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Published on: May 4, 2021
Association between fractional exhaled nitric oxide and therapeutic adherence to controller management in pediatric
Daniela Cleves1, Pedro Vargas1, Ranniery Acuña-Cordero2
1Department of Pediatric Pulmonology, School of Medicine, Universidad El Bosque, Bogota, Colombia.
Insights
Fractional exhaled nitric oxide (FeNO) levels below 20 ppb may help identify children with asthma who adhere to their inhaled steroid treatment. This finding supports using FeNO to monitor adherence in pediatric asthma management.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Diagnostics
Background:
- Asthma management guidelines emphasize confirming correct inhaler technique and treatment adherence before adjusting therapy.
- Fractional exhaled nitric oxide (FeNO) is a validated biomarker for monitoring adherence in adult asthma patients.
- The correlation between FeNO and adherence in pediatric asthma populations requires further investigation.
Purpose of the Study:
- To investigate the relationship between FeNO levels and therapeutic adherence in children with asthma.
- To determine if FeNO can serve as a reliable indicator of inhaled steroid adherence in pediatric asthma patients.
Main Methods:
- An analytical cross-sectional study was conducted with 82 asthma patients aged 5-18 years.
- Data collection included sociodemographic surveys, the Pediatric Inhaler Adherence Questionnaire (PIAQ), and asthma control tests (ACT/cACT).
- Adequate adherence was defined as no missed inhaled steroid doses in the preceding 15 days; Poisson regression analyzed predictors including FeNO, age, and environmental factors.
Main Results:
- 68.3% of the pediatric participants reported adequate therapeutic adherence.
- FeNO levels < 20 ppb were independently associated with adequate adherence (RR=1.5, p=0.04) after adjusting for covariates.
- This suggests FeNO is a significant predictor of adherence in this cohort.
Conclusions:
- Fractional exhaled nitric oxide (FeNO) measurements appear valuable for identifying pediatric asthma patients with good adherence to inhaled corticosteroids.
- FeNO monitoring could be a useful tool in clinical settings for assessing adherence in children with asthma.
Objectives:
Guidelines for asthma management recommend, before establishing additional therapeutic behaviors, to confirm correct use and adequate therapeutic adherence to treatment. Evidence exists on the use of fractional exhaled nitric oxide (FeNO) values for monitoring therapeutic adherence in adults. It is important to establish whether there is a correlation between FeNO and therapeutic adherence in children. This study aims to provide new knowledge about the relationship between FeNO and therapeutic adherence in asthmatic children.
Materials And Methods:
Analytical cross-sectional study including asthma patients 5-18 years of age, attending follow-up at Hospital Militar Central (HMC) between May and November 2022 in Colombia. A sociodemographic survey was carried out, followed by the Pediatric Inhaler Adherence Questionnaire (PIAQ), and asthma control test (ACT) or childhood asthma control test (cACT). We defined adequate therapeutic adherence as not missing a single application of inhaled steroids in the last 15 days according to PIAQ. A poisson regression model was carried out including relevant predictors for therapeutic adherence such as FeNO values, age, tobacco exposure at home, atopy, and time since initiation of use of inhaled controller.
Results:
Eighty-two children with a median age of 10 years (interquartile range: 7-12 years) were included. Adequate therapeutic adherence was reported by 68.3%. After adjusting for age, sex, exposure to cigarette smoke, duration of controller therapy, and atopy, FeNO < 20 ppb was independently associated with adequate therapeutic adherence (RR = 1.5, p = .04, 95% confidence interval: 1.03-2.19).
Conclusions:
FeNO values seem to be useful to identify pediatric patients with asthma who have adequate adherence to inhaled steroids in a MIC.
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