Exhaled nitric oxide (FENO) levels to guide treatment for adults with asthma: A cochrane systematic review

Abstract

Introduction/Aim: Obtaining FeNOlevels routinely in clinical practice adds to the burden of asthma care and resource utilization. On the other hand, routine use of FeNO levels to guide therapy may improve asthma control and reduce exacerbations and hospitalizations related to asthma. The objective of this Cochrane systematic review was to evaluate the efficacy of tailoring asthma therapy based on FeNO levels, in comparison with not using FeNO (i.e. management based on clinical symptoms and/or asthma guidelines), for asthma-related outcomes in adults. In our original review, we found that use of FeNO strategy did not confer any benefit. Methods: The Cochrane Register of Controlled Trials (CENTRAL), the Cochrane Airways Collaborative Review Group Specialised Trials Register, MEDLINE, EMBASE and CINAHL databases were searched by the Cochrane Airways Group. The latest search was performed in January 2015. All randomized controlled trials comparing adjustment of asthma medications based on FeNO levels with clinical symptoms were eligible to be included. Results of searches were reviewed against pre-determined criteria for inclusion. Results: Seven studies were included. Of the 1700 participants randomized, 1546 completed the trial. Six studies reported significant reduction in asthma exacerbations when treatment was based on FeNO levels in comparison to clinical symptoms; OR 0.60 (95% CI 0.43 to 0.84). Secondary outcomes did not show significant difference between the groups. Conclusion: With the availability of studies since our last review, the metaanalysis shows that in adultswith asthma, tailoring asthmamedications based on FeNOlevels (compared with primarily on clinical symptoms) decreases the frequency of asthma exacerbations but has not been shown to impact on dayto- day clinical symptoms or ICS dose.L723165592016-06-29 <br />