Fractional exhaled nitric oxide as a predictor of response to inhaled corticosteroids in patients with non-specific respiratory symptoms and insignificant bronchodilator reversibility: a randomised controlled trial
David B Price, Roland Buhl, Adrian Chan, et al.
Lancet Respir Med 2018;6:29–39
Patients with non-specific respiratory symptoms, such as coughing and breathlessness, present a significant challenge in primary care. Inhaled corticosteroids (ICS) are often prescribed to manage these symptoms, but concern regarding overuse has triggered calls to exercise more caution when prescribing these drugs. In a double-blind randomised controlled trial, David Price (University of Aberdeen) and colleagues from across the UK and Singapore evaluated the possible association between baseline fractional exhaled nitric oxide (FeNO) and response to ICS.
Enrolled patients were aged between 18–80 years with coughing, wheezing or breathlessness, no confirmed respiratory diagnosis, and less than 20% bronchodilator reversibility. After two weeks’ assessment and four weeks’ treatment with either ICS or placebo, a significant positive association was found. Patients with higher baseline FeNO levels were significantly more likely to be responsive to ICS treatment. The authors believe their findings support the use of FeNO measurement in primary care as a tool to reduce the unnecessary prescription of ICS to patients unlikely to benefit from such treatment.