Biomarkers of airway inflammation: the use of exhaled nitric oxide (FeNO) in the management of adult asthma in UK primary care

Wilson, Emma Elizabeth (2013) Biomarkers of airway inflammation: the use of exhaled nitric oxide (FeNO) in the management of adult asthma in UK primary care. PhD thesis, University of Nottingham.

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Current asthma guidelines recommend reducing inhaled corticosteroid (ICS) therapy dose by 50% in patients with mild to moderate asthma who have demonstrated three months of good symptom control however there is evidence to suggest that this does not occur.


We tested whether exhaled nitric oxide (FeNO) measurements or other clinical indices could be utilised to predict a safe reduction of ICS dose, without provoking loss of symptom control or exacerbation within 3 months. We also investigated relationships between airway inflammation and asthma symptoms in the mild to moderate asthma cohort.


191 patients with stable asthma were recruited from primary care. Patients had their FeNO level measured at baseline and then had their inhaled corticosteroid (ICS) dose reduced by 50%. FeNO measurements were reassessed seven days later. The primary outcomes were whether baseline FeNO or a change in FeNO following ICS dose reduction could predict asthma stability at 3 months. Results: 128/191 patients (67%) completed the ICS dose reduction successfully at three months. 63/191 patients (33%) suffered from either a loss of control or an exacerbation. Baseline FeNO, or change in FeNO (post step-down minus pre step-down) were not statistically significantly different between the two groups.


67% of patients with well-controlled asthma can safely reduce their ICS dose by half without suffering from a loss of control or exacerbation within three months; however neither baseline nor change in FeNO measurements or routine clinical indices can be used to predict which patients can or cannot successfully tolerate a reduction in ICS dose.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Harrison, T.
McKeever, T.
Shaw, D.E.
Keywords: Biochemical markers, Nitric oxide, Inhaled corticosteroid therapy, Dose reduction, Asthma management
Subjects: W Medicine and related subjects (NLM Classification) > WF Respiratory system
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 29710
Depositing User: Blore, Mrs Kathryn
Date Deposited: 27 Aug 2015 09:44
Last Modified: 15 Oct 2017 01:23

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