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The Role of FeNO in Predicting Asthma
1Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC-Sophia, University Medical Center Rotterdam, Rotterdam, Netherlands.
Insights
Fraction of exhaled nitric oxide (FeNO) may help predict asthma in children. High FeNO levels in preschool and school-aged children can indicate a higher risk of developing asthma or impaired lung growth.
Area of Science:
- Pediatric Pulmonology
- Biomarkers
- Respiratory Medicine
Background:
- Asthma-like symptoms, including wheezing and dyspnea, affect a significant portion of preschool children.
- Identifying reliable biomarkers is crucial for targeted treatment and avoiding unnecessary medication in children with respiratory symptoms.
Purpose of the Study:
- To evaluate the predictive value of the fraction of exhaled nitric oxide (FeNO) for later asthma development and lung growth in preschool children.
- To assess the utility of FeNO in differentiating preschool wheezing phenotypes and identifying children at risk for adverse respiratory outcomes.
Main Methods:
- Review of studies assessing the predictive value of FeNO in preschool wheezing children.
- Analysis of data on FeNO measurement in younger children using various developed methods.
- Examination of studies in school children linking FeNO levels to asthma development and lung function growth.
Main Results:
- FeNO shows potential in defining preschool wheezing phenotypes and assessing risks for future asthma or impaired lung growth.
- Studies in school children indicate high FeNO predicts asthma development and lower lung function growth.
- FeNO demonstrates diagnostic value for asthma in school children, particularly in atopic individuals, primarily for ruling in the diagnosis.
Conclusions:
- FeNO may serve as a valuable biomarker in pediatric respiratory medicine, aiding in risk stratification for asthma and lung development.
- While FeNO shows promise, further research is needed to clarify its added value over clinical parameters and its predictive role in lung development for school-aged children.
Abstract:
Asthma-like symptoms like wheezing and dyspnea affect 1 in every 3 preschool children. An easily available biomarker that predicts later asthma or unfavorable lung growth in these children may be helpful in targeting the right child with the right drugs and avoiding exposure to potentially harmful drugs in others. The fraction of exhaled nitric oxide (FeNO) has been suggested as a marker of eosinophilic inflammation. FeNO can be measured in a standardized way from the age of 4 but several methods have been developed to measure FeNO also in younger children. Several studies have assessed the predictive value of FeNO in preschool wheezing children for asthma later in life. These studies have shown that FeNO may be helpful in defining different preschool wheezing phenotypes, and in assessing the risk of later asthma or impaired lung growth. However, data are conflicting on the added value over clinical parameters. In two studies in school children, high FeNO was predictive for asthma development during follow up and also predicted lower lung function growth. In school children with respiratory symptoms suggestive of asthma, particularly in atopic children, FeNO has diagnostic value for an asthma diagnosis, mostly for ruling in asthma. There are not enough data to assess if FeNO has a predictive value for lung development in school children.
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