Exhaled nitric oxide monitoring does not reduce exacerbation frequency or inhaled corticosteroid dose in paediatric asthma: a randomised controlled trial
Article first published online: 10 AUG 2012
© 2012 Blackwell Publishing Ltd
The Clinical Respiratory Journal
Volume 7, Issue 2, pages 204–213, April 2013
How to Cite
Please cite this paper as: Exhaled nitric oxide monitoring does not reduce exacerbation frequency or inhaled corticosteroid dose in paediatric asthma: a randomised controlled trial. Clin Respir J 2013; 7: 204–213., , , , , , , , , , , , , and .
The study was conceived by Graham Roberts and developed with the other authors. Katharine Pike, Nikki Lancaster, Kirsty Drew, Ruth Morris, Anna Selby and Sophie Price assessed the study participants. Katharine Pike and Graham Roberts analysed the study data and prepared the first draft of the manuscript. All the authors reviewed and discussed the data and approved the final manuscript.
The study was reviewed by the local research ethics committee and been performed in accordance with the ethical standards laid down in an appropriate version of the 2000 Declaration of Helsinki (http://www.wma.net/e/policy/b3.htm). The parents of all participants gave informed consent for their child to participant in the study prior to their inclusion.
Conflict of interest
The authors have stated explicitly that there are no conflicts of interest in connection with this article.
Trial Registration: Controlled-Trials ISRCTN50872816.
The trial was approved by Southampton and South West Hampshire Research Ethics Committee (06/Q1702/9) and registered with Controlled-Trials.Com (ISRCTN50872816). Informed consent was obtained from each child's parents.
- Issue published online: 22 APR 2013
- Article first published online: 10 AUG 2012
- Accepted manuscript online: 2 JUL 2012 05:10AM EST
- Manuscript Accepted: 13 JUN 2012
- Manuscript Revised: 7 MAY 2012
- Manuscript Received: 10 MAR 2012
- exhaled airway markers;
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.
This study aimed to evaluate whether monitoring FENO can improve outpatient management of children with moderate to severe asthma using a pragmatic design.
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.
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.
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.