title: Exhaled nitric oxide monitoring does not reduce exacerbation frequency or inhaled corticosteroid dose in paediatric asthma: a randomised controlled trial.
abstract: BACKGROUND
  Inhaled corticosteroid therapy (ICS) for asthma is currently modified according to symptoms and lung function. Fractional exhaled nitric oxide (FENO) has been demonstrated to be a non-invasive marker of eosinophilic inflammation. Studies of FENO-driven asthma management show variable success. Objectives: This study aimed to evaluate whether monitoring FENO can improve outpatient management of children with moderate to severe asthma using a pragmatic design.
  
  
  METHODS
  Children aged 6–17 years with moderate to severe asthma were recruited. Their asthma was stabilised before randomisation to FENO-driven therapy or to a standard management group where therapy was driven by conventional markers of asthma control. ICS or long-acting bronchodilator therapies were altered according to FENO levels in combination with reported symptoms in the FENO group. Participants were assessed 2 monthly for 12 months. ICS dose and exacerbation frequency change were compared between groups in an intention to treat analysis.
  
  
  RESULTS
  Ninety children were randomised. No difference was found between the two groups in either change in corticosteroid dose or exacerbation frequency. Results were similar in a planned secondary analysis of atopic asthmatics.
  
  
  CONCLUSIONS
  FENO-guided ICS titration does not appear to reduce corticosteroid usage or exacerbation frequency in paediatric outpatients with moderate to severe asthma. This may reflect limitations in FENO-driven management algorithms, as there are now concerns that FENO levels relate to atopy as much as they relate to asthma control.
authors: University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors: Katharine
authors: K
authors: Pike
authors: Anna
authors: A
authors: Selby
authors: Sophie
authors: S
authors: Price
authors: John
authors: J
authors: Warner
authors: Gary
authors: G
authors: Connett
authors: Julian
authors: J
authors: Legg
authors: Jane S A
authors: JS
authors: Lucas
authors: Sheila
authors: S
authors: Peters
authors: Hannah
authors: H
authors: Buckley
authors: Krzysztof
authors: K
authors: Magier
authors: Keith
authors: K
authors: Foote
authors: Kirsty
authors: K
authors: Drew
authors: Ruth
authors: R
authors: Morris
authors: Nikki
authors: N
authors: Lancaster
authors: Graham
authors: G
authors: Roberts
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy* / Q000378:metabolism; D015415:Biomarkers / Q000032:analysis / Q000378:metabolism; D002648:Child; D045853:Exhalation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D009569:Nitric Oxide / Q000032:analysis* / Q000378:metabolism; D011788:Quality of Life; D011795:Surveys and Questionnaires
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D015415:Biomarkers; D009569:Nitric Oxide