Published ahead of print on October 17, 2008, doi:10.1164/rccm.200807-1010OC Am. J. Respir. Crit. Care Med., Volume 179, Number 2, January 2009, 93-97 A more recent version of this article appeared on January 15, 2009
Submitted on July 2, 2008 Daily Telemonitoring of Exhaled Nitric Oxide and Symptoms in the Treatment of Childhood AsthmaJohan C. De Jongste1*,1 Division of Pediatric Respiratory Medicine, Department of Pediatrics, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, Netherlands, 2 Department of Pediatrics, University of Padova, Unit of Allergy and Respiratory Medicine, Padova, Italy, 3 Department of Biostatistics, Erasmus University Medical Center, Rotterdam, Netherlands, 4 Pediatrics, University of Padova, Padova, Italy * To whom correspondence should be addressed. 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. Objective: We assessed daily FeNO0.05 telemonitoring in the management of childhood asthma. Methods: Atopic asthmatic children (n=151) were randomly assigned to two groups: FeNO0.05 + symptom monitoring, or monitoring of symptoms only. All scored asthma symptoms in an electronic diary during 30 weeks, 77 received a portable NO-analyzer. Data were daily transmitted to the coordinating centers. Patients were phoned every 3 weeks and their steroid dose was adapted according to FeNO0.05 and symptoms, or to symptoms. Children were seen at 3, 12, 21 and 30 weeks for examination and lung function testing. Primary endpoint 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%, 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% CI: -10 to 11%). There was a trend for fewer exacerbations in the FeNO0.05 group. Conclusion: 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 to daily symptom monitoring only. *CHARISM Study Group is an author on this paper Key words: Airway inflammation • inhaled corticosteroid • symptom-free days • lung function • telemedicine
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