Offline Exhaled Nitric Oxide in Emergency Department and Subsequent Acute Asthma Control

Background. Few studies have evaluated exhaled NO measurement during acute asthma. Objectives. To evaluate exhaled NO fraction (FENO) and peak expiratory flow (PEF) time-courses during acute asthma treatment ( 2-agonist plus systemic steroid) and to assess whether FENO time-course predicts subsequent asthma control. Methods. Sixty-five asthmatic patients (mean SD, 34 10 years) were prospectively enrolled in three Emergency Departments. Results. Sixteen patients were excluded (failure of offline FENO measurement at 100 mL/s [FENO 0.1], n = 4, and early discharge). The 49 remaining patients performed FENO 0.1 and PEF on admission, at the 2nd (H2) and 6th hour (H6). Follow-up using an Asthma Control Diary was obtained in 27 of 49 patients, whether they were hospitalized (n = 9) or discharged (n = 18). All but 2 patients had elevated FENO on admission (median [interquartile], 49 [26-78] ppb). Unlike PEF, mean FENO 0.1 of our sample was not significantly modified by treatment. No significant relationship was evidenced between exhaled NO and PEF variations. The variation of FENO 0.1 [H0 minus H6] was different in patients who were hospitalized (decrease of 8 20 ppb) versus discharged (increase of 5 20 ppb, p = 0.04). This variation of FENO 0.1 was correlated with the Diary score (control of subsequent week), an initial increase in FENO 0.1 being associated with better asthma control. Nevertheless, neither exhaled NO nor PEFR were good predictors of asthma control. Conclusions. An increase in FENO is observed in almost all patients with acute asthma, and its subsequent increase within 6 hours is associated with a better degree of asthma control in the subsequent week.