Comparison of treatment guidance based on bronchial responsiveness to mannitol, spirometry or exhaled nitric oxide in stable asthmatic children
Orally exhaled nitric oxide (ENO) correlates with several variables of airway inflammation and might be useful to direct asthma therapy. If this is true, ENO should correlate with disease severity and the therapeutic decisions made. - In 74 children with allergic asthma (age 9.7 years, range 4-16) disease severity was determined by history, clinical symptoms, and lung function and inhaled therapy was adjusted according to the NIH criteria. ENO was also measured, but the patients, their parents and the physicians who made the therapeutic decision were left unaware of the results. 31 healthy children served as controls. ENO was higher in asthmatics than in controls, but did not differ with asthma severity. ENO was weakly correlated with the changes in asthma therapy recommended (r = 0.303, P = 0.009). ENO values above normal (> 13 ppb) had a sensitivity of 0.67 and a specificity of 0.65 to predict a step up in therapy. Due to the non-normal distribution of ENO there was a substantial overlap between the different groups. The lack of correlation with disease severity and the weak prediction of physician recommended inhaled therapy, suggest that ENO may be of some value to guide asthma therapy. Studies using ENO to direct therapy are necessary for a definite answer.