Source: Annual Congress 2013 –Diagnosis and management of respiratory diseases
Disease area: Airway diseases

Abstract

Background:
A major goal of asthma management is achieving and maintaining optimal control. Current assessment is based on symptoms and lung function. Portable monitors for FeNO have now become available.
Objectives:
We evaluated whether domiciliary daily home FeNO monitoring could be useful as an index of asthma control.
Methods:
Fifty asthmatic subjects and 15 healthy volunteers with a range of asthma severity underwent asthma control questionnaire (ACQ), spirometry before and after salbutamol and sputum induction. FeNO and peak expiratory flow (PEF) were measured twice daily for 2 weeks. A record of exacerbations was obtained 3 months later.
Results:
Diurnal FeNO variation in uncontrolled asthmatics was significantly greater than in controlled asthmatics (p<0.01). PEF variation was not different. The daily variation of FeNO levels was also greater in uncontrolled asthmatics compared to controlled asthmatic and healthy subjects (p<0.01). 80% of uncontrolled asthmatics experienced at least one or more exacerbations over the 3 months after the enrolment. The combination of diurnal FeNO variation ≥16.6% and ACQ scores ≤ 1.8 was best at predicting uncontrolled asthma (AUC; 0.91, 95%CI: 0.86-0.97, p<0.001).Conclusions:Diurnal variation in FeNO combined with ACQ scores can be used as a better marker of asthma control and as a predictor of the risk of future exacerbation. Prospective studies are warranted.

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Citations should be made in the following way:
J. Saito, D. Gibeon, P. Macedo, A. Menzies-Gow, P. Bhavsar, F. Chung (London, United Kingdom; Fukushima, Japan). Domiciliary diurnal variation of fractional exhaled nitric oxide (FeNO) to monitor asthma control. Eur Respir J 2013; 42: Suppl. 57, 4158

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