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Published ahead of print on June 23, 2005, doi:10.1164/rccm.200503-458OC

Am. J. Respir. Crit. Care Med., Volume 172, Number 7, October 2005, 831-836

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Submitted on March 22, 2005
Accepted on June 17, 2005

Titrating Steroids on Exhaled Nitric Oxide in Asthmatic Children: a Randomized Controlled Trial

Marielle W Pijnenburg1*, E. Marije Bakker1, Wim C Hop2, and Johan C De Jongste1

1 Department of Pediatric Respiratory Medicine, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands, 2 Department of Epidemiology and Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands

* To whom correspondence should be addressed. E-mail: m.pijnenburg{at}erasmusmc.nl.

Rationale: Corticosteroids are the anti-inflammatory treatment of choice in asthma. Treatment guidelines are mainly symptom-driven but symptoms are not closely related to airway inflammation. Nitric oxide in exhaled air (FeNO) is a marker of airway inflammation in asthma. Objective: We evaluated whether titrating steroids on FeNO improved asthma management in children. Methods: Eighty-five atopic asthmatic children using inhaled steroids were allocated to a FeNO group (n=39), where treatment decisions were made on both FeNO and symptoms, or in a symptom group (n=46), treated on symptoms only. Children were seen every 3 months during 1 year. Measurements: Symptoms were scored during 2 weeks before visits and 4 weeks before the final visit. FeNO was measured at all visits, and airway hyperresponsiveness and Forced Expiratory Volume in 1 second (FEV1) at start and end of the study. Primary endpoint was cumulative steroid dose. Results: Changes in steroid dose from baseline did not differ between groups. In the FeNO group, hyperresponsiveness improved more than in the symptom group (2.5 vs 1.1 doubling dose, p=0.04). FEV1 in the FeNO-group improved, the change in FEV1 was not significantly different between groups. The FeNO group had 8 severe exacerbations versus 18 in the symptom group. The change in symptom scores did not differ between groups. FeNO increased in the symptom group; the change in FeNO from baseline differed between groups (p=0.02). Conclusion: In asthmatic children, 1 year of steroid titration on FeNO did not result in higher steroid doses and improved airway hyperresponsiveness and - inflammation.
Key words: corticosteroids, lung function, symptoms, airway hyperresponsiveness, treatment




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