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FeNO and asthma treatment in children: a systematic review and meta-analysis
Min Lu1, Beirong Wu, Datian Che
1From the Department of Pulmonary Medicine (ML, BRW, DTC, HXG); and Department of Digestive Medicine (RQ), Children's Hospital of Shanghai, Jiaotong University School of Medicine, Shanghai, China.
Insights
Monitoring fraction of exhaled nitric oxide (FeNO) in children with asthma showed little clinical benefit for treatment adjustments. However, FeNO monitoring may reduce asthma exacerbations compared to traditional methods.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Clinical Research
Background:
- Traditional asthma management in children relies on symptoms and spirometry.
- Inflammatory markers like fraction of exhaled nitric oxide (FeNO) are increasingly used for tailored treatments.
Purpose of the Study:
- To evaluate the benefits of incorporating FeNO monitoring into guideline-based management for childhood asthma.
- To compare FeNO-guided treatment with conventional monitoring strategies.
Main Methods:
- A meta-analysis of randomized control trials (RCTs) sourced from PubMed and Cochrane CENTRAL databases up to November 2013.
- Included studies compared FeNO monitoring against conventional methods (spirometry, symptoms) in managing pediatric asthma.
- Six RCTs involving 506 children in the FeNO group and 511 in the conventional group were analyzed.
Main Results:
- No significant differences were observed in FeNO values, FEV1 changes, or steroid use between FeNO and conventional groups.
- The FeNO group showed a statistically significant lower frequency of more than one asthma exacerbation (95% CI: 0.532, 0.895).
Conclusions:
- Using FeNO to guide asthma treatment in children offers limited clinical benefit for direct management adjustments.
- FeNO monitoring may contribute to a reduction in asthma exacerbations, supporting its potential role alongside guideline-based care.
Abstract:
Traditional asthma treatments are typically adjusted in children with asthma using symptoms and spirometry. Treatments tailored in accordance to inflammatory markers, such as fraction of exhaled nitric oxide (FeNO) or sputum eosinophils, are increasing in use. This meta-analysis evaluated the potential benefit of incorporating the use of monitoring FeNO with guideline-based management in treating children with asthma. PubMed and Cochrane CENTRAL databases were searched until November 2013 for randomized control trials that investigated the use of FeNO compared with conventional monitoring in managing asthma in children. Included studies had at least 2 intervention groups: one that utilized FeNO and the other that utilized only conventional or standard methods (eg, spirometry, symptoms, and others) to guide treatment. Six studies were included in the meta-analysis comprising 506 subjects whose treatment was monitored using FeNO and 511 subjects who were managed using conventional methods. We found no difference between the FeNO and the conventional groups in FeNO value (95% confidence interval [CI]: -0.31, 0.1), change from baseline in FEV1 (95% CI: -0.07, 0.20), or steroid use (95% CI: -0.67, 1.80). However, the FeNO group was associated with a lower frequency of >1 asthma exacerbation (95% CI: 0.532, 0.895). This meta-analysis suggests that using FeNO to guide treatment decisions has little clinical benefit, although may result in a decrease in asthma exacerbations. Our findings support the use of guideline-based asthma management and diagnosis.
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