A Systematic Review of Fractional Exhaled Nitric Oxide in the Routine Management of Childhood Asthma

Timothy Gomersall, Sue Harnan, Munira Essat, Paul Tappenden, Ruth Wong, Rod Lawson, Ian Pavord, Mark Lloyd Everard

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background:
Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of eosinophilic inflammation which may be used to guide the management of asthma in childhood.

Objectives:
To synthesise the available evidence on the efficacy of FeNO-guided management of childhood asthma.

Methods:
Databases including MEDLINE and the Cochrane Library were searched, and randomised controlled trials (RCTs) comparing FeNO-guided management with any other monitoring strategy were included. Study quality was assessed using the Cochrane risk of bias tool for RCTs, and a number of outcomes were examined, including: exacerbations, medication use, quality of life, adverse events, and other markers of asthma control. Meta-analyses were planned if multiple studies with suitable heterogeneity were available. However, due to wide variations in study characteristics, meta-analysis was not possible.

Results:
Seven RCTs were identified. There was some evidence that FeNO-guided monitoring results in improved asthma control during the first year of management, although few results attained statistical significance. The impact on severe exacerbations was unclear. Similarly, the impact on use of anti-asthmatic drugs was unclear, and appears to depend on the step up/down protocols, and the clinical characteristics of patients.

Conclusions:
The potential benefit of FeNO monitoring is equivocal. Trends toward reduced exacerbation and increased medication use were seen, but typically failed to reach statistical significance. There are a number of issues that complicate data interpretation, including differences in the likely severity of included cohorts and variations in treatment algorithms. Further work is needed to systematically explore the impact of these parameters.
LanguageEnglish
Pages316-328
Number of pages13
JournalPediatric Pulmonology
Volume51
Issue number3
Early online date1 Feb 2016
DOIs
Publication statusPublished - Mar 2016
Externally publishedYes

Fingerprint

Nitric Oxide
Asthma
Randomized Controlled Trials
Meta-Analysis
Anti-Asthmatic Agents
Clinical Protocols
MEDLINE
Libraries
Biomarkers
Quality of Life
Databases
Inflammation
Therapeutics

Cite this

Gomersall, Timothy ; Harnan, Sue ; Essat, Munira ; Tappenden, Paul ; Wong, Ruth ; Lawson, Rod ; Pavord, Ian ; Everard, Mark Lloyd. / A Systematic Review of Fractional Exhaled Nitric Oxide in the Routine Management of Childhood Asthma. In: Pediatric Pulmonology. 2016 ; Vol. 51, No. 3. pp. 316-328.
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title = "A Systematic Review of Fractional Exhaled Nitric Oxide in the Routine Management of Childhood Asthma",
abstract = "Background:Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of eosinophilic inflammation which may be used to guide the management of asthma in childhood.Objectives:To synthesise the available evidence on the efficacy of FeNO-guided management of childhood asthma.Methods:Databases including MEDLINE and the Cochrane Library were searched, and randomised controlled trials (RCTs) comparing FeNO-guided management with any other monitoring strategy were included. Study quality was assessed using the Cochrane risk of bias tool for RCTs, and a number of outcomes were examined, including: exacerbations, medication use, quality of life, adverse events, and other markers of asthma control. Meta-analyses were planned if multiple studies with suitable heterogeneity were available. However, due to wide variations in study characteristics, meta-analysis was not possible.Results:Seven RCTs were identified. There was some evidence that FeNO-guided monitoring results in improved asthma control during the first year of management, although few results attained statistical significance. The impact on severe exacerbations was unclear. Similarly, the impact on use of anti-asthmatic drugs was unclear, and appears to depend on the step up/down protocols, and the clinical characteristics of patients.Conclusions:The potential benefit of FeNO monitoring is equivocal. Trends toward reduced exacerbation and increased medication use were seen, but typically failed to reach statistical significance. There are a number of issues that complicate data interpretation, including differences in the likely severity of included cohorts and variations in treatment algorithms. Further work is needed to systematically explore the impact of these parameters.",
keywords = "Allergy, Evidence-based medicine and outcomes, Nitric oxide (NO), Biomarkers, Asthma and early wheeze",
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Gomersall, T, Harnan, S, Essat, M, Tappenden, P, Wong, R, Lawson, R, Pavord, I & Everard, ML 2016, 'A Systematic Review of Fractional Exhaled Nitric Oxide in the Routine Management of Childhood Asthma', Pediatric Pulmonology, vol. 51, no. 3, pp. 316-328. https://doi.org/10.1002/ppul.23371

A Systematic Review of Fractional Exhaled Nitric Oxide in the Routine Management of Childhood Asthma. / Gomersall, Timothy; Harnan, Sue; Essat, Munira; Tappenden, Paul; Wong, Ruth; Lawson, Rod; Pavord, Ian; Everard, Mark Lloyd.

In: Pediatric Pulmonology, Vol. 51, No. 3, 03.2016, p. 316-328.

Research output: Contribution to journalArticle

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T1 - A Systematic Review of Fractional Exhaled Nitric Oxide in the Routine Management of Childhood Asthma

AU - Gomersall, Timothy

AU - Harnan, Sue

AU - Essat, Munira

AU - Tappenden, Paul

AU - Wong, Ruth

AU - Lawson, Rod

AU - Pavord, Ian

AU - Everard, Mark Lloyd

PY - 2016/3

Y1 - 2016/3

N2 - Background:Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of eosinophilic inflammation which may be used to guide the management of asthma in childhood.Objectives:To synthesise the available evidence on the efficacy of FeNO-guided management of childhood asthma.Methods:Databases including MEDLINE and the Cochrane Library were searched, and randomised controlled trials (RCTs) comparing FeNO-guided management with any other monitoring strategy were included. Study quality was assessed using the Cochrane risk of bias tool for RCTs, and a number of outcomes were examined, including: exacerbations, medication use, quality of life, adverse events, and other markers of asthma control. Meta-analyses were planned if multiple studies with suitable heterogeneity were available. However, due to wide variations in study characteristics, meta-analysis was not possible.Results:Seven RCTs were identified. There was some evidence that FeNO-guided monitoring results in improved asthma control during the first year of management, although few results attained statistical significance. The impact on severe exacerbations was unclear. Similarly, the impact on use of anti-asthmatic drugs was unclear, and appears to depend on the step up/down protocols, and the clinical characteristics of patients.Conclusions:The potential benefit of FeNO monitoring is equivocal. Trends toward reduced exacerbation and increased medication use were seen, but typically failed to reach statistical significance. There are a number of issues that complicate data interpretation, including differences in the likely severity of included cohorts and variations in treatment algorithms. Further work is needed to systematically explore the impact of these parameters.

AB - Background:Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of eosinophilic inflammation which may be used to guide the management of asthma in childhood.Objectives:To synthesise the available evidence on the efficacy of FeNO-guided management of childhood asthma.Methods:Databases including MEDLINE and the Cochrane Library were searched, and randomised controlled trials (RCTs) comparing FeNO-guided management with any other monitoring strategy were included. Study quality was assessed using the Cochrane risk of bias tool for RCTs, and a number of outcomes were examined, including: exacerbations, medication use, quality of life, adverse events, and other markers of asthma control. Meta-analyses were planned if multiple studies with suitable heterogeneity were available. However, due to wide variations in study characteristics, meta-analysis was not possible.Results:Seven RCTs were identified. There was some evidence that FeNO-guided monitoring results in improved asthma control during the first year of management, although few results attained statistical significance. The impact on severe exacerbations was unclear. Similarly, the impact on use of anti-asthmatic drugs was unclear, and appears to depend on the step up/down protocols, and the clinical characteristics of patients.Conclusions:The potential benefit of FeNO monitoring is equivocal. Trends toward reduced exacerbation and increased medication use were seen, but typically failed to reach statistical significance. There are a number of issues that complicate data interpretation, including differences in the likely severity of included cohorts and variations in treatment algorithms. Further work is needed to systematically explore the impact of these parameters.

KW - Allergy

KW - Evidence-based medicine and outcomes

KW - Nitric oxide (NO)

KW - Biomarkers

KW - Asthma and early wheeze

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DO - 10.1002/ppul.23371

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JO - Pediatric Pulmonology

T2 - Pediatric Pulmonology

JF - Pediatric Pulmonology

SN - 8755-6863

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