Tommy is a 15-year-old boy who had mild asthma and has been on low dose ICS for the past several years.

Tommy is on his annual visit to his doctor.

Results of examination:
• No symptoms.
• Physical examination is normal.
• FENO is 15 ppb.
• Spirometry is normal.

Tommy’s doctor suggests discontinuing his daily dose of steroids, as there have been no signs or symptoms for more than six months and the FENO value is low. There is a chance that he has outgrown his asthma during puberty.

Tommy and his doctor decide that they should meet again after two months, but if he experiences any symptoms he should come back immediately.

Results of examination at next visit:
• No symptoms.
• Physical examination is normal.
• FENO is now 17 ppb.
There is only a small and non-significant increase of the FENO value and no signs of asthma relapse.

Actions:
The doctor decides that Tommy should discontinue his ICS and come back in six months (in keeping with NHLBI guidelines5) or give him a call if his symptoms recur.