title: Impact of exhaled nitric oxide measurements on treatment decisions in an asthma specialty clinic.
abstract: BACKGROUND
  Asthma management in an outpatient setting is best accomplished by clinical evaluation coupled with spirometry and symptom evaluation, but these assessments do not provide information about airway inflammation. Exhaled nitric oxide (fraction of exhaled nitric oxide [FeNO]) measures T-helper cell type 2-mediated airway inflammation and may be a useful adjunct in asthma management.
  
  
  OBJECTIVE
  To determine whether the use of FeNO in the specialist management of asthma results in more effective and cost-effective treatment decisions.
  
  
  METHODS
  Fifty subjects 7 to 60 years old with established asthma participated in this observational study. Subjects were evaluated by clinical examination, spirometry, and symptom assessment using the Asthma Control Test, and clinicians estimated airway inflammation and made treatment decisions based on these assessments. Then, FeNO was measured, and changes in therapy based on FeNO levels were documented. The estimated cost impact of using FeNO was calculated presuming ongoing FeNO use in patient management.
  
  
  RESULTS
  Without FeNO, the clinician's assessment of airway inflammation was incorrectly classified in 50% of subjects. FeNO results substantially altered treatment decisions in more than one third of subjects, notably medication augmentation in 10 (20%) and medication decreases in 8 (16%). Use of FeNO in addition to standard of care was estimated to save $629 per subject per year.
  
  
  CONCLUSIONS
  Measurement of FeNO augments routine clinical assessment of asthma by measuring airway inflammation. Knowledge of FeNO affects medication treatment decisions to augment or decrease pharmacotherapy, which has important long-term asthma management implications, most notably the potential to lower the costs and morbidity associated with asthma exacerbation.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier NCT01729247.
authors: North Carolina Clinical Research, Raleigh, North Carolina.
authors: Craig
authors: C
authors: LaForce
authors: Reimbursement Principles, Littleton, Colorado.
authors: Elizabeth
authors: E
authors: Brooks
authors: Aerocrine, Inc, Morrisville, North Carolina.
authors: Nancy
authors: N
authors: Herje
authors: Cipla, Durham, North Carolina.
authors: Paul
authors: P
authors: Dorinsky
authors: Aerocrine, Inc, Morrisville, North Carolina. Electronic address: karmd5@yahoo.com.
authors: Kathy
authors: K
authors: Rickard
mesh_terms: D000293:Adolescent; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000191:economics / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology; D015415:Biomarkers / Q000378:metabolism; D001944:Breath Tests; D002648:Child; D045853:Exhalation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000032:analysis* / Q000096:biosynthesis; D013147:Spirometry; D018418:Th2 Cells / Q000378:metabolism / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D018927:Anti-Asthmatic Agents; D015415:Biomarkers; D009569:Nitric Oxide