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Is exhaled nitric oxide a useful adjunctive test for assessing asthma?
Jonathan A Bernstein1, Ben Davis, María J Alvarez-Puebla
1University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, Ohio, USA.
Summary
Fractionated exhaled nitric oxide (FeNO) can help assess asthma, particularly in mild, untreated cases. However, its utility is limited by asthma severity and treatment variations in broader patient groups.
Area of Science:
- Pulmonology
- Allergy and Immunology
- Clinical Diagnostics
Background:
- Asthma patient characterization relies on clinical and physiological markers.
- Key parameters include the Asthma Control Test (ACT), forced expiratory volume in 1 second (FEV1), and fractionated exhaled nitric oxide (FeNO).
Purpose of the Study:
- To evaluate the clinical utility of ACT, FEV1, and FeNO in characterizing asthma patients.
- To compare these parameters between distinct patient populations in the US and Spain.
Main Methods:
- Two independent cross-sectional studies enrolled 100 (US) and 109 (Spain) adult asthma patients.
- Asthma diagnosis was physician-confirmed with bronchodilator response or airway hyperresponsiveness.
- Patients with COPD or current smoking were excluded; no restrictions on asthma severity or treatment.
Main Results:
- Significant differences observed in age, %FEV1, FeNO, inhaled corticosteroid (ICS) use, and atopy between US and Spain sites.
- Milder asthma and lower ICS use noted in the Spain cohort.
- FeNO levels decreased with improved asthma control categories at both sites, with lower mean FeNO in the US.
- A significant negative correlation between ACT and FeNO was found in Spain patients not using ICS.
Conclusions:
- FeNO shows promise as an adjunctive tool for assessing asthma, especially in mild, ICS-naïve patients.
- The heterogeneity of asthma severity and treatment regimens complicates the correlation of ACT with FeNO across diverse patient populations.
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