New Guideline on Nitric Oxide Helps Guide Asthma Therapy

Asthma therapy can be improved with the new clinical practice guideline on usage of the fractional exhaled nitric oxide (FeNO). The guideline was published in the Journal of Respiratory and Critical Care Medicine.

The guideline is designed to provide guidance to clinicians who care for adults and children four years and older with asthma, including pulmonologists, adult and pediatric allergists, internists, pediatricians, family medicine specialists, and other health care professionals who care for individuals with asthma.

‘In patients with asthma in whom treatment is being considered, physicians suggest the use of FeNO in addition to usual care over usual care alone.’

Following the initial development of FeNO as a test in 2011, the American Thoracic Society developed a clinical practice guideline for the interpretation of FeNO in adults and in children over four years of age.

The question that was chosen assesses the utility of the FeNO test in management of individuals in whom treatment is being contemplated.

Using the thorough, evidence-based Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework, the expert panel made the following recommendation, which addressed this question above:

In patients with asthma in whom treatment is being considered, we suggest the use of FeNO in addition to usual care over usual care alone.

"While our task was to review whether FeNO testing be performed when treatment is being considered, the studies being evaluated as well as the interpretation of results via our methodology suggest that any patient with asthma may be eligible for the measurement of FeNO in decision making regarding therapy," noted guideline co-chairs Sumita B. Khatri, MD, MA and Teal S. Hallstrand, MD, MPH.

"As rigorous as our evaluation of the single question we were asked to investigate was, it should be noted that this guideline does not address the question of FeNO to establish the diagnosis of asthma or the utility of FeNO in monitoring asthma.

We believe these issues that were identified by the panel as being important should be addressed in the future in a systematic manner."

The ATS has published more than 20 clinical practice guidelines on various conditions, ranging from allergy and asthma to TB and other pulmonary infections. For ATS guideline implementation tools and derivatives, go here.



Source: Medindia