TY - JOUR T1 - Utility of fractional exhaled nitric oxide suppression as a prediction tool for progression to biologic therapy JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00273-2021 SP - 00273-2021 AU - C. A. Butler AU - A. J. McMichael AU - K. Honeyford AU - L. Wright AU - J. Logan AU - J. Holmes AU - J. Busby AU - C. E. Hanratty AU - F. Yang AU - S. J. Smith AU - K. Murray AU - R. Chaudhuri AU - L. G. Heaney A2 - , Y1 - 2021/01/01 UR - http://openres.ersjournals.com/content/early/2021/06/17/23120541.00273-2021.abstract N2 - Rationale The utility of fractional exhaled nitric oxide (FeNO) suppression (FeNOSuppT) to identify non-adherence with inhaled corticosteroid (ICS) treatment has previously been reported, but whether it can predict clinical outcome remains unclear.Objectives We examined the utility of FeNOSuppT in prediction of progression to biologic agents or discharge from specialist care.Methods FeNOSuppT was measured at home using remote monitoring technology of inhaler use alongside daily FeNO measurement over 7 days. Long-term clinical outcome in terms of progression to biologic agent or discharge from specialist care were compared for non-suppressors and suppressors.Measurements and Main Results Of the 162 subjects, 135 successfully completed the test with 81 (60%) positive FeNO suppression tests. Subjects with a negative FeNOSuppT were more likely to proceed to biologic therapy (39 of 54 patients, 72%) compared to those with a positive FeNOSuppT (35 of 81 patients, 43%, p=0.001). In subjects with a positive FeNOSuppT, predictors of progression to biologic included higher dose of maintenance steroid at initial assessment and prior intensive care unit admission. These subjects had a significant rise in FeNO between post suppression test and follow-up (median, 33 [IQR, 25–55] versus 71 [IQR, 24–114]; p=0.009) which was not explained by altered corticosteroid dose.Conclusions A negative FeNOSuppT correlates with progression to biologic therapy. A positive FeNOSuppT, with subsequent maintenance of “optimised” FeNO, predicts a sub-group of patients in whom asthma control is preserved with adherence to high dose ICS/LABA and can be discharged from specialist care.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: C.A. Butler reports Vitalograph provided support for the INCA device used to assess adherence during the conduct of the study; and fees for lectures from AstraZeneca and GlaxoSmithKline, and conference support from NAPP and Chiesi, outside the submitted work.Conflict of interest: Dr. McMichael has nothing to disclose.Conflict of interest: Dr. Honeyford has nothing to disclose.Conflict of interest: Dr. Wright has nothing to disclose.Conflict of interest: Dr. Logan has nothing to disclose.Conflict of interest: Mr. Holmes has nothing to disclose.Conflict of interest: Dr. Busby has nothing to disclose.Conflict of interest: Dr. Hanratty has nothing to disclose.Conflict of interest: Dr. Yang has nothing to disclose.Conflict of interest: Dr. Smith has nothing to disclose.Conflict of interest: Dr. murray has nothing to disclose.Conflict of interest: R. Chaudhuri reports advisory board meeting fees, a research grant, speaker fees and conference travel support from AstraZeneca; advisory board meeting and speaker fees from GSK, Teva, Novartis and Chiesi; and conference travel support from Napp Pharmaceuticals, all outside the submitted work.Conflict of interest: L.G. Heaney reports sponsorship for attending international scientific meetings from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK and Napp Pharmaceuticals; personal fees for lectures and advisory boards from Novartis, Hoffman la Roche/Genentech Inc., Sanofi, Evelo Biosciences, Glaxo Smith Kline, AstraZeneca, Teva, Theravance and Circassia; and institutional grant funding from Medimmune, Novartis UK, Roche/Genentech Inc. and GlaxoSmithKline; and is Academic Lead for the Medical Research Council Stratified Medicine UK Consortium in Severe Asthma, which involves Industrial Partnerships with Amgen, Genentech/Hoffman la Roche, AstraZeneca, Medimmune, GlaxoSmithKline, Aerocrine and Vitalograph, all outside the submitted work. ER -