FeNO-guided Asthma Treatment Reduces Exacerbations

Swedish researchers saw almost 50% fewer asthma exacerbations without an increase in the average dose of corticosteroids used in asthma patients whose treatment was guided by fractional exhaled nitric oxide (FeNO) measurement.

Patients with allergic airway inflammation generally have higher levels of nitric oxide in their exhaled breath. Used as a biomarker of allergic airway inflammation in patients with underlying asthma, FeNO is a measure of the concentration of nitric oxide in exhaled breath. Jörgen Syk, MD, and colleagues wanted to test whether FeNO-guided anti-inflammatory treatment could improve asthma-related quality of life and asthma symptom control, and reduce exacerbations in atopic asthma patients within primary care.

“Primary care physicians use similar approaches to treat other diseases—for instance, using measures of hemoglobin A1C to treat diabetes in order to achieve long-term control,” says pulmnologist Kathy Rickard, MD, chief medical officer for Aerocrine, the manufacturer of the device used to measure FeNO in the study.

“Treating asthma based on the patient’s underlying inflammation status using exhaled nitric oxide is a similar concept and one that should be very easily implemented in primary care.” Dr Syk and colleagues recruited participants with mild-to-moderate asthma from 17 primary health care centers in Sweden.

They enrolled a total of 187 asthma patients, ages 18 to 64, with perennial allergy who were on regular inhaled corticosteroid treatment and were non-smokers. They randomly assigned the patients to 2 groups and followed up for 1 year—one group received treatment according to standard of care and the other received FeNO-guided treatment.

Overall, FeNO-guided management resulted in improved asthma symptom control and reduced the number and frequency of exacerbations in adults with asthma. “In mild to moderate asthma, FeNO can help physicians to keep patients on the lowest medication dose needed for control and to step up treatment when necessary,” Dr Rickard says.

“That’s why you see a decrease in exacerbations and improvement of symptoms—because the medication is targeted to the patient’s specific needs.” Although there was no difference in perceived quality of life between the groups, the FeNO-guided group reported fewer symptoms than the group who received standard-of-care treatment.

“The primary care setting is where the majority of patients are being treated for asthma, and it’s where you can get the disease under control before you increase the cost of care,” Dr Rickard says.

“I think this is something that FeNO helps you do—this takes some of the guesswork out of it, so hopefully you’ll see better control at a lower dose of medication and a lower cost.” The complete study appears in the Journal of Allergy & Clinical Immunology: In Practice.

—Colleen Mullarkey

Reference

Syk J, Malinovschi A, Johansson G, Unden A, Andreasson A, Lekander M, Alving K. Anti-inflammatory treatment of atopic asthma guided by exhaled nitric oxide: a randomized, controlled trial. JACI: In Practice. Published online 11 October 2013.