RT Journal Article
SR Electronic
T1 Predictive value of exhaled nitric oxide in the management of asthma: a systematic review
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 706
OP 714
DO 10.1183/13993003.00699-2016
VO 48
IS 3
A1 Lauri Lehtimäki
A1 Péter Csonka
A1 Eeva Mäkinen
A1 Jaana Isojärvi
A1 Sirpa-Liisa Hovi
A1 Anneli Ahovuo-Saloranta
YR 2016
UL http://erj.ersjournals.com/content/48/3/706.abstract
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