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Eur Respir J 2007, doi:10.1183/09031936.00020407
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ORIGINAL ARTICLE |
Exhaled nitric oxide and asthma control: a longitudinal study in unselected patients
1 Chest Dept – Erasme University Hospital – Brussels, Belgium
* To whom correspondence should be addressed. E-mail: avmuylem{at}ulb.ac.be.
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Abstract |
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Controlled studies have shown that monitoring exhaled nitric oxide (FENO) improve asthma management. However, they seldom consider the full range of patients seen in clinical practise. In this study, we investigated the ability of FENO to reflect asthma control (AC) over time, and identified, in a regular clinical setting, meaningful FENO cut-points and changes.
AC questionnaire and FENO were recorded at least once in 341 unselected asthma patients. The whole population and sub-groups were considered: inhaled steroïds (ICS) naïve and low or high-to medium (
or >500 µg.equ·BDD·day-1) ICS doses groups.
FENO decrease <40% or increase <30% precludes AC optimization or deterioration respectively (negative predictive value, NPV=79% and 82%). In our low dose group, a decrease >40% indicates AC optimization (positive predictive value, PPV=83%). In ICS naïve patients, FENO>35 ppb predicts AC improvement in response to ICS (PPV=68%). In most cases, FEV1 assessments were not useful.
In conclusion, in a given patient, FENO is significantly related to asthma control over time. The overall ability of FENO to reflect asthma control is reduced in patients using high doses of ICS. FEV1 has little additional value in assessing asthma control.
Keywords: Asthma control, exhaled nitric oxide, lung function
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