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NO help: Nitric oxide monitoring does not help most children with asthma
Date:1/6/2009

nearly twice as many dosage changes as the symptom-only group, which supports the idea that the lack of difference may be a reflection on the limits of compliance, rather than an inherent limitation in the technique. Still, the added cost and apparent lack of benefit of daily FENO monitoring found in this study suggests that applying the technique in this way is not of benefit to the asthmatic population at large, when compared to daily symptom monitoring.

Another possible explanation for the lack of improvement is that FENO monitoring is most likely to prompt a medication change that symptom-only monitoring would not suggest in patients whose symptoms and underlying inflammation are in discord, but the current study was not designed to assess these patients independently.

Still, in light of these findings, it is clear that FENO monitoring should only be applied to those who stand to gain the most. "There can be no doubt that adding frequent assessments of FENO to management plans of most children and adults with asthma will add unjustifiable costs without providing clinical benefit. Whether there is a role for monitoring FENO to aid management of severe asthma is untested," wrote Stephen Stick, Ph.D., of the Princess Margaret Hospital for Children in Perth, Australia and Peter Franklin, Ph.D., of the Centre for Asthma, Allergy and Respiratory Research at the University of Western Australia in Perth in an editorial that accompanied the article.

"We did not address other possible applications of frequent FENO monitoring, such as prediction of steroid effect. Loss of control, prediction and prevention of exacerbations, and tapering of steroids in symptom-free children who wheezed in the past," noted Dr. de Jongste. "We think there is good reason to study these potential applications."

Furthermore, as D. Robin Taylor, M.D., of the Dunedin School of Medicine at the University of Otago, in New Zealand, pointed out in separate editor
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Contact: Keely Savoie
ksavoie@thoracic.org
212-315-8620
American Thoracic Society
Source:Eurekalert

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