Added cost may also rule out this additional measure, study suggests
FRIDAY, Jan. 9 (HealthDay News) -- Measuring nitric oxide levels in an asthmatic child's breath every day does not improve the effectiveness of adjusting the child's medications, a new study shows.
Nitric oxide (NO) amounts in an asthmatic's breath can foretell the worsening of symptoms or even an attack. But a 30-week Dutch study of children with the breathing condition found basing daily asthma management on this added knowledge did not improve exacerbation rates, symptoms, or the use of medications any more than just calibrating medication use based on the child's symptoms alone.
However, those in the study -- in which families were regularly contacted by doctors to report on symptoms and receive instructions on adjusting medication -- showed a greater overall improvement in symptoms while cutting inhaled steroid doses in half, regardless of whether their fractional exhaled nitric oxide (FeNO) was being checked.
"We speculate that daily supervision and frequent phone contacts have produced an improvement that could not be beaten by additional monitoring of FeNO, most likely because of a ceiling effect on compliance," Dr. Johan C. de Jongste, of the Erasmus University Medical Center-Sophia Children's Hospital in the Netherlands, wrote in the study.
The findings were published in the second January issue of the American Journal of Respiratory and Critical Care Medicine.
Those in the study's FeNO group had nearly twice as many changes in medication as the symptom-only group, but the cost of the additional monitoring and its lack of apparent benefit would rule out adding this regimen to most asthmatic children's routine.
"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," Stephen Stick, of the Princess Margaret Hospital for Children in Perth, Australia, and Peter Franklin, of the Centre for Asthma, Allergy and Respiratory Research at the University of Western Australia in Perth, wrote in an accompanying editorial.
The Asthma and Allergy Foundation of America has more about asthma.
-- Kevin McKeever
SOURCE: American Thoracic Society, news release, Jan. 7, 2009
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