Intervention
These were obtained from a systematic review of published randomized clinical trials and systematic reviews of randomized clinical trials (RCT). Searches of computerized databases (MEDLINE, EMBASE, CENTRAL, and LILACS) and references cited in published literature identified the potentially applicable studies. The structured literature searches in these databases were made using the following criteria: (asthma OR wheeze) and (“Nitric Oxide”[tiab] or FeNO or eNO “exhaled NO”[tiab]). The searches yielded 493 citations, and a total of 34 studies were examined in full text. Included studies comparing adjustment of asthma medications based on FeNO levels versus management based on clinical symptoms or current asthma guidelines or both. We excluded studies with the following comorbidities/ characteristics: eosinophilic bronchitis, asthma-related to underlying lung disease such as bronchiectasis and chronic obstructive pulmonary disease or diagnostic categories such as ’cough variant asthma’ and ’wheezy bronchitis’. After applying these criteria, data from 8 studies were included. A random-effect meta-analysis of the 8 eligible studies was performed to summarize their results. The meta-analysis was based on the model of Dersimonian and Laird. The analysis found a reduction of risk of exacerbation (RR 0.76 CI0.63-092, I2 39%), between the exacerbation rates observed in the FeNO-SC arm and SC arm (figure 2 ). The evidence on the usage of inhaled corticosteroids is based on a systematic review that found an approximately 20% average reduction in use of ICS when FeNO monitoring was applied in pediatrics patients (11-12)