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Guideline-Recommended Fractional Exhaled Nitric Oxide is a Poor Predictor of Health Care Use Among Inner-city Children and Adolescents Receiving Usual Asthma Care.

Chest. 2013 Jun 13;

Authors: McCormack MC, Aloe C, Curtin-Brosnan J, Diette GB, Breysse PN, Matsui EC

Abstract
ABSTRACT BACKGROUND: Recent American Thoracic Society (ATS) guidelines support use of FENO in patients with asthma and highlight gaps in the evidence base. Little is known about use of FENO to predict asthma exacerbations among high-risk, urban, minority populations receiving usual care. METHODS: 138 children with persistent asthma were enrolled in a prospective observational cohort study and skin tested at baseline (wheal?3mm=+SPT). Fractional exhaled nitric oxide (FENO) levels, lung function, and asthma-related health care use were assessed at baseline and every three months thereafter for one year. Relationships between FENO and health care utilization in the subsequent three months were examined. Final models accounted for repeated outcome measures and were adjusted for age, gender and lung function. RESULTS: The mean age was 11 years (range 5-17), and most were male (57%), African American (91%), and atopic (90%). At baseline, FENO was (median [IQR]: 31.5ppb [16-61]) and FEV1/FVC was (mean ± SD: 80.7±9.6%). There were 237 acute asthma-related health care visits, 105 unscheduled doctor (UD) visits, 125 ED visits, and 7 hospitalizations during the follow-up period. FENO was not a significant predictor of acute visits, ED visits, UD visits, or hospitalization in either unadjusted or adjusted analyses. Use of recommended cutpoints did not improve the predictive value of FENO (PPV 0.6-32.8%), nor did application of the guideline-based algorithm to assess change over time. CONCLUSIONS: FENO may not be a clinically useful predictor of health care use for asthma exacerbations in urban minority children with asthma.

PMID: 23764806 [PubMed – as supplied by publisher]

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