Is it necessary to treat all asthmatic children with raised levels of exhaled nitric oxide? Treating the patient or the data

Abstract

Background The aim of the present study is to assess whether a single determination of the fraction of exhaled nitric oxide (FENO), added to the measurements usually taken during a routine checkup, helps in the prediction of the recurrence of asthma attacks in controlled patients who are not receiving any baseline treatment; and whether or not treatment of the said latent inflammation is appropriate. Methods Observational study of prospective cohorts. Over a period of three months, data was collected from 28 patients (6 to 14 years) who met the conditions of the inclusion criteria, with a follow up appointment after six months. Results Patients were divided into two groups: 13 with FENO values of 49 and over, and 15 with values of under 49. Five patients in the subgroup with low FENO values suffered recurrence, in contrast to only one in the group with high values. The positive predictive value of the high values of the FENO was 7.69, with no significant differences between the two groups. Conclusions Certain doubts were raised about the usefulness of the FENO, as opposed to the traditional methods of asthma control with regard to the therapeutic management of clinically controlled patients who are not receiving treatment and who have high FENO values. It would appear unwise to recommend the systematic treatment of patients with high FENO values, when measured during a routine check-up, in cases of asthma with an allergic component and are asymptomatic or in a phase of asthma under good control.