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Using fractional exhaled nitric oxide to guide step-down treatment decisions in asthma: practical considerations

Kay Wang, Jan Y. Verbakel, Jason Oke, Alexander Fleming-Nouri, Norihiro Harada, Ryo Atsuta, Tomoyuki Fujisawa, Tomotaka Kawayama, Hiromasa Inoue, Stephen Lazarus, Stanley Szefler, Fernando D. Martinez, Dominick Shaw, Ian D. Pavord, Mike Thomas
European Respiratory Journal 2020 56: 2002809; DOI: 10.1183/13993003.02809-2020
Kay Wang
1Nuffield Dept of Primary Care Health Sciences, University of Oxford, Oxford, UK
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  • For correspondence: kay.wang@phc.ox.ac.uk
Jan Y. Verbakel
2KU Leuven, Dept of Public Health and Primary Care, Leuven, Belgium
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Jason Oke
1Nuffield Dept of Primary Care Health Sciences, University of Oxford, Oxford, UK
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  • ORCID record for Jason Oke
Alexander Fleming-Nouri
3Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, UK
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Norihiro Harada
4Dept of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
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  • ORCID record for Norihiro Harada
Ryo Atsuta
4Dept of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
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Tomoyuki Fujisawa
5Second Division Dept of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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  • ORCID record for Tomoyuki Fujisawa
Tomotaka Kawayama
6Division of Respirology, Neurology, and Rheumatology, Kurume University School of Medicine, Kurume, Japan
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Hiromasa Inoue
7Dept of Pulmonary Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Stephen Lazarus
8Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA
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Stanley Szefler
9Children's Hospital Colorado, The Breathing Institute, Dept of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
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Fernando D. Martinez
10Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
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Dominick Shaw
11Nottingham Respiratory Research Unit, University of Nottingham, Nottingham, UK
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Ian D. Pavord
12Nuffield Dept of Medicine, University of Oxford, Oxford, UK
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Mike Thomas
13Primary Care, Population Sciences and Medical Education (PPM), University of Southampton, Southampton, UK
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Extract

We thank L. Pérez de Llano and colleagues for their comments on our study [1] and for comparing our findings with those of their prospective multicentre study describing a simple score for predicting step-down failure in adults with well-controlled asthma [2]. However, we would like to clarify that recent systematic review findings conclude that there is insufficient evidence, rather than evidence against, the ability of low fractional exhaled nitric oxide (FENO) to identify individuals in whom treatment can be safely stepped down [3].

Abstract

Using FENO to guide safe step-down treatment decisions in patients with well-controlled asthma should involve gradual, carefully monitored reductions and consider other potential risk factors for acute exacerbations https://bit.ly/2E2W679

Footnotes

  • Conflict of interest: K. Wang reports grants from National Institute for Health Research, during the conduct of the study.

  • Conflict of interest: J.Y. Verbakel has nothing to disclose.

  • Conflict of interest: J. Oke has nothing to disclose.

  • Conflict of interest: A. Fleming-Nouri has nothing to disclose.

  • Conflict of interest: N. Harada reports personal fees from AstraZeneca and GSK, outside the submitted work; and has a patent pending (Japanese Patent Application 2018-097070).

  • Conflict of interest: R. Atsuta has nothing to disclose.

  • Conflict of interest: T. Fujisawa has nothing to disclose.

  • Conflict of interest: T. Kawayama reports grants from Novartis, and personal fees from AstraZeneca, GlaxoSmithKline and Boehringer Ingelheim, outside the submitted work.

  • Conflict of interest: H. Inoue reports grants from Boehringer-Ingelheim, GlaxoSmithKline, Novartis, and personal fees from AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Kyorin, Sanofi, outside the submitted work.

  • Conflict of interest: S. Lazarus reports grants from NIH/NHLBI, during the conduct of the study; grants from NIH/NHLBI and American Lung Association - Airway Clinical Research Centers Network (ALA-ACRC), outside the submitted work.

  • Conflict of interest: S. Szefler reports other from Boehringer-Ingelheim, Genentech, GlaxoSmithKline, AstraZeneca, Daiichi Sankyo, Propeller Health, Sanofi and Regeneron, and grants from GlaxoSmithKline, outside the submitted work.

  • Conflict of interest: F.D. Martinez reports grants from NIH/NHLBI, NIH/NIEHS, NIH/NIAID, NIH/Office of Director, Johnson & Johnson, and personal fees from Copeval, outside the submitted work.

  • Conflict of interest: D. Shaw reports personal fees from AstraZeneca, GSK, TEVA, and Novartis, outside the submitted work.

  • Conflict of interest: I.D. Pavord reports personal fees from AstraZeneca, Boehringer Ingelheim, Aerocrine, Almirall, Novartis, GlaxoSmithKline, Genentech and Regeneron; other funding from Teva, Chiesi, Sanofi, Circassia and Knopp, and grants from NIHR, outside the submitted work.

  • Conflict of interest: M. Thomas reports personal fees from GSK, Novartis and Boehringer Ingelheim, outside the submitted work; and recent membership of the BTS SIGN Asthma guideline steering group and the NICE Asthma Diagnosis and Monitoring guideline development group.

  • Received July 16, 2020.
  • Accepted July 16, 2020.
  • Copyright ©ERS 2020
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Using fractional exhaled nitric oxide to guide step-down treatment decisions in asthma: practical considerations
Kay Wang, Jan Y. Verbakel, Jason Oke, Alexander Fleming-Nouri, Norihiro Harada, Ryo Atsuta, Tomoyuki Fujisawa, Tomotaka Kawayama, Hiromasa Inoue, Stephen Lazarus, Stanley Szefler, Fernando D. Martinez, Dominick Shaw, Ian D. Pavord, Mike Thomas
European Respiratory Journal Aug 2020, 56 (2) 2002809; DOI: 10.1183/13993003.02809-2020

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Using fractional exhaled nitric oxide to guide step-down treatment decisions in asthma: practical considerations
Kay Wang, Jan Y. Verbakel, Jason Oke, Alexander Fleming-Nouri, Norihiro Harada, Ryo Atsuta, Tomoyuki Fujisawa, Tomotaka Kawayama, Hiromasa Inoue, Stephen Lazarus, Stanley Szefler, Fernando D. Martinez, Dominick Shaw, Ian D. Pavord, Mike Thomas
European Respiratory Journal Aug 2020, 56 (2) 2002809; DOI: 10.1183/13993003.02809-2020
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