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Office-based exhaled nitric oxide measurement in children 4 years of age and older
Jill R Hanson1, Stephen A De Lurgio, David D Williams
1Pediatric Residency Program, Children's Mercy Hospital, Kansas City, Missouri.
Insights
Fractional exhaled nitric oxide (FENO) testing is feasible and useful for managing asthma in children as young as 4 years old. This study found FENO levels correlate with age and asthma severity in young children.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Respiratory Medicine
Background:
- Fractional exhaled nitric oxide (FENO) is a valuable tool for asthma management.
- Data on FENO values and their clinical correlations in young children (4-7 years) are limited.
- This study addresses the need for more data in this pediatric population.
Purpose of the Study:
- To establish FENO values in 4- to 7-year-old children with suspected asthma.
- To analyze the relationship between FENO levels and clinical variables in this age group.
- To examine FENO levels in relation to age and sex in children aged 4 to 18 years with suspected asthma.
Main Methods:
- Retrospective analysis of FENO testing data from 825 children (4-18 years) using the NIOX MINO device.
- Detailed chart reviews were conducted for 75 children aged 4-7 years.
- Regression analysis was employed to identify correlations between FENO levels and clinical factors.
Main Results:
- FENO values ranged from <=5 to 89 ppb in 4- to 7-year-olds and <=5 to 300 ppb in 7- to 18-year-olds.
- Approximately 10% of younger children and 33% of older children exhibited FENO levels (>35 ppb) indicating eosinophilic inflammation.
- Higher FENO levels in 4- to 7-year-olds were associated with increasing age, asthma severity, and atopic dermatitis, while inhaled corticosteroid use was linked to lower FENO.
Conclusions:
- This study presents the largest cohort of young children (4-7 years) undergoing FENO testing for asthma management.
- FENO level correlations with clinical variables in this cohort align with findings in older children.
- FENO assessment appears feasible and beneficial for office-based asthma management in children from age 4.
Background:
Fractional exhaled nitric oxide (FENO) is increasingly being used in the office-based management of asthma, but data in children are limited.
Objectives:
To report FENO values in 4- to 7-year-old children with suspected asthma and characterize their relation to clinical variables and describe the relation among FENO levels, age, and sex in 4- to 18-year-old children with suspected asthma.
Methods:
Retrospective data in 4- to 18-year-old children (n = 825) who underwent FENO testing using the NIOX MINO device were collected and analyzed. Chart reviews were performed for the 4- to 7-year-old children (n = 75).
Results:
FENO values ranged from less than or equal to 5 to 89 ppb in 75 4- to 7-year-old children and less than or equal to 5 to 300 ppb in 750 > 7 to 18-year-old children. Approximately one tenth of 4- to 7-year-old children and one third of > 7 to 18-year-old children had FENO values indicative of eosinophilic/allergic inflammation (>35 ppb). In regression analysis of the 4- to 7-year-old children, increasing age (P = .03) and asthma severity (P = .01) were associated with higher FENO levels. Atopic dermatitis was significantly associated (P = .03), whereas allergic rhinitis was marginally associated (P = .06), with higher FENO levels. Inhaled corticosteroid use was associated with lower FENO levels (P = .02).
Conclusion:
This study characterizes the largest cohort of 4- to 7-year-old children to undergo FENO testing in ambulatory asthma management. Correlations between FENO levels and clinical variables were consistent with established findings in older children. This preliminary real-world study suggests that FENO assessment may be feasible and useful in the office-based asthma management of children as young as 4 years.
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