Published ahead of print on October 17, 2008, doi:10.1164/rccm.200807-1010OC
© 2009 American Thoracic Society doi: 10.1164/rccm.200807-1010OC
Daily Telemonitoring of Exhaled Nitric Oxide and Symptoms in the Treatment of Childhood Asthma1 Division of Pediatric Respiratory Medicine, Department of Pediatrics, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands; 2 Unit of Allergy and Respiratory Medicine, Department of Pediatrics, University of Padua, Padua, Italy; and 3 Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands Correspondence and requests for reprints should be addressed to J. C. de Jongste, M.D., Ph.D., Department of Pediatrics, Erasmus University Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands. E-mail: j.c.dejongste{at}erasmusmc.nl Rationale: Asthma treatment might improve when inhaled steroids are titrated on airway inflammation. Fractional exhaled nitric oxide (FENO0.05), a marker of eosinophilic airway inflammation, can be measured at home. Objectives: We assessed daily FENO0.05 telemonitoring in the management of childhood asthma. Methods: Children with atopic asthma (n = 151) were randomly assigned to two groups: FENO0.05 plus symptom monitoring, or monitoring of symptoms only. All patients scored asthma symptoms in an electronic diary over 30 weeks; 77 received a portable nitric oxide (NO) analyzer. Data were transmitted daily to the coordinating centers. Patients were phoned every 3 weeks and their steroid dose was adapted according to FENO0.05 and symptoms, or according to symptoms. Children were seen at 3, 12, 21, and 30 weeks for examination and lung function testing. The primary end point was the proportion of symptom-free days in the last 12 study weeks. Measurements and Main Results: Telemonitoring was feasible with reliable FENO0.05 data for 86% of days, and valid diary entries for 79% of days. Both groups showed an increase in symptom-free days, improvement of FEV1 and quality of life, and a reduction in steroid dose. None of the changes from baseline differed between groups. The difference in symptom-free days over the last 12 weeks was 0.3% (P = 0.95; 95% confidence interval, –10 to 11%). There was a trend for fewer exacerbations in the FENO0.05 group. Conclusions: Thirty weeks of daily FENO0.05 and symptom telemonitoring was associated with improved asthma control and a lower steroid dose. We found no added value of daily FENO0.05 monitoring compared with daily symptom monitoring only.
Key Words: airway inflammation • inhaled corticosteroid • symptom-free days • lung function • telemedicine
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