Abstract

Background: Nitric oxide in exhaled air (FE_NO) is a marker of eosinophilic airway inflammation. A study was undertaken to determine whether FE_NO predicts asthma relapse in asymptomatic asthmatic children in whom inhaled corticosteroids are discontinued.

Methods: Forty children (21 boys) of mean age 12.2 years on a median dose of 400 μg budesonide or equivalent (range 100–400) were included. FE_NO was measured before and 2, 4, 12, and 24 weeks after withdrawal of steroids. A relapse was defined as more than one exacerbation per month, or need for β agonist treatment on 4 days per week for at least 2 weeks, or diurnal peak flow variability of >20%. FE_NO measurements were performed online with an expiratory flow of 50 ml/s.

Results: Nine patients relapsed. Two and 4 weeks after withdrawal of steroids geometric mean FE_NO in children who were about to relapse was higher than in those who did not relapse: 35.3 ppb v 15.7 ppb at 2 weeks (ratio 2.3; 95% CI 1.2 to 4.1; p = 0.01) and 40.8 ppb v 15.9 ppb at 4 weeks (ratio 2.6; 95% CI 1.3 to 5.1). An FE_NO value of 49 ppb at 4 weeks after discontinuation of steroids had the best combination of sensitivity (71%) and specificity (93%) for asthma relapse.

Conclusion: FE_NO 2 and 4 weeks after discontinuation of steroids in asymptomatic asthmatic children may be an objective predictor of asthma relapse.