Felicia is a 14-year-old girl with atopic asthma. She has been treated with ICS since she was diagnosed at the age of seven.
Felicia is on a fixed maintenance dose of ICS and meets with her doctor three times a year (consistent with NHLBI guidelines).5 She is compliant and usually symptom-free.
Her FENO value is usually between 7–13 ppb. Since she has been stable and symptom-free for more than six months, with low FENO values, Felicia’s doctor suggests a reduction of her steroid dose.
Felicia returns for an appointment two months later. She reports she is feeling fine.
• No symptoms.
• Physical examination is normal.
• FENO shows a slight increase to 18 ppb.
• Spirometry is normal.
Felicia actively participates in sports, but during the spring she experiences breathing problems while training and contacts her doctor again.
• Physical examination is normal.
• FENO is now 30 ppb.
• Spirometry is normal.
The history and FENO value suggest that Felicia has an allergic inflammation. As she is atopic, the inflammation probably results from increased pollen exposure during the spring.
Felicia’s doctor advises her to use her original dose of ICS during the pollen season because she was symptom-free on that dose. During non-pollen season she will be placed back on her low dose.