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Tailored interventions based on exhaled nitric oxide versus clinical symptoms for asthma in children and adults

Petsky, H., Cates, C., Li, A., Kynaston, J., Turner, C. and Chang, Anne B. (2008). Tailored interventions based on exhaled nitric oxide versus clinical symptoms for asthma in children and adults. Cochrane Database of Systematic Reviews,2008(2):1-41.

Document type: Journal Article

IRMA ID 10491xPUB126
Title Tailored interventions based on exhaled nitric oxide versus clinical symptoms for asthma in children and adults
Author Petsky, H.
Cates, C.
Li, A.
Kynaston, J.
Turner, C.
Chang, Anne B.
Journal Name Cochrane Database of Systematic Reviews
Publication Date 2008
Volume Number 2008
Issue Number 2
ISSN 1469-493X   (check CDU catalogue open catalogue search in new window)
Start Page 1
End Page 41
Total Pages 41
Place of Publication UK
Publisher Update Software Ltd.
Field of Research 1103 - Clinical Sciences
HERDC Category C1 - Journal Article (DEST)
Abstract Background
The measurement of severity and control of asthma in both children and adults can be based on subjective or objective measures. It has been advocated that fractional exhaled nitric oxide (FeNO) can be used to monitor airway inflammation as it correlates with some markers of asthma. Interventions for asthma therapies have been traditionally based on symptoms and/or spirometry.

Objectives
To evaluate the efficacy of tailoring asthma interventions based on exhaled nitric oxide in comparison to clinical symptoms (with or without spirometry/peak flow) for asthma related outcomes in children and adults.

Search strategy
We searched the Cochrane Airways Group Specialised Register of Trials, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and reference lists of articles. The last search was completed in December 2006.

Selection criteria
All randomised controlled comparisons of adjustment of asthma therapy based on exhaled nitric oxide compared to traditional methods (primarily clinical symptoms and spirometry/peak flow).

Data collection and analysis
Results of searches were reviewed against pre-determined criteria for inclusion. Relevant studies were independently selected in duplicate. Two authors independently assessed trial quality and extracted data. Authors were contacted for further information but none were received. Data was analysed as "intervention received" and sensitivity analyses performed.

Main results
Four (2 adult and 2 paediatric) studies were included; these studies differed in a variety of ways including definition of asthma exacerbations, FeNO cut off levels and duration of study. Of 356 participants randomised, 324 completed the trials. In the meta-analysis, there was no difference between groups for the primary outcome of asthma exacerbations or for other outcomes (clinical symptoms, FeNO level and spirometry). In post-hoc analysis, a significant reduction in mean final daily dose inhaled corticosteroid per adult was found in the group where treatment was based on FeNO in comparison to clinical symptoms; WMD -282.46 (95% CI -422.08 to -142.84). There was no difference in ICS dose between the groups in the overall daily dose in the adult studies or in the paediatric studies.

Authors' conclusions
Tailoring the dose of inhaled corticosteroids based on exhaled nitric oxide in comparison to clinical symptoms was carried out in different ways in the four studies that were found, and the results show only modest differences. The role of utilising exhaled nitric oxide to tailor the dose of inhaled corticosteroids is currently uncertain.
DOI http://dx.doi.org/10.1002/14651858.CD006340.pub2   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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Created: Thu, 07 May 2009, 08:54:58 CST by Sarena Wegener