Relations between exhaled nitric oxide and measures of disease activity among children with mild-to-moderate asthma

Objective Exhaled nitric oxide (FENO) was evaluated in children with asthma after 4 to 6 years of treatment with budesonide, nedocromil, or albuterol as needed. Study design FENO, spirometry, total eosinophil count, and serum eosinophil cationic protein levels were obtained from 118 children at the Denver site of the Childhood Asthma Management Program upon completion of treatment and after a 2- to 4-month washout. Results Budesonide-treated patients had significantly lower median (1st, 3rd quartile) FENO (21.5 [13.2, 84.4] vs 62.5 [26.2, 115.0] ppb, P <.01) and eosinophil cationic protein levels (17.4 [10.1, 24.3] vs 24.0 [15.4, 33.9] mg/dL, P = .05) compared with placebo, whereas no differences were noted between nedocromil and placebo groups. After washout, FENO levels were similar between the three treatments. FENO levels significantly correlated with degree of bronchial hype rresponsiveness, bronchodilator reversibility, allergen skin prick tests, serum IgE, and total eosinophil count. FENO levels were also higher in patients with nocturnal symptoms and in patients requiring beta-agonist use at least once weekly. Conclusions Budesonide therapy was more effective than nedocromil in reducing FENO. Unfortunately, the effects of longterm budesonide were not sustained after its discontinuation. FENO may be a complementary tool to current practice guidelines in assessing asthma control and medication response.