Domiciliary fractional exhaled nitric oxide and spirometry in monitoring asthma control and exacerbations

Ran Wang, Omar S Usmani, Kian Fan Chung, Jacob Sont, Andrew Simpson, Matteo Bonini, Persijn J Honkoop, Stephen J Fowler

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Domiciliary measurements of airflow obstruction and inflammation may assist healthcare teams and patients in determining asthma control and facilitate self-management. Objective: To evaluate parameters derived from domiciliary spirometry and fractional exhaled nitric oxide (FENO) in monitoring asthma exacerbations and control. Methods: Patients with asthma were provided with hand-held spirometry and FENO devices in addition to their usual asthma care. Patients were instructed to perform twice-daily measurements for 1 month. Daily symptoms and medication change were reported through a mobile health system. The Asthma Control Questionnaire was completed at the end of the monitoring period. Results: One hundred patients had spirometry, of which 60 were given additional FENO devices. Compliance rates for twice-daily measurements were poor (median [interquartile range], 43% [25%-62%] for spirometry; 30% [3%-48%] for FENO); at least 15% of patients took little or no spirometry measurements and 40% rarely measured FENO. The coefficient of variation (CV) values in FEV 1 and FENO were higher, and the mean % personal best FEV 1 lower in those who had major exacerbations compared with those without (P < .05). FENO CV and FEV 1 CV were associated with asthma exacerbation during the monitoring period (area under the receiver-operating characteristic curve, 0.79 and 0.74, respectively). Higher FENO CV also predicted poorer asthma control (area under the receiver-operating characteristic curve, 0.71) at the end of the monitoring period. Conclusions: Compliance with domiciliary spirometry and FENO varied widely among patients even in the setting of a research study. However, despite significant missing data, FENO and FEV 1 were associated with asthma exacerbations and control, making these measurements potentially clinically valuable if used.

Original languageEnglish
JournalThe journal of allergy and clinical immunology. In practice
Volume11
Issue number6
DOIs
Publication statusPublished - 18 Feb 2023

Keywords

  • Adult asthma
  • Home monitoring
  • Asthma management
  • Monitoring
  • Asthma
  • Humans
  • Lung
  • Breath Tests
  • Asthma/drug therapy
  • Exhalation
  • Nitric Oxide
  • Fractional Exhaled Nitric Oxide Testing

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