Exhaled nitric oxide in childhood allergic asthma management: a randomised controlled trial

Pediatr Pulmonol. 2014 Jul;49(7):624-31. doi: 10.1002/ppul.22873. Epub 2013 Sep 4.


Objective: We investigated the potential yield of incorporating fractional exhaled nitric oxide (FeNO) measurements in childhood allergic asthma management.

Methods: Ninety-nine children with persistent allergic asthma were included in this multicentre, single-blind, randomized controlled trial. Treatment was based on the Global Initiative for Asthma (GINA) guidelines. In the FeNO group, asthma management was also guided by FeNO measurements. Health outcomes were evaluated over a 52-week timeframe.

Results: Fewer asthma exacerbations were registered in the FeNO group. 24% of the children in the FeNO group experienced one or more exacerbations per year, compared with 48% in the clinical group (P = 0.017). The proportion of symptom-free days did not differ between groups. In the FeNO group, more months of leukotriene receptor antagonist use (median (interquartile range)) were observed: 12 (9-12) months, compared with 9 (3-12) months in the clinical group (P = 0.019). Next, the evolution of inhaled corticosteroid doses between visits 1 and 5 (median change (interquartile range)) showed a significant increase of +100 µg (0, +400) in the FeNO group and a change of 0 µg (-200, +80) in the clinical group (P = 0.016).

Conclusions: FeNO measurements in childhood asthma management did not improve the proportion of symptom-free days, but did result in fewer asthma exacerbations associated with an increased leukotriene receptor antagonist use and an augmentation of the inhaled corticosteroid doses.

Trial registration: ClinicalTrials.gov NCT00562991.

Keywords: airway inflammation; asthma exacerbations; inhaled corticosteroids; leukotriene receptor antagonist.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones / therapeutic use*
  • Algorithms
  • Anti-Asthmatic Agents / therapeutic use*
  • Asthma / diagnosis*
  • Asthma / drug therapy*
  • Asthma / metabolism
  • Biomarkers / metabolism
  • Breath Tests
  • Child
  • Child, Preschool
  • Decision Support Techniques
  • Drug Administration Schedule
  • Female
  • Humans
  • Leukotriene Antagonists / therapeutic use*
  • Logistic Models
  • Male
  • Nitric Oxide / metabolism*
  • Single-Blind Method
  • Treatment Outcome


  • Adrenal Cortex Hormones
  • Anti-Asthmatic Agents
  • Biomarkers
  • Leukotriene Antagonists
  • Nitric Oxide

Associated data

  • ClinicalTrials.gov/NCT00562991