Featured Research

from universities, journals, and other organizations

NO Help: Nitric Oxide Monitoring Does Not Help Most Children With Asthma

Date:
January 8, 2009
Source:
American Thoracic Society
Summary:
A recent multi-center prospective study found that calibrating medications based on daily monitoring of the fractional exhaled nitric oxide and symptoms in asthmatic children showed no significant improvement over medicating based on daily symptom monitoring alone.

The level of nitric oxide (NO) in an asthmatic's exhaled breath can portend worsening asthma symptoms, and may even signify an imminent attack linked to underlying airway inflammation. This has made the monitoring of NO levels, particularly in children, of significant interest as a potential way to help clinicians fine-tune medications and improve treatment outcomes.

Related Articles


However, a recent multi-center prospective study found that calibrating medications based on daily monitoring of the fractional exhaled nitric oxide (FENO) and symptoms in asthmatic children showed no significant improvement over medicating based on daily symptom monitoring alone.

The results were reported in the second issue for January of the American Journal of Respiratory and Critical Care Medicine, a publication of the American Thoracic Society.

Johan C. de Jongste, M.D., Ph.D., at the Erasmus University Medical Center-Sophia Children's Hospital in the Netherlands, and colleagues randomized 151 children from 15 academic centers and hospitals with mild to moderate asthma to a 30-week monitoring course. Families were called every three weeks and reported on the daily symptoms in the prior three weeks. The child's medication was adjusted accordingly.

The researchers compared the rates of exacerbation, symptoms, use of medications and other endpoints between the last 12 weeks in the two groups. There were no significant differences whether or not FENO had been part of the daily monitoring. However, both groups enjoyed an impressive overall improvement in symptoms, despite a reduction of about 50 percent in inhaled steroid dose, suggesting considerable benefit of frequent monitoring.

"We speculate that daily supervision and frequent phone contacts have produced an improvement that could not be beaten by additional monitoring of FENO, most likely because of a ceiling effect on compliance," wrote Dr. de Jongste.

The FENO group did, however, have nearly twice as many dosage changes as the symptom-only group, which supports the idea that the lack of difference may be a reflection on the limits of compliance, rather than an inherent limitation in the technique. Still, the added cost and apparent lack of benefit of daily FENO monitoring found in this study suggests that applying the technique in this way is not of benefit to the asthmatic population at large, when compared to daily symptom monitoring.

Another possible explanation for the lack of improvement is that FENO monitoring is most likely to prompt a medication change that symptom-only monitoring would not suggest in patients whose symptoms and underlying inflammation are in discord, but the current study was not designed to assess these patients independently.

Still, in light of these findings, it is clear that FENO monitoring should only be applied to those who stand to gain the most. "There can be no doubt that adding frequent assessments of FENO to management plans of most children and adults with asthma will add unjustifiable costs without providing clinical benefit. Whether there is a role for monitoring FENO to aid management of severe asthma is untested," wrote Stephen Stick, Ph.D., of the Princess Margaret Hospital for Children in Perth, Australia and Peter Franklin, Ph.D., of the Centre for Asthma, Allergy and Respiratory Research at the University of Western Australia in Perth in an editorial that accompanied the article.

"We did not address other possible applications of frequent FENO monitoring, such as prediction of steroid effect. Loss of control, prediction and prevention of exacerbations, and tapering of steroids in symptom-free children who wheezed in the past," noted Dr. de Jongste. "We think there is good reason to study these potential applications."

Furthermore, as D. Robin Taylor, M.D., of the Dunedin School of Medicine at the University of Otago, in New Zealand, pointed out in separate editorial, "FENO measurements shed complementary light on the underlying inflammatory phenotype and, more importantly, on the potential response to anti-inflammatory treatment. Historically, this has been assessed either by empiric "trials of steroid" or, even more imperfectly. With reference to before/after changes in spirometry, serial or repeated FENO measurements in individual patients may provide additional diagnostic as well as prognostic insights."


Story Source:

The above story is based on materials provided by American Thoracic Society. Note: Materials may be edited for content and length.


Cite This Page:

American Thoracic Society. "NO Help: Nitric Oxide Monitoring Does Not Help Most Children With Asthma." ScienceDaily. ScienceDaily, 8 January 2009. <www.sciencedaily.com/releases/2009/01/090107085024.htm>.
American Thoracic Society. (2009, January 8). NO Help: Nitric Oxide Monitoring Does Not Help Most Children With Asthma. ScienceDaily. Retrieved March 5, 2015 from www.sciencedaily.com/releases/2009/01/090107085024.htm
American Thoracic Society. "NO Help: Nitric Oxide Monitoring Does Not Help Most Children With Asthma." ScienceDaily. www.sciencedaily.com/releases/2009/01/090107085024.htm (accessed March 5, 2015).

Share This


More From ScienceDaily



More Health & Medicine News

Thursday, March 5, 2015

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Bupa Eyes India Healthcare Opportunities

Bupa Eyes India Healthcare Opportunities

Reuters - Business Video Online (Mar. 5, 2015) — Bupa is hoping to expand in India&apos;s fast-growing health insurance market, once a rule change on foreign investment is implemented. The British private healthcare group&apos;s CEO tells Grace Pascoe why it&apos;s so keen on the new opportunity. Video provided by Reuters
Powered by NewsLook.com
Doctor in Your Pocket Is Getting Smarter

Doctor in Your Pocket Is Getting Smarter

Reuters - Business Video Online (Mar. 5, 2015) — Mobile apps are turning smartphones into a personal doctors, with users able to measure heart rate, blood pressure and even blood sugar. But will it change our behaviour? Ivor Bennett reports from the Mobile World Congress in Barcelona. Video provided by Reuters
Powered by NewsLook.com
AbbVie Inks $21B Deal To Buy Cancer Drugmaker Pharmacyclics

AbbVie Inks $21B Deal To Buy Cancer Drugmaker Pharmacyclics

Newsy (Mar. 5, 2015) — AbbVie announced Wednesday it will buy cancer drugmaker Pharmacyclics in a $21 billion deal. Video provided by Newsy
Powered by NewsLook.com
Adults Only Get The Flu Twice A Decade, Researchers Say

Adults Only Get The Flu Twice A Decade, Researchers Say

Newsy (Mar. 4, 2015) — Researchers found adults only get the flu about once every five years. Scientists analyzed how a person&apos;s immunity builds up over time as well. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:

Strange & Offbeat Stories

 

Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins