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)