Abstract
Obtaining FeNO levels routinely in clinical practice adds to the burden of asthma care and resource utilisation. On the other hand, routine use of FeNO levels to guide therapy may improve asthma control and reduce exacerbations and hospitalisations related to asthma. The objective of this Cochrane review was to evaluate the efficacy of tailoring asthma therapy based on FeNO levels, in comparison with not using FeNO (i.e. management based on clinical symptoms and/or asthma guidelines), for asthma related outcomes in children. In our original review, we found that the use of FeNO strategy did not confer any benefit.
Methods: The Cochrane Register of Controlled Trials (CENTRAL), the Cochrane Airways Collaborative Review Group Specialised Trials Register, MEDLINE, EMBASE and CINAHL databases were searched by the Cochrane Airways Group. The latest search was performed in January 2016. All RCT's comparing adjustment of asthma medications based on FeNO levels with clinical symptoms were eligible to be included. Results of searches were reviewed against pre-determined criteria for inclusion.
Results: Nine studies were included. Three studies reported significant reduction in asthma exacerbations when treatment was based on FeNO levels in comparison to clinical symptoms and 6 did not. Combining all studies, 1426 participants were randomised and 1370 completed the trial. The meta-analyses using GIV showed that use of FeNO for guiding treatment significantly reduced asthma exacerbations OR 0.63 (95% CI 0.49 to 0.83).
Conclusion: Tailoring asthma medications based on FeNO levels (compared with primarily on clinical symptoms) decreases the frequency of asthma exacerbations in children.
- Copyright ©the authors 2016
