What is a clinically meaningful change in exhaled nitric oxide for children with asthma?

Shona Fielding, Marielle Pijnenburg, Johan de Jongste, Katherine Pike, Graham Roberts, Helen Petsky, Anne B. Chang, Maria Fritsch, Thomas Frischer, Stanley Szefler, Peter Gergen, Françoise Vermeulen, Robin Vael, Steve Turner*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Introduction: Fractional exhaled nitric oxide (FENO) may be a useful objective measurement to guide asthma treatment. What remains uncertain is what change in FENO is clinically significant. Methods: An individual patient data analysis was performed using data from seven randomized clinical trials which used FENO to guide asthma treatment. The absolute and percentage intra-subject change in FENO measurements over “stable” and also “unstable” 3-month periods were described. Results: Data were available in 1112 randomized controlled trial participants and ≥1 stable period was present for 665 individuals. The interquartile range (IQR) and limits of agreement (LoA) for change in absolute FENO among individuals whose initial FENO was <50 parts per billion (ppb) were −7 to +9 ppb and −43 to +50 ppb, and for those with initial FENO ≥50 ppb IQR was −29 to +17 ppb and LoA was −80 to +76 ppb. For percentage change in FENO, the IQR and LoA for individuals whose initial FENO was <50 ppb were −33% to +51% and −157% to +215%, and for those with initial FENO ≥50 ppb were −33% to +35% and −159% to +192%. The variation in FENO values for a stable period was similar irrespective of whether it was followed by a stable or unstable period. Conclusions: Over a 3-month period where FENO is initially <50 ppb, a rise of <10 ppb or of <50% (based on IQR) is unlikely to be related to asthma. When FENO is initially ≥50 ppb an percentage change of <50% (based on IQR) is unlikely to be asthma-related.

Original languageEnglish
Pages (from-to)599–606
Number of pages7
JournalPediatric Pulmonology
Volume55
Issue number3
Early online date7 Jan 2020
DOIs
Publication statusPublished - Mar 2020

Keywords

  • asthma
  • child
  • exhaled nitric oxide
  • monitoring

Fingerprint Dive into the research topics of 'What is a clinically meaningful change in exhaled nitric oxide for children with asthma?'. Together they form a unique fingerprint.

  • Cite this

    Fielding, S., Pijnenburg, M., de Jongste, J., Pike, K., Roberts, G., Petsky, H., Chang, A. B., Fritsch, M., Frischer, T., Szefler, S., Gergen, P., Vermeulen, F., Vael, R., & Turner, S. (2020). What is a clinically meaningful change in exhaled nitric oxide for children with asthma? Pediatric Pulmonology, 55(3), 599–606. https://doi.org/10.1002/ppul.24630