EStudy of the role of exhaled nitric oxide (NO) in predicting controlled or uncontrolled asthma in asthmatic children

Background: Exhaled nitric oxide (NO), especially fractional concentration of exhaled NO (FENO) has been used to predict the responsiveness of inhaled corticosteroid (ICS) in children with asthma. However, the use of exhaled NO for predicting asthma control in children is still controversial. Methods: This was a perspective observational study. Asthmatic children who were naive to inhaled corticosteroid (ICS) were included in the present study. The measurements of FENO and CANO (concentration of NO in the gas phase of the alveolar), spirometry, blood eosinophil counts (BEC), and total IgE levels were done for each asthmatic child. All study subjects started proper asthma treatment after the enrollment. Results: Ninety-three asthmatic children (9 +/- 3 years) with moderate (63.4%) to severe (36.6%) asthma were included and finished the 3-month study. The levels of FENO and CANO at inclusion were 37 +/- 11 ppb and 5.8 +/- 1.4 ppb, respectively; the mean of BEC was 617 +/- 258 cells/mu L; the level of total IgE was 1563 +/- 576 UI/mL; 89% of subjects were positive for at least one respiratory allergen. The percentage of severe asthma was reduced significantly after 3 months (P<0.001). Well controlled asthma subjects at 3 months had higher levels of FENO and lower levels of CANO at inclusion (P<0.05 and P<0.05). FENO<20 ppb or CANO>5ppb had a risk of uncontrolled asthma at 3 months (OR: 1.7, CI 95% [(0.8) - (3.3)], P<0.05; OR: 1.9, CI 95% [(0.9) - (2.7)], P<0.05; respectively). FENO>35 ppb at inclusion had a positive predictive value for asthma control at 3 months (OR: 3.5, CI 95% [2.2 - 5.9], P<0.01). Conclusions: Exhaled NO is a biomarker of asthma which may have a potential role to predict the control of asthma in short-term follow-up in asthmatic children.