CONTEXT: The utility of fractional exhaled nitric oxide (FeNO) measurement in real-world asthma management requires investigation. OBJECTIVE: To determine whether FeNO-assisted care added to standard asthma management improves asthma control in a managed care organization. DESIGN: Prospective observational study in patients aged 12 years and older with uncontrolled persistent asthma identified during a scheduled visit to an Allergy Department that routinely used FeNO (FeNO-assisted care, n = 426) vs visits to 4 Allergy Departments that did not, but followed routine guideline-based care (standard care, n = 925). The FeNO-assisted care was based on FeNO level, asthma control status, and step-care level. MAIN OUTCOME MEASURES: Composite primary outcome was 1 or more asthma exacerbations or 7 or more dispensed canisters containing short-acting β2-agonists in the follow-up year. Inverse probability of treatment weighting propensity scoring balanced covariates, and multivariable regression analyses compared outcomes between groups. RESULTS: Compared with standard care, FeNO-assisted care was not associated with reducing the primary composite outcome (adjusted risk ratio = 0.94, 95% confidence interval = 0.69-1.29, p = 0.71), nor with a reduction in asthma exacerbations or dispensing of 7 or more short-acting β2-agonist canisters as separate outcomes. In an atopic subgroup with aeroallergen sensitization, the composite outcome was similar between groups, but the rate of asthma exacerbations was lower with FeNO-assisted treatment (adjusted rate ratio = 0.67, 95% confidence interval = 0.49-0.91, p = 0.01). CONCLUSION: These findings suggest future studies of FeNO-assisted care should be directed at the atopic phenotype.
CONTEXT: The utility of fractional exhaled nitric oxide (FeNO) measurement in real-world asthma management requires investigation. OBJECTIVE: To determine whether FeNO-assisted care added to standard asthma management improves asthma control in a managed care organization. DESIGN: Prospective observational study in patients aged 12 years and older with uncontrolled persistent asthma identified during a scheduled visit to an Allergy Department that routinely used FeNO (FeNO-assisted care, n = 426) vs visits to 4 Allergy Departments that did not, but followed routine guideline-based care (standard care, n = 925). The FeNO-assisted care was based on FeNO level, asthma control status, and step-care level. MAIN OUTCOME MEASURES: Composite primary outcome was 1 or more asthma exacerbations or 7 or more dispensed canisters containing short-acting β2-agonists in the follow-up year. Inverse probability of treatment weighting propensity scoring balanced covariates, and multivariable regression analyses compared outcomes between groups. RESULTS: Compared with standard care, FeNO-assisted care was not associated with reducing the primary composite outcome (adjusted risk ratio = 0.94, 95% confidence interval = 0.69-1.29, p = 0.71), nor with a reduction in asthma exacerbations or dispensing of 7 or more short-acting β2-agonist canisters as separate outcomes. In an atopic subgroup with aeroallergen sensitization, the composite outcome was similar between groups, but the rate of asthma exacerbations was lower with FeNO-assisted treatment (adjusted rate ratio = 0.67, 95% confidence interval = 0.49-0.91, p = 0.01). CONCLUSION: These findings suggest future studies of FeNO-assisted care should be directed at the atopic phenotype.
Authors: Michael Schatz; Robert S Zeiger; William M Vollmer; David Mosen; Andrea J Apter; Thomas B Stibolt; Albin Leong; Michael S Johnson; Guillermo Mendoza; E Francis Cook Journal: J Allergy Clin Immunol Date: 2006-03-31 Impact factor: 10.793
Authors: Raed A Dweik; Peter B Boggs; Serpil C Erzurum; Charles G Irvin; Margaret W Leigh; Jon O Lundberg; Anna-Carin Olin; Alan L Plummer; D Robin Taylor Journal: Am J Respir Crit Care Med Date: 2011-09-01 Impact factor: 21.405
Authors: Heather Powell; Vanessa E Murphy; D Robin Taylor; Michael J Hensley; Kirsten McCaffery; Warwick Giles; Vicki L Clifton; Peter G Gibson Journal: Lancet Date: 2011-09-10 Impact factor: 79.321
Authors: Michael Schatz; Robert S Zeiger; William M Vollmer; David Mosen; Guillermo Mendoza; Andrea J Apter; Thomas B Stibolt; Albin Leong; Michael S Johnson; E Francis Cook Journal: Chest Date: 2006-07 Impact factor: 9.410
Authors: Robert A Nathan; Christine A Sorkness; Mark Kosinski; Michael Schatz; James T Li; Philip Marcus; John J Murray; Trudy B Pendergraft Journal: J Allergy Clin Immunol Date: 2004-01 Impact factor: 10.793