Exhaled nitric oxide in childhood allergic asthma management: A randomised controlled trial

Summary Objective We investigated the potential yield of incorporating fractional exhaled nitric oxide (FeNO) measurements in childhood allergic asthma management. Methods Ninety‐nine children with persistent allergic asthma were included in this multicentre, single‐blind, randomized controlled trial. Treatment was based on the Global Initiative for Asthma (GINA) guidelines. In the FeNO group, asthma management was also guided by FeNO measurements. Health outcomes were evaluated over a 52‐week timeframe. Results Fewer asthma exacerbations were registered in the FeNO group. 24% of the children in the FeNO group experienced one or more exacerbations per year, compared with 48% in the clinical group (P = 0.017). The proportion of symptom‐free days did not differ between groups. In the FeNO group, more months of leukotriene receptor antagonist use (median (interquartile range)) were observed: 12 (9–12) months, compared with 9 (3–12) months in the clinical group (P = 0.019). Next, the evolution of inhaled corticosteroid doses between visits 1 and 5 (median change (interquartile range)) showed a significant increase of +100 µg (0, +400) in the FeNO group and a change of 0 µg (−200, +80) in the clinical group (P = 0.016). Conclusions FeNO measurements in childhood asthma management did not improve the proportion of symptom‐free days, but did result in fewer asthma exacerbations associated with an increased leukotriene receptor antagonist use and an augmentation of the inhaled corticosteroid doses. Pediatr Pulmonol. 2014; 49:624–631. © 2013 Wiley Periodicals, Inc.