Exhaled NO is a poor marker of asthma control in children with a reported use of asthma medication: a pharmacy-based study

Susanne J. H. Vijverberg, Ellen S. Koster, Leo Koenderman, Hubertus G. M. Arets, Cornelis K. van der Ent, Dirkje S. Postma, Gerard H. Koppelman, Jan A. M. Raaijmakers, Anke-Hilse Maitland-van der Zee

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Abstract

To cite this article: Vijverberg SJH, Koster ES, Koenderman L, Arets HGM, van der Ent CK, Postma DS, Koppelman GH, Raaijmakers JAM, Maitland-van der Zee A-H. Exhaled NO is a poor marker of asthma control in children with a reported use of asthma medication: a pharmacy-based study. Pediatr Allergy Immunol 2012: 23: 529536. Abstract Background: A high fraction of nitric oxide in exhaled breath (FeNO) has been suggested to be a marker of ongoing airway inflammation and poorly controlled disease in asthma. The usefulness of FeNO to monitor asthma control is still debated today. Aim: To assess the validity of FeNO as a marker of asthma control in children with reported use of asthma medication. Methods: Fraction of nitric oxide in exhaled breath was measured in 601 children (aged 412 yr) with reported use of asthma medication in the past 6 months and in 63 healthy non-asthmatic children (aged 512). Asthma control was assessed by the Asthma Control Questionnaire (ACQ). A receiver-operator characteristics (ROC) curve was generated to assess the accuracy of FeNO as a marker for asthma control. Logistic regression analysis was used to study whether clinical, healthcare, medication, and environmental factors are associated with high FeNO levels (>25 ppb). Results: Fraction of nitric oxide in exhaled breath had a poor accuracy to discriminate well-controlled from not well-controlled asthma [area under the ROC curve: 0.56 (95% CI: 0.520.61, p = 0.008)]. In addition, high FeNO (>25 ppb) was associated with lower medication adherence rates (OR: 0.4; 95% CI 0.30.6), fewer antibiotic courses in the past year (OR: 0.6; 95% CI: 0.40.9), fewer leukotriene antagonists use in the past year (OR: 0.4; 95% CI: 0.20.9), and fewer visits to a (pulmonary) pediatrician (OR: 0.6; 95% CI: 0.40.9). Children living in a non-urban environment had more often high FeNO levels (OR: 1.7; 95% CI: 1.12.6). Conclusion: High FeNO is a poor marker of asthma control in children with reported use of asthma medication. Various other factors, including medication adherence and medication use, are associated with increased FeNO levels
Original languageEnglish
Pages (from-to)529-+
JournalPediatric allergy and immunology
Volume23
Issue number6
DOIs
Publication statusPublished - 2012

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