Effectiveness of fractional exhaled nitric oxide for asthma management in children: A systematic review and meta-analysis.

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.