Nitric oxide monitoring of great benefit for kids' asthma

Nitric oxide monitoring is of great benefit for kids' asthma despite some recent news articles claiming the opposite.

In the January 15 (2009) issue of the Am J Respir Crit Care Med there is a publication entitled Daily Telemonitoring of Exhaled Nitric Oxide and Symptoms in the treatment of Childhood Asthma by Drs de Jongste and Baraldi.

In summary: Thirty weeks of daily FENO and symptom telemonitoring was associated with an impressive overall improvement in symptoms, despite a reduction of about 50 % in inhaled steroid dose, suggesting a considerable benefit of frequent monitoring. But there was no added value of daily FENO monitoring compared to daily symptom monitoring only.

Inclusion into a randomize controlled trial per se causes significant improvement in asthma patients, which leaves very little scope for exhaled NO to improve outcomes further.

“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 a ceiling effect on compliance” wrote Dr. de Jongste.

In a real-life clinical situation exhaled NO is a great tool.
It helps you sort out which patients with non-specific respiratory symptoms do really have airway inflammation that will respond to antiinflammatory treatment, and, vice versa, will help you find the patients that are not likely to respond to steroids. In the latter case, you may need to find other reasons than asthma for the patients’ symptoms.

“FENO measurements shed complimentary light on the underlying inflammatory phenotype and, more importantly, on the potential response to anti-inflammatory treatment” wrote Dr. Taylor in the editorial.

Aerocrine statement about the study.