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Exhaled nitric oxide as a marker of asthma control in smoking patients

Chest Depts, ¹ CUB Erasme, Brussels, ² CHU Sart-Tilmant, Liège, and ³ CHU André Vésale, Montigny-le-Tilleul, Belgium.

CORRESPONDENCE: A. Van Muylem, Chest Dept, CUB Erasme, 808 Route de Lennik, 1070 Brussels, Belgium. Fax: 32 25554411. E-mail: avmuylem{at}ulb.ac.be

Keywords: Asthma control, exhaled nitric oxide, tobacco smoking

Received: October 13, 2008
Accepted January 3, 2009

Exhaled nitric oxide fraction (F_eNO), which is a reliable marker of eosinophilic airway inflammation, is partially suppressed by tobacco smoking. Consequently, its potential as a biomarker in asthma management has never been evaluated in smoking patients. In the present study, the authors tested the validity of F_eNO to predict asthma control in this population.

F_eNO and the Asthma Control Questionnaire (ACQ) were recorded at least once in 411 nonsmoking (345 with at least two visits) and 59 smoking (51 with at least two visits) asthma patients.

Despite similar mean ACQ scores (1.5 versus 1.7), F_eNO was reduced in smoking asthmatics (18.1 ppb versus 33.7 ppb). A decrease in F_eNO of <20% precludes asthma control improvement in nonsmoking (negative predictive value (NPV) 78%) and in smoking patients (NPV 72%). An increase in F_eNO <30% is unlikely to be associated with deterioration in asthma control in both groups of patients (NPV = 86% and 84% in nonsmoking and smoking patients, respectively).

It is concluded that, even in smokers, sequential changes in F_eNO have a relationship with asthma control. The present study is the first to indicate that cigarette smoking does not obviate the clinical value of measuring F_eNO in asthma among smokers.

This article has been cited by other articles:

				A. I. Papaioannou, M. Minas, K. Tanou, K. I. Gourgoulianis, and K. Kostikas Exhaled NO may predict loss of asthma control: the effect of concomitant allergic rhinitis Eur. Respir. J., October 1, 2009; 34(4): 1006 - 1007. [Full Text] [PDF]