Fractional exhaled nitric oxide for the management of asthma in adults: A systematic review

Munira Essat, Sue Harnan, Tim Gomersall, Paul Tappenden, Ruth Wong, Ian Pavord, Rod Lawson, Mark L. Everard

Research output: Contribution to journalReview articlepeer-review

72 Citations (Scopus)


The aim of this review was to evaluate the clinical effectiveness of fractional exhaled nitric oxide (FeNO) measured in a clinical setting for the management of asthma in adults. 13 electronic databases were searched and studies were selected against predefined inclusion criteria. Quality assessment was conducted using QUADAS-2. Class effect meta-analyses were performed. Six studies were included. Despite high levels of heterogeneity in multiple study characteristics, exploratory class effect meta-analyses were conducted. Four studies reported a wider definition of exacerbation rates (major or severe exacerbation) with a pooled rate ratio of 0.80 (95% CI 0.63-1.02). Two studies reported rates of severe exacerbations (requiring oral corticosteroid use) with a pooled rate ratio of 0.89 (95% CI 0.43-1.72). Inhaled corticosteroid use was reported by four studies, with a pooled standardised mean difference of-0.24 (95% CI-0.56-0.07). No statistically significant differences for health-related quality of life or asthma control were found. FeNO guided management showed no statistically significant benefit in terms of severe exacerbations or inhaled corticosteroid use, but showed a statistically significant reduction in exacerbations of any severity. However, further research is warranted to clearly define which management protocols (including cut-off points) offer best efficacy and which patient groups would benefit the most.

Original languageEnglish
Pages (from-to)751-768
Number of pages18
JournalEuropean Respiratory Journal
Issue number3
Early online date4 Feb 2016
Publication statusPublished - 1 Mar 2016
Externally publishedYes


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