Can exhaled nitric oxide fraction predict adherence to inhaled corticosteroids in atopic and nonatopic children with asthma?

• Published in: The journal of allergy and clinical immunology in practice (Cambridge, MA) Vol. 5; no. 2; pp. 521 - 522
• Main Authors: Klok, Ted, MD, Brand, Paul L.P., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2017; Elsevier Limited
• Subjects: Adrenal Cortex Hormones - therapeutic use; Allergy and Immunology; Anti-Asthmatic Agents - therapeutic use; Asthma; Asthma - diagnosis; Asthma - drug therapy; Asthma - epidemiology; Child; Child, Preschool; Cohort Studies; Exhalation; Female; Fractions; Humans; Hypotheses; Internal Medicine; Male; Medication Adherence - statistics & numerical data; Nitric Oxide - metabolism; Pediatrics; Predictive Value of Tests; Prognosis; Spirometry - methods; Studies
• ISSN: 2213-2198; 2213-2201
• DOI: 10.1016/j.jaip.2016.09.038

Adherence was assessed by Smartinhaler (for metered dose inhaler/spacer combinations) and SmartDisk devices, validated electronic adherence loggers that record the date and time of each actuation on a microchip.6 Adherence was calculated as the ratio between the Smartinhaler/SmartDisk-recorded dosages and the prescribed dosages, expressed as a percentage, censored at 100%.5 At follow-up visits after 6- or 12-month follow-up, Feno was measured according to European Respiratory Society guidelines using the NIOX analyzer (Aerocrine, Solna, Sweden).7 During these follow-up visits, asthma control was assessed by parent-completed Asthma Control Questionnaire (ACQ, lower scores indicating better asthma control),8 by the attending physician (visual analogue scale score ranging from 0 to 100, higher scores indicating better asthma control), and by lung function before and after inhaling salbutamol 400 μg. We analyzed the relation between Feno and ICS adherence, and adjusted this for asthma control, age, concomitant use of nasal corticosteroids, and parental smoking in multiple regression analyses because these factors may have an impact on Feno. The generalizability of this study is limited because of the high median adherence level and good asthma control that we achieved, which is unusual in other asthma adherence studies. Because we also showed that poor adherence is commonly associated with low Feno levels, we consider it unlikely that the random assessment of Feno will perform better as a proxy measure of adherence in a cohort with lower median adherence levels and low Feno levels.