International Journal of Multidisciplinary Health Sciences and Research

Category: Original Article,      DOI: Recived: 03/04/2023, Accepted: 22/06/2023, Published online: 29/06/2023

Evaluation of a Personalized Approach to Inhaled Corticosteroid Dosing in Asthma Based on Exhaled Nitric Oxide Levels: A Prospective Study

Sanjeev Kumar1*, Shikhar Agarwal2

Background: Asthma management traditionally follows standardized step-up/step-down approaches, but growing evidence suggests that personalized treatment strategies may improve outcomes. Fractional exhaled nitric oxide (FeNO) serves as a valuable biomarker of airway inflammation, potentially guiding individualized inhaled corticosteroid (ICS) dosing. The study aims to evaluate the efficacy of a FeNO-guided approach to ICS dose adjustment compared to standard guideline-based care in achieving optimal asthma control.

Methods: In this 12-month prospective, randomized controlled trial, 240 adults with persistent asthma were allocated to either FeNO-guided or guideline-based ICS dosing. The FeNO-guided group underwent monthly dose adjustments based on predetermined FeNO thresholds, while the control group followed standard clinical guidelines. Primary outcomes included time to first exacerbation and changes in Asthma Control Test (ACT) scores.

Results: FeNO-guided participants demonstrated significantly lower annual exacerbation rates (0.38 vs 0.52 events/patient-year, p<0.001) and higher mean improvement in ACT scores (3.2 vs 2.1 points, p=0.008). Overall ICS consumption was reduced by 27% in the FeNO-guided group without compromising control.

Conclusion: FeNO-guided ICS dosing represents an effective strategy for personalizing asthma management, resulting in improved clinical outcomes and optimized medication use. This approach warrants consideration for integration into routine clinical practice.