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Pike, K., Selby, A., Price, S., Warner, J., Connett, G., Legg, J., Lucas, J.S., Peters, S., Buckley, H., Magier, K., Foote, K., Drew, K., Morris, R., Lancaster, N. and Roberts, G. (2012) Exhaled nitric oxide monitoring does not reduce exacerbation frequency or inhaled corticosteroid dose in paediatric asthma: A randomised controlled trial. Clinical Respiratory Journal.

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• TITLE: Comparison of treatment guidance based on bronchial responsiveness to mannitol, spirometry or exhaled nitric oxide in stable asthmatic children

  AUTHORS: Lurà Marco Patrick, Inci Demet, Jung Andreas, Knoepfli Bruno, Wildhaber Johannes Heinrich, Moeller Alexander

  KEYWORDS: Exhaled Nitric Oxide; Mannitol; Treatment Guidance; Asthma; Children

  JOURNAL NAME: Open Journal of Pediatrics, Vol.3 No.4, December 20, 2013

  ABSTRACT: Aim: The goal of this study was to compare asthma treatment guidance based on bronchial hyper-responsiveness to mannitol, spirometry or exhaled nitric oxide (FeNO) in stable asthmatic children. Methods: 60 stable allergic asthmatic children aged 7 to 16 years on a low to medium dose treatment with inhaled corticosteroids (ICS) were recruited to a double blind randomised controlled trial. At study entry (visit 1), the following was assessed: FeNO, spirometry, bronchial hyper-responsiveness to mannitol (MDP-test), quality of life (paediatric asthma quality-of-life questionnaire; PAQLQ) and asthma control (asthma control test; ACT). Subjects were randomly assigned to one of three groups and treatment was modified by a blinded respiratory physician according to the test results of visit 1: ICS dose was doubled when FeNO was >22 ppb (group 1), in case of a positive MDP-test (group 2) or when FEV1 was 22 ppb, 8 children out of 16 (50%) in group 2 showed a positive MDP-test and 3 children out of 16 (18.7%) in group 3 had a FEV1 inistered PAQLQ (p = 0.02 resp. p = 0.033) as well as the ACT (p = 0.031) increased. Neither the number of children with a positive mannitol challenge nor spirometric results changed significantly. In group 2 and group 3, there were no significant changes in none of the assessed parameters. Conclusion: In this small pragmatic double blind randomised controlled study, we showed that ICS dose modification based on FeNO led to increased quality of life and enhanced asthma control, and to a reduction in airway inflammation and was superior to treatment modifications based on bronchial hyper-responsiveness to mannitol or on FEV1.