FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 352:2163-2173 May 26, 2005 Number 21 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Editorial by Deykin, A. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background International guidelines for the treatment of asthma recommend adjusting the dose of inhaled corticosteroids on the basis of symptoms, bronchodilator requirements, and the results of pulmonary-function tests. Measurements of the fraction of exhaled nitric oxide (FE_NO) constitute a noninvasive marker that may be a useful alternative for the adjustment of inhaled-corticosteroid treatment.

Methods In a single-blind, placebo-controlled trial, we randomly assigned 97 patients with asthma who had been regularly receiving treatment with inhaled corticosteroids to have their corticosteroid dose adjusted, in a stepwise fashion, on the basis of either FE_NO measurements or an algorithm based on conventional guidelines. After the optimal dose was determined (phase 1), patients were followed up for 12 months (phase 2). The primary outcome was the frequency of exacerbations of asthma; the secondary outcome was the mean daily dose of inhaled corticosteroid.

Results Forty-six patients in the FE_NO group and 48 in the group whose asthma was treated according to conventional guidelines (the control group) completed the study. The final mean daily doses of fluticasone, the inhaled corticosteroid that was used, were 370 µg per day for the FE_NO group (95 percent confidence interval, 263 to 477) and 641 µg per day for the control group (95 percent confidence interval, 526 to 756; P=0.003), a difference of 270 µg per day (95 percent confidence interval, 112 to 430). The rates of exacerbation were 0.49 episode per patient per year in the FE_NO group (95 percent confidence interval, 0.20 to 0.78) and 0.90 in the control group (95 percent confidence interval, 0.31 to 1.49), representing a nonsignificant reduction of 45.6 percent (95 percent confidence interval for mean difference, –78.6 percent to 54.5 percent) in the FE_NO group. There were no significant differences in other markers of asthma control, use of oral prednisone, pulmonary function, or levels of airway inflammation (sputum eosinophils).

Conclusions With the use of FE_NO measurements, maintenance doses of inhaled corticosteroids may be significantly reduced without compromising 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.

Full Text of this Article

Related Letters:

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.
Extract | Full Text | PDF  
N Engl J Med 2005; 353:732-733, Aug 18, 2005. Correspondence

This article has been cited by other articles:

• Haldar, P., Pavord, I. D., Shaw, D. E., Berry, M. A., Thomas, M., Brightling, C. E., Wardlaw, A. J., Green, R. H. (2008). Cluster Analysis and Clinical Asthma Phenotypes. Am. J. Respir. Crit. Care Med. 178: 218-224 [Abstract] [Full Text]  
• Michils, A., Peche, R., Baldassarre, S., Mourid, Z., Van Muylem, A. (2008). Comparisons between portable and chemoluminescence exhaled nitric oxide measurements. Eur Respir J 32: 243-244 [Full Text]  
• Moore, W. C. (2008). Update in Asthma 2007. Am. J. Respir. Crit. Care Med. 177: 1068-1073 [Full Text]  
• Lim, K. G., Mottram, C. (2008). The Use of Fraction of Exhaled Nitric Oxide in Pulmonary Practice. Chest 133: 1232-1242 [Abstract] [Full Text]  
• Grob, N. M., Dweik, R. A. (2008). Exhaled Nitric Oxide in Asthma: From Diagnosis, to Monitoring, to Screening: Are We There Yet?. Chest 133: 837-839 [Full Text]  
• Kostikas, K., Papaioannou, A. I., Tanou, K., Koutsokera, A., Papala, M., Gourgoulianis, K. I. (2008). Portable Exhaled Nitric Oxide as a Screening Tool for Asthma in Young Adults During Pollen Season. Chest 133: 906-913 [Abstract] [Full Text]  
• Michils, A., Baldassarre, S., Van Muylem, A. (2008). Exhaled nitric oxide and asthma control: a longitudinal study in unselected patients. Eur Respir J 31: 539-546 [Abstract] [Full Text]  
• Singh, D., Richards, D., Knowles, R. G., Schwartz, S., Woodcock, A., Langley, S., O'Connor, B. J. (2007). Selective Inducible Nitric Oxide Synthase Inhibition Has No Effect on Allergen Challenge in Asthma. Am. J. Respir. Crit. Care Med. 176: 988-993 [Abstract] [Full Text]  
• Bodini, A., Peroni, D., Loiacono, A., Costella, S., Pigozzi, R., Baraldi, E., Boner, A. L., Piacentini, G. L. (2007). Exhaled Nitric Oxide Daily Evaluation Is Effective in Monitoring Exposure to Relevant Allergens in Asthmatic Children. Chest 132: 1520-1525 [Abstract] [Full Text]  
• Montuschi, P. (2007). Review: Analysis of exhaled breath condensate in respiratory medicine: methodological aspects and potential clinical applications. Therapeutic Advances in Respiratory Disease 1: 5-23 [Abstract]  
• Balbi, B., Pignatti, P., Corradi, M., Baiardi, P., Bianchi, L., Brunetti, G., Radaeli, A., Moscato, G., Mutti, A., Spanevello, A., Malerba, M. (2007). Bronchoalveolar lavage, sputum and exhaled clinically relevant inflammatory markers: values in healthy adults. Eur Respir J 30: 769-781 [Abstract] [Full Text]  
• Olivieri, M., Corradi, M., Malerba, M. (2007). Gender and Exhaled Nitric Oxide. Chest 132: 1410-1410 [Full Text]  
• Nuijsink, M., Hop, W. C. J., Sterk, P. J., Duiverman, E. J., de Jongste, J. C., on behalf of the Children Asthma Therapy Optimal (, (2007). Long-term asthma treatment guided by airway hyperresponsiveness in children: a randomised controlled trial. Eur Respir J 30: 457-466 [Abstract] [Full Text]  
• Taylor, D. R. (2007). Exhaled NO: Forward, Backward, or Sideways?. Am. J. Respir. Crit. Care Med. 176: 221-222 [Full Text]  
• Travers, J., Marsh, S., Aldington, S., Williams, M., Shirtcliffe, P., Pritchard, A., Weatherall, M., Beasley, R. (2007). Reference Ranges for Exhaled Nitric Oxide Derived from a Random Community Survey of Adults. Am. J. Respir. Crit. Care Med. 176: 238-242 [Abstract] [Full Text]  
• Shaw, D. E., Berry, M. A., Thomas, M., Green, R. H., Brightling, C. E., Wardlaw, A. J., Pavord, I. D. (2007). The Use of Exhaled Nitric Oxide to Guide Asthma Management: A Randomized Controlled Trial. Am. J. Respir. Crit. Care Med. 176: 231-237 [Abstract] [Full Text]  
• Suresh, V., Mih, J. D., George, S. C. (2007). Measurement of IL-13-Induced iNOS-Derived Gas Phase Nitric Oxide in Human Bronchial Epithelial Cells. Am. J. Respir. Cell Mol. Bio. 37: 97-104 [Abstract] [Full Text]  
• Wechsler, M. E., Shepard, J.-A. O., Mark, E. J. (2007). Case 15-2007 -- A 20-Year-Old Woman with Asthma and Cardiorespiratory Arrest. NEJM 356: 2083-2091 [Full Text]  
• Hunt, J. (2007). If It Smells Like a Duck, It Might Be an Asthma Subphenotype. Am. J. Respir. Crit. Care Med. 175: 975-976 [Full Text]  
• Clarke, M., Hopewell, S., Chalmers, I. (2007). Reports of clinical trials should begin and end with up-to-date systematic reviews of other relevant evidence: a status report. JRSM 100: 187-190 [Abstract] [Full Text]  
• Menzies, D., Nair, A., Lipworth, B. J. (2007). Portable Exhaled Nitric Oxide Measurement: Comparison With the "Gold Standard" Technique. Chest 131: 410-414 [Abstract] [Full Text]  
• Condorelli, P., Shin, H.-W., Aledia, A. S., Silkoff, P. E., George, S. C. (2007). A simple technique to characterize proximal and peripheral nitric oxide exchange using constant flow exhalations and an axial diffusion model. J. Appl. Physiol. 102: 417-425 [Abstract] [Full Text]  
• Heffner, J. E. (2006). Update in pulmonary medicine.. ANN INTERN MED 145: 765-773 [Full Text]  
• Kharitonov, S. A., Barnes, P. J. (2006). Exhaled biomarkers.. Chest 130: 1541-1546 [Abstract] [Full Text]  
• FitzGerald, J M, Gibson, P G (2006). Asthma exacerbations {middle dot} 4: Prevention.. Thorax 61: 992-999 [Abstract] [Full Text]  
• Haahtela, T., Tamminen, K., Malmberg, L. P., Zetterstrom, O., Karjalainen, J., Yla-Outinen, H., Svahn, T., Ekstrom, T., Selroos, O. (2006). Formoterol as needed with or without budesonide in patients with intermittent asthma and raised NO levels in exhaled air: a SOMA study. Eur Respir J 28: 748-755 [Abstract] [Full Text]  
• Trow, T. K. (2006). Clinical Year in Review I: Diagnostic Imaging, Asthma, Lung Transplantation, and Interventional Pulmonology. Proc Am Thorac Soc 3: 553-556 [Full Text]  
• Taylor, D R, Pijnenburg, M W, Smith, A D, Jongste, J C D (2006). Exhaled nitric oxide measurements: clinical application and interpretation.. Thorax 61: 817-827 [Abstract] [Full Text]  
• Bonetto, G., Corradi, M., Carraro, S., Zanconato, S., Alinovi, R., Folesani, G., Da Dalt, L., Mutti, A., Baraldi, E. (2006). Longitudinal Monitoring of Lung Injury in Children after Acute Chlorine Exposure in a Swimming Pool. Am. J. Respir. Crit. Care Med. 174: 545-549 [Abstract] [Full Text]  
• Hargreave, F. E., Parameswaran, K. (2006). Asthma, COPD and bronchitis are just components of airway disease.. Eur Respir J 28: 264-267 [Full Text]  
• Chipps, B. E. (2006). Use of Exhaled Nitric Oxide Measurements to Guide Treatment in Chronic Asthma. Pediatrics 118: S33-S34 [Abstract]  
• Cockcroft, D. W. (2006). Deep inhalation bronchodilation and oral corticosteroids in asthma.. Chest 130: 7-8 [Full Text]  
• Town, G I, Crane, J (2006). Respiratory health and lung research in New Zealand. Chronic Respiratory Disease 3: 167-169 [Abstract]  
• Barnes, P. J., Chowdhury, B., Kharitonov, S. A., Magnussen, H., Page, C. P., Postma, D., Saetta, M. (2006). Pulmonary Biomarkers in Chronic Obstructive Pulmonary Disease. Am. J. Respir. Crit. Care Med. 174: 6-14 [Abstract] [Full Text]  
• Haahtela, T. (2006). Lung Function Decline in Asthma and Early Intervention With Inhaled Corticosteroids. Chest 129: 1405-1406 [Full Text]  
• Gelb, A. F., Flynn Taylor, C., Shinar, C. M., Gutierrez, C., Zamel, N. (2006). Role of Spirometry and Exhaled Nitric Oxide To Predict Exacerbations in Treated Asthmatics. Chest 129: 1492-1499 [Abstract] [Full Text]  
• Green, R. H., Brightling, C. E., McKenna, S., Hargadon, B., Neale, N., Parker, D., Ruse, C., Hall, I. P., Pavord, I. D. (2006). Comparison of asthma treatment given in addition to inhaled corticosteroids on airway inflammation and responsiveness. Eur Respir J 27: 1144-1151 [Abstract] [Full Text]  
• Ihre, E., Gyllfors, P., Gustafsson, L. E., Kumlin, M., Dahlen, B. (2006). Early rise in exhaled nitric oxide and mast cell activation in repeated low-dose allergen challenge. Eur Respir J 27: 1152-1159 [Abstract] [Full Text]  
• Vestbo, J. (2006). Clinical Assessment, Staging, and Epidemiology of Chronic Obstructive Pulmonary Disease Exacerbations. Proc Am Thorac Soc 3: 252-256 [Abstract] [Full Text]  
• van Veen, I. H., Sterk, P. J., Schot, R., Gauw, S. A., Rabe, K. F., Bel, E. H. (2006). Alveolar nitric oxide versus measures of peripheral airway dysfunction in severe asthma. Eur Respir J 27: 951-956 [Abstract] [Full Text]  
• Brightling, C. E. (2006). Clinical Applications of Induced Sputum. Chest 129: 1344-1348 [Abstract] [Full Text]  
• Heraghty, J L, Henderson, A J (2006). Highlights in asthma 2005.. Arch. Dis. Child. 91: 422-425 [Abstract] [Full Text]  
• Choi, J., Hoffman, L. A., Rodway, G. W., Sethi, J. M. (2006). Markers of lung disease in exhaled breath: nitric oxide.. Biol Res Nurs 7: 241-255 [Abstract]  
• Rees, J. (2006). Asthma control in adults.. BMJ 332: 767-771 [Full Text]  
• (2006). Endpoints in asthma drug trials - what do they mean?. DTB 44: 21-24 [Abstract] [Full Text]  
• Brightling, C. E. (2006). Sputum Induction in Asthma. Chest 129: 503-504 [Full Text]  
• Rees, P J. (2006). Using exhaled NO concentrations to adjust inhaled corticosteroid dose maintained asthma control and reduced the dose. Evid. Based Med. 11: 20-20 [Full Text]  
• Barnes, P., Virchow, J. C., Sanchis, J., Welte, T., Pedersen, S. (2005). Asthma management: important issues. ERR 14: 147-151 [Abstract] [Full Text]  
• (2005). Journal Watch. Arch. Dis. Child. 90: 1200-1201 [Full Text]  
• Pijnenburg, M. W., Bakker, E. M., Hop, W. C., De Jongste, J. C. (2005). Titrating Steroids on Exhaled Nitric Oxide in Children with Asthma: A Randomized Controlled Trial. Am. J. Respir. Crit. Care Med. 172: 831-836 [Abstract] [Full Text]  
• de Jongste, J. C. (2005). Yes to NO: the first studies on exhaled nitric oxide-driven asthma treatment. Eur Respir J 26: 379-381 [Full Text]  
• Currie, G P (2005). Monitoring exhaled nitric oxide to guide inhaled steroid dosage in asthma. Thorax 60: 739-739 [Full Text]  
• Silkoff, P. E., Corbetta, L., Fabbri, L. M., Currie, G. P., Lee, D. K.C., Smith, A. D., Taylor, D. R. (2005). Exhaled Nitric Oxide and Asthma. NEJM 353: 732-733 [Full Text]  
• Bauchner, H. (2005). Atoms. Arch. Dis. Child. 90: 771-771 [Full Text]  
• (2005). Measuring Exhaled Nitric Oxide Can Guide the Treatment of Asthma. JWatch Pediatrics 2005: 1-1 [Full Text]  
• Deykin, A. (2005). Targeting Biologic Markers in Asthma -- Is Exhaled Nitric Oxide the Bull's-Eye?. NEJM 352: 2233-2235 [Full Text]