Guideline-recommended fractional exhaled nitric oxide is a poor predictor of health-care use among inner-city children and adolescents receiving usual asthma care

Meredith C. McCormack, Charles Aloe, Jean Curtin-Brosnan, Gregory B. Diette, Patrick N. Breysse, Elizabeth C. Matsui

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: American Thoracic Society guidelines support using fractional exhaled nitric oxide (F ENO) measurements in patients with asthma and highlight gaps in the evidence base. Little is known about the use of F ENO levels to predict asthma exacerbations among high-risk, urban, minority populations receiving usual care. Methods: Children with persistent asthma (n = 138) were enrolled in a prospective, observational cohort study and skin tested at baseline (a wheal ≥ 3 mm indicated a positive skin-prick test). F ENO levels, lung function, and asthma-related health-care use were assessed at baseline and every 3 months thereafter for 1 year. Relationships between F ENO levels and health-care use in the subsequent 3 months were examined. Final models accounted for repeated outcome measures and were adjusted for age, sex, and lung function. Results: The mean age of the children was 11 years (range, 5-17 years), and most were male (57%), black (91%), and atopic (90%). At baseline, the median F ENO level was 31.5 parts per billion (interquartile range, 16-61 ppb) and mean FEV 1 /FVC was 80.7% (SD, ± 9.6%). There were 237 acute asthma-related health-care visits, 105 unscheduled doctor visits, 125 ED visits, and seven hospitalizations during the follow-up period. F ENO level was not a signifi cant predictor of acute visits, ED visits, unscheduled doctor visits, or hospitalization in either unadjusted or adjusted analyses. Use of recommended cut points did not improve the predictive value of the F ENO level (positive predictive value, 0.6%-32.8%) nor did application of the guideline-based algorithm to assess change over time. Conclusions: F ENO level may not be a clinically useful predictor of health-care use for asthma exacerbations in urban minority children with asthma.

Original languageEnglish (US)
Pages (from-to)923-929
Number of pages7
JournalCHEST
Volume144
Issue number3
DOIs
StatePublished - Sep 2013

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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