PT  - JOURNAL ARTICLE
AU  - Lauri Lehtimäki
AU  - Péter Csonka
AU  - Eeva Mäkinen
AU  - Jaana Isojärvi
AU  - Sirpa-Liisa Hovi
AU  - Anneli Ahovuo-Saloranta
TI  - Predictive value of exhaled nitric oxide in the management of asthma: a systematic review
AID  - 10.1183/13993003.00699-2016
DP  - 2016 Sep 01
TA  - European Respiratory Journal
PG  - 706--714
VI  - 48
IP  - 3
4099  - http://erj.ersjournals.com/content/48/3/706.short
4100  - http://erj.ersjournals.com/content/48/3/706.full
SO  - Eur Respir J2016 Sep 01; 48
AB  - The clinical value of measuring fractional exhaled nitric oxide (FeNO) in asthma is not clear. We aimed to assess whether FeNO can reliably predict clinical outcomes in asthma treated with inhaled corticosteroids (ICS). We also evaluated whether its predictive role is influenced by different inflammatory phenotypes of asthma.We conducted a systematic review focusing on five clinically relevant questions. Two authors independently screened search results, extracted data and assessed quality of the included studies. Data were synthesised by qualitative methods.12 prospective studies were included, answering partly three of the five questions. In steroid-naïve asthma, a high FeNO level probably predicts good response to ICS. In ICS-treated asthmatics, a low FeNO level probably predicts low risk of exacerbation, and the patient is unlikely to benefit from increasing ICS dose. There were scarce data to conclude whether FeNO predicts exacerbations when ICS treatment is stopped in well-controlled asthma. Only one study reported results separately in different asthma phenotypes.The current evidence on the predictive value of FeNO and its role in the management of asthma is incomplete. Future studies should focus on clinically meaningful questions and probably target only eosinophilic phenotypes where FeNO is best associated with the activity of airway inflammation.Exhaled nitric oxide may predict clinical outcomes in asthma, but its role in different phenotypes is unclear http://ow.ly/bUDe301n4FN