Enhancing asthma diagnosis and management through advanced Feno measurement techniques

We read with great interest the study by Michils et al1Michils A. Akset M. Haccuria A. Perez-Bogerd S. Malinovschi A. Van Muylem A. The impact of airway obstruction on Feno values in asthma patients.J Allergy Clin Immunol Pract. 2024; 12: 111-117Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar regarding the effect of airway obstruction on fractional exhaled nitric oxide (Feno) values in asthma. We commend the authors for their rigorous methods to control for confounding factors that could affect the accuracy of Feno measurements in asthma diagnosis. This study offers valuable insights into the association between airway obstruction and Feno levels in patients with asthma, but a more thorough exploration of certain aspects could significantly augment the study's depth and applicability. First, an exclusive reliance on prebronchodilator FEV1 for the assessment of lung function serves as a limitation to achieving a comprehensive understanding of pulmonary mechanics. The inclusion of postbronchodilator lung function parameters, such as diffusing capacity (diffusing capacity of the lungs for carbon monoxide), lung volumes, and measurements of airway resistance, would afford a more holistic perspective.2Jarenback L. Eriksson G. Peterson S. Ankerst J. Bjermer L. Tufvesson E. Bronchodilator response of advanced lung function parameters depending on COPD severity.Int J Chron Obstruct Pulmon Dis. 2016; 11: 2939-2950Crossref PubMed Scopus (12) Google Scholar Furthermore, although commendable documentation of inhaled and systemic steroid doses is evident, the absence of comprehensive details regarding medication adherence,3Zabczyk C. Blakey J.D. The effect of connected "smart" inhalers on medication adherence.Front Med Technol. 2021; 3657321Crossref PubMed Scopus (10) Google Scholar inhaler technique, recent dose modifications,4Hale E.M. Greene G. Mulvey C. Mokoka M.C. van Boven J.F.M. Cushen B. et al.Use of digital measurement of medication adherence and lung function to guide the management of uncontrolled asthma (INCA Sun): a multicentre, single-blinded, randomised clinical trial.Lancet Respir Med. 2023; 11: 591-601Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar and tapering schedules detracts from the capacity for a nuanced interpretation of the observed correlations between medications and outcomes. Second, intermittently assessing blood eosinophils, with an average of 3 measurements throughout the study duration, limits our ability to comprehensively depict their trajectory and their correlation with Feno. Conducting more frequent blood eosinophil assessments at each Feno measurement time point would provide a finer-grained insight into the connection between this systemic inflammatory marker and the airway inflammatory marker Feno. Third, the proposed mathematical equation for adjusting Feno to accommodate variations in airway caliber is of interest. However, to ensure its widespread adoption in clinical practice, rigorous validation across diverse patient cohorts and health care settings becomes imperative.5Inaba Y. Chen J.A. Mehta N. Bergmann S.R. Impact of single or multicentre study design on the results of trials examining the efficacy of adjunctive devices to prevent distal embolisation during acute myocardial infarction.EuroIntervention. 2009; 5: 375-383Crossref PubMed Scopus (26) Google Scholar Further regression analyses must be conducted to affirm the precision and reliability of the correction factor. Considering these factors would not only enhance the present study but also make a substantial contribution to the progression of our comprehension regarding the intricate interplay between airway obstruction, various lung function metrics, and Feno within the scope of asthma. In conclusion, the study by Michils et al1Michils A. Akset M. Haccuria A. Perez-Bogerd S. Malinovschi A. Van Muylem A. The impact of airway obstruction on Feno values in asthma patients.J Allergy Clin Immunol Pract. 2024; 12: 111-117Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar is a major milestone toward incorporating Feno values in asthma. This study's integration of Feno measurements promises to revolutionize asthma management by enabling personalized treatment plans, facilitating early intervention, allowing for precise monitoring of treatment efficacy, reducing medication overuse, and enhancing cost-effectiveness in health care. Each of these aspects contributes to a more nuanced understanding of how to optimize care for patients with asthma, potentially reducing exacerbations and improving both outcomes and quality of life. Reply to "Enhancing asthma diagnosis and management through advanced Feno measurement techniques"The Journal of Allergy and Clinical Immunology: In PracticeVol. 12Issue 8