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Tailored interventions based on exhaled nitric oxide versus clinical symptoms for asthma in children and adults

Petsky, HL; Cates, CJ; Li, A; Kynaston, JA; Turner, C; Chang, AB (2009) Tailored interventions based on exhaled nitric oxide versus clinical symptoms for asthma in children and adults. COCHRANE DATABASE OF SYSTEMATIC REVIEWS (4). pp. 1-41. ISSN 1469-493X https://doi.org/10.1002/14651858.CD006340.pub3
SGUL Authors: Cates, Christopher Joseph

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Abstract

BackgroundThe measurement of severity and control of asthma in both children and adults can be based on subjective or objective measures. It has been advocated that fractional exhaled nitric oxide (FeNO) can be used to monitor airway inflammation as it correlates with some markers of asthma. Interventions for asthma therapies have been traditionally based on symptoms and/or spirometry.ObjectivesTo evaluate the efficacy of tailoring asthma interventions based on exhaled nitric oxide in comparison to clinical symptoms (with or without spirometry/peak flow) for asthma related outcomes in children and adults.Search strategyWe searched the Cochrane Airways Group Specialised Register of Trials, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and reference lists of articles. The last search was completed in February 2009.Selection criteriaAll randomised controlled comparisons of adjustment of asthma therapy based on exhaled nitric oxide compared to traditional methods (primarily clinical symptoms and spirometry/peak flow).Data collection and analysisResults of searches were reviewed against pre-determined criteria for inclusion. Relevant studies were independently selected in duplicate. Two authors independently assessed trial quality and extracted data. Authors were contacted for further information with response from one.Main resultsTwo studies have been added for this update, which now includes six (2 adults and 4 children/adolescent) studies; these studies differed in a variety of ways including definition of asthma exacerbations, FeNO cut off levels, the way in which FeNO was used to adjust therapy and duration of study. Of 1053 participants randomised, 1010 completed the trials. In the meta-analysis, there was no significant difference between groups for the primary outcome of asthma exacerbations or for other outcomes (clinical symptoms, FeNO level and spirometry). In post-hoc analysis, a significant reduction in mean final daily dose inhaled corticosteroid per adult was found in the group where treatment was based on FeNO in comparison to clinical symptoms, (mean difference -450 mcg; 95% CI -677 to 223 mcg budesonide equivalent/day). However, the total amount of inhaled corticosteroid used in one of the adult studies was 11% greater in the FeNO arm. In contrast, in the paediatric studies, there was a significant increase in inhaled corticosteroid dose in the FeNO strategy arm (mean difference of 140 mcg; 95% CI 29 to 251, mcg budesonide equivalent/day).Authors' conclusionsTailoring the dose of inhaled corticosteroids based on exhaled nitric oxide in comparison to clinical symptoms was carried out in different ways in the six studies and found only modest benefit at best and potentially higher doses of inhaled corticosteroids in children. The role of utilising exhaled nitric oxide to tailor the dose of inhaled corticosteroids cannot be routinely recommended for clinical practice at this stage and remains uncertain.

Item Type: Article
Additional Information: This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2009, Issue 4. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review. Petsky HL, Cates CJ, Li A, Kynaston JA, Turner C, & Chang AB. Tailored interventions based on exhaled nitric oxide versus clinical symptoms for asthma in children and adults. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD006340. DOI: 10.1002/14651858.CD006340.pub3.
Keywords: Science & Technology, Life Sciences & Biomedicine, Medicine, General & Internal, General & Internal Medicine, Adrenal Cortex Hormones [*administration & dosage], Anti-Asthmatic Agents [*administration & dosage], Asthma [*drug therapy; metabolism], Biological Markers [analysis], Breath Tests [methods], Nitric Oxide [*analysis], Randomized Controlled Trials as Topic, Adult, Child, Humans, RANDOMIZED CONTROLLED-TRIAL, MILD ASTHMA, CHILDHOOD ASTHMA, AIRWAY INFLAMMATION, INHALED BUDESONIDE, MANAGEMENT, RESPONSIVENESS, POPULATION, COMMUNITY, MARKERS, Adrenal Cortex Hormones, Adult, Anti-Asthmatic Agents, Asthma, Biological Markers, Breath Tests, Child, Humans, Nitric Oxide, Randomized Controlled Trials as Topic, Adrenal Cortex Hormones [*administration & dosage], Anti-Asthmatic Agents [*administration & dosage], Asthma [*drug therapy; metabolism], Biological Markers [analysis], Breath Tests [methods], Nitric Oxide [*analysis], Randomized Controlled Trials as Topic, Adult, Child, Humans
SGUL Research Institute / Research Centre: Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: COCHRANE DATABASE OF SYSTEMATIC REVIEWS
ISSN: 1469-493X
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Dates:
DateEvent
2009Published
Web of Science ID: WOS:000270686900014
URI: http://openaccess.sgul.ac.uk/id/eprint/2697
Publisher's version: https://doi.org/10.1002/14651858.CD006340.pub3

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