Assessing the utility of fractional exhaled nitric oxide-guided management in adult patients with asthma: A systematic review and meta-analysis

Abstract

Background

Fractional exhaled nitric oxide (FeNO) has been utilized as a reliable biomarker for diagnosis, treatment response, and prediction of future risks in asthma care, that potentially ensures the efficacy of FeNO-guided asthma management. As previous systematic reviews reported limited efficacy with this approach, we evaluated the efficacy of FeNO-guided management in monitoring adults with asthma.

Methods

In this systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Review and Meta-Analyses Statement and the Minds Manual for Guideline Development, we updated a Cochrane systematic review in 2016 by adding six papers reporting randomized controlled trials with a treatment duration ≥12 weeks published between June 2016 and July 2022, and conducted a sub-analysis of two groups stratified by the strategy used: the FeNO-alone and FeNO with symptom score groups.

Results

In thirteen RCTs included, FeNO-guided management improved the numbers of participants with one or more asthma exacerbations and the number of exacerbations per 52 weeks. Compared with conventional management, FeNO-guided management marginally improved asthma control questionnaire scores and decreased inhaled corticosteroid doses. In contrast, FeNO-guided management did not improve severe exacerbations requiring oral corticosteroids or hospitalization, percent predicted forced expiratory volume in 1 s, FeNO levels, or asthma-related quality of life scores. Subgroup analysis revealed that, compared with conventional management, both FeNO-symptom score- and FeNO alone-based management decreased the number of asthma exacerbations.

Conclusion

FeNO-guided management can effectively reduce exacerbations in adults with asthma.