15-Year-Old Male With a History of Asthma and Allergies*

Role of FeNO

FeNO testing helped identify significant airway inflammation in this case.

FeNO testing also highlighted the possibility of nonadherence, providing the opportunity to reinforce the importance of the consistent and proper use of the inhaler.

Patient Background

• 15-year-old male with a history of asthma; peanut allergy; and mild, intermittent allergic rhinitis
• Patient admits <50% adherence to medication
• Previous allergy skin testing showed sensitivities to mold, as well as grass, weed, and tree pollens
• Medication refill history strongly suggestive of treatment nonadherence
• No asthma exacerbations since the last visit 6 months prior, and no recent increase in rhinitis
• Currently not on medication for rhinitis
• Asthma control test (ACT) score of 25, normal pulmonary function tests (PFTs), and presumed maintenance with beclomethasone

NIOX-Guided Assessment

Evaluation of fractional exhaled nitric oxide (FeNO) showed a value of 118 ppb.

Treatment

• Patient counseled on the importance of consistent adherence to inhaled controller medication to bring airway inflammation into the normal range
• Prescribed an inhaled steroid with a once-daily dosing regimen to encourage better adherence

Follow-Up

• 6-week follow-up visit revealed good asthma control (ACT = 24), exercise tolerance, and normal lung function, however, adherence with ICS inhaler is still only 50%
• Significant improvement in spirometry as indicated by changes in all parameters
• FeNO value was modestly reduced to 70 ppb
• Further follow-up was planned for 2 to 3 months to recheck FeNO, ICS use, and inhaler adherence