Fractional exhaled nitric oxide for the management of asthma in adults: a systematic review

Eur Respir J. 2016 Mar;47(3):751-68. doi: 10.1183/13993003.01882-2015. Epub 2016 Feb 4.


The aim of this review was to evaluate the clinical effectiveness of fractional exhaled nitric oxide (FeNO) measured in a clinical setting for the management of asthma in adults.13 electronic databases were searched and studies were selected against predefined inclusion criteria. Quality assessment was conducted using QUADAS-2. Class effect meta-analyses were performed.Six studies were included. Despite high levels of heterogeneity in multiple study characteristics, exploratory class effect meta-analyses were conducted. Four studies reported a wider definition of exacerbation rates (major or severe exacerbation) with a pooled rate ratio of 0.80 (95% CI 0.63-1.02). Two studies reported rates of severe exacerbations (requiring oral corticosteroid use) with a pooled rate ratio of 0.89 (95% CI 0.43-1.72). Inhaled corticosteroid use was reported by four studies, with a pooled standardised mean difference of -0.24 (95% CI -0.56-0.07). No statistically significant differences for health-related quality of life or asthma control were found.FeNO guided management showed no statistically significant benefit in terms of severe exacerbations or inhaled corticosteroid use, but showed a statistically significant reduction in exacerbations of any severity. However, further research is warranted to clearly define which management protocols (including cut-off points) offer best efficacy and which patient groups would benefit the most.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use*
  • Adult
  • Anti-Asthmatic Agents / therapeutic use*
  • Asthma / diagnosis
  • Asthma / drug therapy*
  • Biomarkers / analysis
  • Breath Tests
  • Disease Management
  • Disease Progression
  • Exhalation
  • Humans
  • Nitric Oxide / analysis*
  • Quality of Life
  • Randomized Controlled Trials as Topic


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