Background International guidelines for the treatment of asthmarecommend adjusting the dose of inhaled corticosteroids on thebasis of symptoms, bronchodilator requirements, and the resultsof pulmonary-function tests. Measurements of the fraction ofexhaled nitric oxide (FENO) constitute a noninvasive markerthat may be a useful alternative for the adjustment of inhaled-corticosteroidtreatment.
Methods In a single-blind, placebo-controlled trial, we randomlyassigned 97 patients with asthma who had been regularly receivingtreatment with inhaled corticosteroids to have their corticosteroiddose adjusted, in a stepwise fashion, on the basis of eitherFENO measurements or an algorithm based on conventional guidelines.After the optimal dose was determined (phase 1), patients werefollowed up for 12 months (phase 2). The primary outcome wasthe frequency of exacerbations of asthma; the secondary outcomewas the mean daily dose of inhaled corticosteroid.
Results Forty-six patients in the FENO group and 48 in the groupwhose asthma was treated according to conventional guidelines(the control group) completed the study. The final mean dailydoses of fluticasone, the inhaled corticosteroid that was used,were 370 µg per day for the FENO group (95 percent confidenceinterval, 263 to 477) and 641 µg per day for the controlgroup (95 percent confidence interval, 526 to 756; P=0.003),a difference of 270 µg per day (95 percent confidenceinterval, 112 to 430). The rates of exacerbation were 0.49 episodeper patient per year in the FENO group (95 percent confidenceinterval, 0.20 to 0.78) and 0.90 in the control group (95 percentconfidence interval, 0.31 to 1.49), representing a nonsignificantreduction of 45.6 percent (95 percent confidence interval formean difference, –78.6 percent to 54.5 percent) in theFENO group. There were no significant differences in other markersof asthma control, use of oral prednisone, pulmonary function,or levels of airway inflammation (sputum eosinophils).
Conclusions With the use of FENO measurements, maintenance dosesof inhaled corticosteroids may be significantly reduced withoutcompromising asthma control.
Source Information
From the Respiratory Research Unit, Department of Medicine (A.D.S., J.O.C., K.P.B., D.R.T.), and the Department of Preventive and Social Medicine (G.P.H.), Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Address reprint requests to Dr. Taylor at the Department of Medicine, Dunedin School of Medicine, P.O. Box 913, Dunedin, New Zealand, or at robin.taylor{at}stonebow.otago.ac.nz.
Exhaled Nitric Oxide and Asthma
Silkoff P. E., Corbetta L., Fabbri L. M., Currie G. P., Lee D. K.C., Smith A. D., Taylor D. R.
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N Engl J Med 2005;
353:732-733, Aug 18, 2005.
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