Xia Wang1,2,3, Xiangsheng Tan4, Qubei Li1,2,3. 1. Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China. 2. National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China. 3. Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China. 4. The First Hospital Affiliated to Army Medical University, Chongqing, 400038, China.
Abstract
BACKGROUND: Fractional exhaled nitric oxide (FENO) is a non-invasive strategy for diagnosing and managing asthma, but limited evidence is available for the effects of FENO-guided asthma management in children. This meta-analysis aimed to evaluate the effectiveness of fractional exhaled nitric oxide for asthma management in children. METHODS: In total, 6 databases were searched, and 23 randomized controlled trials that compared the effects of FENO-guided asthma management with those not using FENO in pediatric asthma were included. Methodological quality was assessed using the Cochrane risk-of-bias tool. Data for relevant endpoint were extracted and analyzed. RESULTS: Our meta-analysis of the effectiveness of fractional exhaled nitric oxide for asthma management in children showed that FENO-guided asthma management helped reduce the numbers of children with asthma exacerbations (risk ratio (RR) 0.73, 95% confidence interval (CI) 0.63 to 0.84; P < 0.0001) and the exacerbation frequency (standardized mean difference (SMD) -1.57, 95% CI -2.25 to -0.88; P < 0.00001). Furthermore, it improved the predicted forced expiratory volume in 1 minute (FEV1%pred) (weighted mean difference (WMD) 3.67, 95% CI 0.91 to 6.43; P = 0.009), and was also found to be associated with an increase of daily inhaled corticosteroid (ICS) dose (WMD 64.17μg, 95% CI 53.59 to 74.75; P < 0.00001). CONCLUSIONS: This meta-analysis indicated that the FENO-guided asthma management strategy could partially improve the outcomes of pediatric asthma at the expense of increased ICS use. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
BACKGROUND: Fractional exhaled nitric oxide (FENO) is a non-invasive strategy for diagnosing and managing asthma, but limited evidence is available for the effects of FENO-guided asthma management in children. This meta-analysis aimed to evaluate the effectiveness of fractional exhaled nitric oxide for asthma management in children. METHODS: In total, 6 databases were searched, and 23 randomized controlled trials that compared the effects of FENO-guided asthma management with those not using FENO in pediatric asthma were included. Methodological quality was assessed using the Cochrane risk-of-bias tool. Data for relevant endpoint were extracted and analyzed. RESULTS: Our meta-analysis of the effectiveness of fractional exhaled nitric oxide for asthma management in children showed that FENO-guided asthma management helped reduce the numbers of children with asthma exacerbations (risk ratio (RR) 0.73, 95% confidence interval (CI) 0.63 to 0.84; P < 0.0001) and the exacerbation frequency (standardized mean difference (SMD) -1.57, 95% CI -2.25 to -0.88; P < 0.00001). Furthermore, it improved the predicted forced expiratory volume in 1 minute (FEV1%pred) (weighted mean difference (WMD) 3.67, 95% CI 0.91 to 6.43; P = 0.009), and was also found to be associated with an increase of daily inhaled corticosteroid (ICS) dose (WMD 64.17μg, 95% CI 53.59 to 74.75; P < 0.00001). CONCLUSIONS: This meta-analysis indicated that the FENO-guided asthma management strategy could partially improve the outcomes of pediatric asthma at the expense of increased ICS use. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.