Sara is a 7-year-old girl with atopic asthma. She is sensitive to pollen and mites.
Since the diagnosis, Sara has been prescribed a twice-daily, 200-μg dose of budesonide. Her father reports that she has no symptoms, but she is tired and prefers reading over more physical activities.
Physical examination does not show any abnormalities.
The NIOX Value is 58 ppb.
Lung function is normal.
• Is Sara really asymptomatic?
• Does her father fully understand how she feels?
• Is her asthma under control?
Interpretation
The NIOX Value strongly suggests an ongoing eosinophilic inflammation, which should respond to steroid treatment. However, Sara is already on ICS.
• Does she take the medication?
• Does she use the correct inhalation technique?
• Has anything been changed in terms of allergen exposure?
• Is she taking the optimal steroid dose?
• Has her asthma deteriorated?
• Is she steroid-resistant?
Compliance was discussed with Sara and her father as The NIOX Value suggests poor compliance. Sara’s inhalation technique was reviewed and optimized. The ICS dose was increased to 800 μg twice daily for one week and thereafter to 400 μg twice daily. Special bed covers were advised, as Sara is also sensitized to house dust mite.
Four weeks later The NIOX Value is 24 ppb.
Despite the lack of clear symptoms and her apparently normal lung function, Sara has asthma. Her inflammation was not properly controlled. Non-compliance, as well as a suboptimal dose of ICS, contributed to her situation. It was only by testing The NIOX Value that this was discovered.
Sara’s inflammation is now under control, but has to be monitored on a regular basis.