{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T01:32:52Z","timestamp":1776735172406,"version":"3.51.2"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T00:00:00Z","timestamp":1754352000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001505","name":"Health Research Council of New Zealand","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001505","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Experimental Allergy"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The minimal clinically important difference (MCID) for fractional exhaled nitric oxide (FeNO) in asthma is uncertain. The American Thoracic Society (ATS) suggests this may be a relative change \u2265\u200920%; however, this recommendation is not validated against a clinical outcome measure. A secondary analysis of two randomised controlled trials (RCTs) examining associations between changes in FeNO and the Asthma Control Questionnaire\u20105 (ACQ\u20105) may help estimate the MCID.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The PRACTICAL and Novel START were 52\u2010week RCTs that compared as\u2010required short\u2010acting beta\u2010agonists with or without maintenance inhaled corticosteroids (ICS) versus as\u2010required ICS\u2010formoterol in mild\u2013moderate asthma. In this secondary analysis, participants with measurements of FeNO and ACQ\u20105 were included. FeNO was analysed on the logarithm transformed scale. Logistic regression assessed associations between FeNO and ACQ\u20105 changes from baseline to end of study, relative to the ACQ\u20105 MCID (0.5 points). A t\u2010test was used to compare the difference in log FeNO for those whose ACQ\u20105 fell by the MCID for an improvement in ACQ.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Data from 1553 participants were included. There was a weak association between the change in FeNO and change in ACQ\u20105; correlation coefficient was 0.08 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). The mean (SD) change in log FeNO for those with a clinically important improvement in ACQ\u20105 was \u22120.25 (0.64),\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009530; geometric mean ratio was 0.78, representing a 22% change in the geometric mean of FeNO. The change in log FeNO was \u22120.14 (0.60) for those without an improvement in ACQ\u20105,\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u2009852; geometric mean ratio was 0.87. The sensitivity and specificity for a 20% change in geometric mean FeNO were 47% and 57%, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Changes in FeNO are a poor surrogate for changes in ACQ\u20105. The magnitude of FeNO changes in participants with an MCID improvement in ACQ\u20105 provides weak support for the ATS recommendation that the MCID for FeNO may be about a 20% relative change.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cea.70131","type":"journal-article","created":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T03:04:13Z","timestamp":1754449453000},"page":"53-60","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["External Validation of the Minimal Clinically Important Difference of FeNO Using the Asthma Control Questionnaire"],"prefix":"10.1111","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7620-3125","authenticated-orcid":false,"given":"Jonathan","family":"Noble","sequence":"first","affiliation":[{"name":"Medical Research Institute of New Zealand  Wellington New Zealand"},{"name":"Victoria University of Wellington  Wellington New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Orlagh","family":"Bean","sequence":"additional","affiliation":[{"name":"Medical Research Institute of New Zealand  Wellington New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ross","family":"Sayers","sequence":"additional","affiliation":[{"name":"Medical Research Institute of New Zealand  Wellington New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan","family":"Cullen","sequence":"additional","affiliation":[{"name":"Medical Research Institute of New Zealand  Wellington New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Beasley","sequence":"additional","affiliation":[{"name":"Medical Research Institute of New Zealand  Wellington New Zealand"},{"name":"Victoria University of Wellington  Wellington New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Weatherall","sequence":"additional","affiliation":[{"name":"University of Otago Wellington  Wellington New Zealand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,5]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Global Initiative for Asthma \u201cGlobal Strategy for Asthma Management and Prevention: GINA \u201d(2024) 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Initiative for Asthma \u201cGlobal Stragey for Asthma Management and Prevention: GINA \u201d2014 Revision accessed September 03 2024 https:\/\/ginasthma.org\/archived\u2010reports\/."},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200711-1754OC"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2018-211540"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00020407"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.57.10.889"},{"key":"e_1_2_9_20_1","doi-asserted-by":"crossref","unstructured":"Z.Wang P.Pianosi andK.Keogh \u201cThe Clinical Utility of Fractional Exhaled Nitric Oxide (FeNO) in Asthma Management \u201d(2017) The Clinical Utility of Fractional Exhaled Nitric Oxide (FeNO) in Asthma Management AHRQ Comparative Effectiveness Reviews: Rockville 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