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

    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 pages8
    JournalPediatric Pulmonology
    Volume55
    Issue number3
    DOIs
    Publication statusPublished - Mar 2020

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  • 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