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Fractional exhaled nitric oxide (FeNO) is a surrogate marker of eosinophilic airway inflammation in asthma. The randomized controlled parallel study published by Peirsman et al combined GINA guidelines and FeNO level in guiding drug treatment in children with mild to severe asthma.

Their target was to control the FeNO level below 20 ppb. The FeNO group resulted in increasing the dosage of inhaled corticosteroid and the usage of leukotriene receptor antagonist. However, the study was not truly randomized and drug adherence was not reported. The FeNO-guided algorithm failed to improve the primary outcome, the symptom-free days, but did result in decreasing the number of acute exacerbations and unscheduled contacts.

Unfortunately the authors did not demonstrate a persistent and significant difference in FeNO levels between both groups. As the final FeNO levels were not reported, it remains unclear whether their target was met. Pediatr Pulmonol. © 2014 Wiley Periodicals, Inc.