title: Fractional exhaled nitric oxide for the management of asthma in adults: a systematic review.
abstract: The aim of this review was to evaluate the clinical effectiveness of fractional exhaled nitric oxide (FeNO) measured in a clinical setting for the management of asthma in adults.13 electronic databases were searched and studies were selected against predefined inclusion criteria. Quality assessment was conducted using QUADAS-2. Class effect meta-analyses were performed.Six studies were included. Despite high levels of heterogeneity in multiple study characteristics, exploratory class effect meta-analyses were conducted. Four studies reported a wider definition of exacerbation rates (major or severe exacerbation) with a pooled rate ratio of 0.80 (95% CI 0.63-1.02). Two studies reported rates of severe exacerbations (requiring oral corticosteroid use) with a pooled rate ratio of 0.89 (95% CI 0.43-1.72). Inhaled corticosteroid use was reported by four studies, with a pooled standardised mean difference of -0.24 (95% CI -0.56-0.07). No statistically significant differences for health-related quality of life or asthma control were found.FeNO guided management showed no statistically significant benefit in terms of severe exacerbations or inhaled corticosteroid use, but showed a statistically significant reduction in exacerbations of any severity. However, further research is warranted to clearly define which management protocols (including cut-off points) offer best efficacy and which patient groups would benefit the most.
authors: School of Health and Related Research, University of Sheffield, Sheffield, UK m.essat@sheffield.ac.uk.
authors: Munira
authors: M
authors: Essat
authors: School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors: Sue
authors: S
authors: Harnan
authors: School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors: Tim
authors: T
authors: Gomersall
authors: School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors: Paul
authors: P
authors: Tappenden
authors: School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors: Ruth
authors: R
authors: Wong
authors: Nuffield Dept of Medicine, University of Oxford, Oxford, UK.
authors: Ian
authors: I
authors: Pavord
authors: Dept of Respiratory Medicine, Royal Hallamshire Hospital, Sheffield, UK.
authors: Rod
authors: R
authors: Lawson
authors: School of Paediatrics and Child Health, Princess Margaret Hospital, University of Western Australia, Perth, Australia.
authors: Mark L
authors: ML
authors: Everard
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy*; D015415:Biomarkers / Q000032:analysis; D001944:Breath Tests; D019468:Disease Management; D018450:Disease Progression; D045853:Exhalation; D006801:Humans; D009569:Nitric Oxide / Q000032:analysis*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D015415:Biomarkers; D009569:Nitric Oxide