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Using fractional exhaled nitric oxide to guide step-down treatment decisions in asthma: practical considerations

We thank L. Pérez de Llano and colleagues for their comments on our study [1] and for comparing our findings with those of their prospective multicentre study describing a simple score for predicting step-down failure in adults with well-controlled asthma [2]. However, we would like to clarify that recent systematic review findings conclude that there is insufficient evidence, rather than evidence against, the ability of low fractional exhaled nitric oxide (FENO) to identify individuals in whom treatment can be safely stepped down [3]. Using FENO to guide safe step-down treatment decisions in patients with well-controlled asthma should involve gradual, carefully monitored reductions and consider other potential risk factors for acute exacerbations https://bit.ly/2E2W679