Impact of exhaled nitric oxide measurements on treatment decisions in an asthma specialty clinic

LaForce, Craig; Brooks, Elizabeth; Herje, Nancy; Dorinsky, Paul; Rickard, Kathy

doi:10.1016/j.anai.2014.06.013

Cited by 25 publications

(27 citation statements)

References 24 publications

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“…It has also been described that FeNO levels can be highly variable ranging from low levels to high levels even within one child on stable doses of ICS [47]. Further, FeNO levels may be difficult to clinically predict based on traditional methods of assessing asthma control and may lead a clinician to reconsider dosage adjustment [71]. …”

Section: Feno and Medication Managementmentioning

confidence: 99%

An Overview of Fractional Exhaled Nitric Oxide and Children with Asthma

Rao

Phipatanakul

2016

Expert Review of Clinical Immunology

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SUMMARY Asthma is the most common pediatric chronic disease and is characterized by lung inflammation. Fractional exhaled nitric oxide (FeNO) is thought to reflect the presence of eosinophilic airway inflammation, and is an easy, non-invasive test that has held promise in providing additional objective data. However, not all studies have shown a clinical benefit in the use of FeNO to guide management of asthma in children. This review will describe the results of the most recent studies examining the use of FeNO in the diagnosis and treatment of asthma in infants, pre-school-aged children and in school-aged children. It will aid the clinician in providing a clinical context in which FeNO may be most useful in treating pediatric asthma.

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Section: Feno and Medication Managementmentioning

confidence: 99%

An Overview of Fractional Exhaled Nitric Oxide and Children with Asthma

Rao

Phipatanakul

2016

Expert Review of Clinical Immunology

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“…Exhaled nitric oxide (eNO), a non‐invasive, easily measurable, endogenous biomarker and surrogate for eosinophilic inflammation in the lungs, might be a substance that significantly improves our ability to predict the risk of adverse respiratory events in children undergoing surgery . Indeed, the development of portable eNO technology has enabled point‐of‐care measurement and has the potential to provide clinicians with an instantaneous and objective indication of airway inflammation .…”

Section: Introductionmentioning

confidence: 99%

Prediction of peri‐operative adverse respiratory events in children: the role of exhaled nitric oxide

et al. 2015

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SummaryIncreased levels of exhaled nitric oxide (eNO) may be a more objective predictor in identifying children at higher risk of peri-operative adverse respiratory events than the presence of risk factors such as recent cold or wheeze. Children with either none or ≥ 2 risk factors had eNO measured before surgery and any peri-operative adverse respiratory events were recorded. We found that an elevated eNO level was only predictive of adverse respiratory events in children with ≥ 2 risk factors (OR 2.96 (95% CI 1.48-5.93), p = 0.002). The presence of risk factors had a better predictive capability than a raised eNO level (OR 3.83 (95% CI 1.85-7.95), p < 0.001). The combination of both predictors did not improve the predictive capability for adverse respiratory events (OR 1.93 (95% CI 1.44-2.59), p < 0.001). We conclude that measuring eNO levels does not lead to improved prediction of adverse respiratory events and that, in routine clinical practice, an accurate history of risk factors remains the most appropriate tool for successfully identifying children at risk of peri-operative adverse respiratory events.

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“…A study conducted by Chipps et al 16 looked at a subset of the population with FeNO greater than 100 ppb, and a study by LaForce et al 14 examined the impact of FeNO on clinical decision making. Most importantly, these small observational studies highlighted the need for randomized controlled longitudinal studies to further understand the role of FeNO in the pediatric and adult populations.…”

Section: Novel Diagnostic Techniquesmentioning

confidence: 99%

“…If studied further, FeNO has the potential to guide treatment decisions to result in decreased asthma morbidity and health care usage. 14–16 Three articles focused on the utility of the noninvasive Asthma Predictive Index, the role of methacholine challenge tests, and thresholds of provocative concentrations, respectively, and the ability of each to diagnose and guide treatment decisions in patients with mild asthma. 18–20 …”

Section: Novel Diagnostic Techniquesmentioning

confidence: 99%