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What is a clinically meaningful change in exhaled nitric oxide for children with asthma?

What is a clinically meaningful change in exhaled nitric oxide for children with asthma?
What is a clinically meaningful change in exhaled nitric oxide for children with asthma?
Introduction Fractional exhaled nitric oxide (FENO) may be a useful objective measurement to guide asthma treatment. What remains uncertain is what change in FENO is clinically significant. Methods An individual patient data analysis was performed using data from seven randomized clinical trials which used FENO to guide asthma treatment. The absolute and percentage intra‐subject change in FENO measurements over “stable” and also “unstable” 3‐month periods were described. Results Data were available in 1112 randomized controlled trial participants and ≥1 stable period was present for 665 individuals. The interquartile range (IQR) and limits of agreement (LoA) for change in absolute FENO among individuals whose initial FENO was <50 parts per billion (ppb) were −7 to +9 ppb and −43 to +50 ppb, and for those with initial FENO ≥50 ppb IQR was −29 to +17 ppb and LoA was −80 to +76 ppb. For percentage change in FENO, the IQR and LoA for individuals whose initial FENO was <50 ppb were −33% to +51% and −157% to +215%, and for those with initial FENO ≥50 ppb were −33% to +35% and −159% to +192%. The variation in FENO values for a stable period was similar irrespective of whether it was followed by a stable or unstable period. Conclusions Over a 3‐month period where FENO is initially <50 ppb, a rise of <10 ppb or of <50% (based on IQR) is unlikely to be related to asthma. When FENO is initially ≥50 ppb an percentage change of <50% (based on IQR) is unlikely to be asthma‐related.
asthma, child, exhaled nitric oxide, monitoring
8755-6863
599-606
Fielding, Shona
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Pijnenburg, Marielle
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de Jongste, Johan C.
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Pike, Katharine
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Roberts, Graham
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Petsky, Helen
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Chang, Anne B.
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Fritsch, Maria
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Frischer, Thomas
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Szefler, Stanley
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Gergen, Peter
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Vermeulen, Francoise
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Vael, Robin
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Turner, Steve
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Fielding, Shona
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Pijnenburg, Marielle
5fa69ab2-4a84-44f5-bc82-ea852e382cc7
de Jongste, Johan C.
3902188e-c058-4f21-a024-148fa9c3c346
Pike, Katharine
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Roberts, Graham
ea00db4e-84e7-4b39-8273-9b71dbd7e2f3
Petsky, Helen
a41e62d7-b4c2-42f5-a8a9-777c165f30d0
Chang, Anne B.
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Fritsch, Maria
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Frischer, Thomas
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Szefler, Stanley
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Gergen, Peter
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Vermeulen, Francoise
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Vael, Robin
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Turner, Steve
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Fielding, Shona, Pijnenburg, Marielle, de Jongste, Johan C., Pike, Katharine, Roberts, Graham, Petsky, Helen, Chang, Anne B., Fritsch, Maria, Frischer, Thomas, Szefler, Stanley, Gergen, Peter, Vermeulen, Francoise, Vael, Robin and Turner, Steve (2020) What is a clinically meaningful change in exhaled nitric oxide for children with asthma? Pediatric Pulmonology, 55 (3), 599-606. (doi:10.1002/ppul.24630).

Record type: Article

Abstract

Introduction Fractional exhaled nitric oxide (FENO) may be a useful objective measurement to guide asthma treatment. What remains uncertain is what change in FENO is clinically significant. Methods An individual patient data analysis was performed using data from seven randomized clinical trials which used FENO to guide asthma treatment. The absolute and percentage intra‐subject change in FENO measurements over “stable” and also “unstable” 3‐month periods were described. Results Data were available in 1112 randomized controlled trial participants and ≥1 stable period was present for 665 individuals. The interquartile range (IQR) and limits of agreement (LoA) for change in absolute FENO among individuals whose initial FENO was <50 parts per billion (ppb) were −7 to +9 ppb and −43 to +50 ppb, and for those with initial FENO ≥50 ppb IQR was −29 to +17 ppb and LoA was −80 to +76 ppb. For percentage change in FENO, the IQR and LoA for individuals whose initial FENO was <50 ppb were −33% to +51% and −157% to +215%, and for those with initial FENO ≥50 ppb were −33% to +35% and −159% to +192%. The variation in FENO values for a stable period was similar irrespective of whether it was followed by a stable or unstable period. Conclusions Over a 3‐month period where FENO is initially <50 ppb, a rise of <10 ppb or of <50% (based on IQR) is unlikely to be related to asthma. When FENO is initially ≥50 ppb an percentage change of <50% (based on IQR) is unlikely to be asthma‐related.

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Accepted/In Press date: 22 December 2019
e-pub ahead of print date: 7 January 2020
Keywords: asthma, child, exhaled nitric oxide, monitoring

Identifiers

Local EPrints ID: 436833
URI: http://eprints.soton.ac.uk/id/eprint/436833
ISSN: 8755-6863
PURE UUID: 792efcd9-df1a-4c96-ace7-ad4ed1bac230
ORCID for Graham Roberts: ORCID iD orcid.org/0000-0003-2252-1248

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Date deposited: 10 Jan 2020 17:34
Last modified: 26 Nov 2021 05:16

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Contributors

Author: Shona Fielding
Author: Marielle Pijnenburg
Author: Johan C. de Jongste
Author: Katharine Pike
Author: Graham Roberts ORCID iD
Author: Helen Petsky
Author: Anne B. Chang
Author: Maria Fritsch
Author: Thomas Frischer
Author: Stanley Szefler
Author: Peter Gergen
Author: Francoise Vermeulen
Author: Robin Vael
Author: Steve Turner

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