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Effectiveness of fractional exhaled nitric oxide for asthma management in children: A systematic review and meta‐analysis
Author(s) -
Wang Xia,
Tan Xiangsheng,
Li Qubei
Publication year - 2020
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.24898
Subject(s) - medicine , exhaled nitric oxide , asthma , meta analysis , confidence interval , exacerbation , asthma management , randomized controlled trial , strictly standardized mean difference , spirometry
Background Fractional exhaled nitric oxide (FENO) is a noninvasive strategy for diagnosing and managing asthma, but limited evidence is available for the effects of FENO‐guided asthma management in children. This meta‐analysis aimed to evaluate the effectiveness of FENO for asthma management in children. Methods In total, six databases were searched, and 23 randomized controlled trials that compared the effects of FENO‐guided asthma management with those not using FENO in pediatric asthma were included. Methodological quality was assessed using the Cochrane risk‐of‐bias tool. Data for relevant endpoints were extracted and analyzed. Results Our meta‐analysis of the effectiveness of FENO for asthma management in children showed that FENO‐guided asthma management helped reduce the numbers of children with asthma exacerbations (risk ratio: 0.73; 95% confidence interval [CI:] 0.63‐0.84; P < .0001) and the exacerbation frequency (standardized mean difference: −1.57; 95% CI: −2.25 to −0.88; P < .00001). Furthermore, it improved the predicted forced expiratory volume in 1 minute (weighted mean difference [WMD]: 3.67; 95% CI: 0.91‐6.43; P = .009) and was also found to be associated with an increase of daily inhaled corticosteroid (ICS) dose (WMD: 64.17 μg; 95% CI: 53.59‐74.75; P < .00001). Conclusions This meta‐analysis indicated that the FENO‐guided asthma management strategy could partially improve the outcomes of pediatric asthma at the expense of increased ICS use.