TY - JOUR T1 - Fractional exhaled nitric oxide for the management of asthma in adults: a systematic review JF - European Respiratory Journal JO - Eur Respir J SP - 751 LP - 768 DO - 10.1183/13993003.01882-2015 VL - 47 IS - 3 AU - Munira Essat AU - Sue Harnan AU - Tim Gomersall AU - Paul Tappenden AU - Ruth Wong AU - Ian Pavord AU - Rod Lawson AU - Mark L. Everard Y1 - 2016/03/01 UR - http://erj.ersjournals.com/content/47/3/751.abstract N2 - The aim of this review was to evaluate the clinical effectiveness of fractional exhaled nitric oxide (FeNO) measured in a clinical setting for the management of asthma in adults.13 electronic databases were searched and studies were selected against predefined inclusion criteria. Quality assessment was conducted using QUADAS-2. Class effect meta-analyses were performed.Six studies were included. Despite high levels of heterogeneity in multiple study characteristics, exploratory class effect meta-analyses were conducted. Four studies reported a wider definition of exacerbation rates (major or severe exacerbation) with a pooled rate ratio of 0.80 (95% CI 0.63–1.02). Two studies reported rates of severe exacerbations (requiring oral corticosteroid use) with a pooled rate ratio of 0.89 (95% CI 0.43–1.72). Inhaled corticosteroid use was reported by four studies, with a pooled standardised mean difference of −0.24 (95% CI −0.56–0.07). No statistically significant differences for health-related quality of life or asthma control were found.FeNO guided management showed no statistically significant benefit in terms of severe exacerbations or inhaled corticosteroid use, but showed a statistically significant reduction in exacerbations of any severity. However, further research is warranted to clearly define which management protocols (including cut-off points) offer best efficacy and which patient groups would benefit the most.FeNO testing for adult asthma management may confer clinical benefit, but research is needed to establish its role http://ow.ly/WGWkx ER -