar 

  11. Volbeda F, Broekema M, Lodewijk ME, Hylkema MN, Reddel HK, Timens W, et al. Clinical control of asthma associates with measures of airway inflammation. Thorax. 2013;68:19–24.

    Article  PubMed  Google Scholar 

  12. Ozier A, Girodet PO, Bara I, Tunon de Lara JM, Marthan R, Berger P. Control maintenance can be predicted by exhaled NO monitoring in asthmatic patients. Respir Med. 2011;105:989–96.

    Article  PubMed  Google Scholar 

  13. Delgado-Corcoran C, Kissoon N, Murphy SP, Duckworth LJ. Exhaled nitric oxide reflects asthma severity and asthma control. Pediatr Crit Care Med. 2004;5:48–52.

    Article  PubMed  Google Scholar 

  14. Meyts I, Proesmans M, De Boeck K. Exhaled nitric oxide corresponds with office evaluation of asthma control. Pediatr Pulmonol. 2003;36:283–9.

    Article  PubMed  Google Scholar 

  15. Sippel JM, Holden WE, Tilles SA, O’Hollaren M, Cook J, Thukkani N, et al. Exhaled nitric oxide levels correlate with measures of disease control in asthma. J Allergy Clin Immunol. 2000;106:645–50.

    Article  CAS  PubMed  Google Scholar 

  16. Bernstein JA, Davis B, Alvarez-Puebla MJ, Nguyen D, Levin L, Olaguibel JM. Is exhaled nitric oxide a useful adjunctive test for assessing asthma? J Asthma. 2009;46:955–60.

    Article  CAS  PubMed  Google Scholar 

  17. Green RJ, Klein M, Becker P, Halkas A, Lewis H, Kitchin O, et al. Disagreement between common measures of asthma control in children. Chest. 2013;143:117–22.

    Article  PubMed  Google Scholar 

  18. Ito Y, Adachi Y, Itazawa T, Okabe Y, Adachi YS, Higuchi O, et al. Association between the results of the childhood asthma control test and objective parameters in asthmatic children. J Asthma. 2011;48:1076–80.

    Article  CAS  PubMed  Google Scholar 

  19. Vijverberg SJ, Koster ES, Koenderman L, Arets HG, van der Ent CK, Postma DS, et al. Exhaled NO is a poor marker of asthma control in children with a reported use of asthma medication: a pharmacy-based study. Pediatr Allergy Immunol. 2012;23:529–36.

    Article  PubMed  Google Scholar 

  20. Michils A, Baldassarre S, van Mvylam A. Exhaled nitric oxide and asthma control: A longitudinal study in unselected patients. Eur Respir J. 2008;31:539–46.

    Article  CAS  PubMed  Google Scholar 

  21. Yavuz ST, Civelek E, Sahiner UM, Buyuktiryaki AB, Tuncer A, Karabulut E, et al. Identifying uncontrolled asthma in children with the childhood asthma control test or exhaled nitric oxide measurement. Ann Allergy Asthma Immunol. 2012;109:36–40.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Pulmonology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India

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

Authors
  1. Raj Kumar Meena
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  2. Dinesh Raj
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  3. Rakesh Lodha
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  4. S. K. Kabra
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Correspondence to S. K. Kabra.

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Meena, R.K., Raj, D., Lodha, R. et al. Fractional exhaled nitric oxide for identification of uncontrolled asthma in children. Indian Pediatr 53, 307–310 (2016). https://doi.org/10.1007/s13312-016-0842-z

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  • DOI: https://doi.org/10.1007/s13312-016-0842-z

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