Change in FEV1 and FeNO measurements as predictors of future asthma outcomes in children

Shona Fielding, Mariëlle Pijnenburg, Johan C. de Jongste, Katharine C Pike, Graham Roberts, Helen Petsky, Anne B Chang, Maria Fritsch, Thomas Frischer, Stanley Szefler, Peter Gergen, Francoise Vermeulen, Robin Vael, Steve Turner (Corresponding Author)

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background
Repeated measurements of spirometry and fractional exhaled nitric oxide (FeNO) are recommended as part of the management of childhood asthma, but the evidence base for such recommendations is small. We tested the hypothesis that reducing spirometric indices or increasing FeNO will predict poor future asthma outcomes.

Methods
A one-stage individual patient data meta-analysis used data from seven randomised controlled trials where FeNO was used to guide asthma treatment, and where spirometric indices were also measured. Change in %FEV1 and % change in FeNO between baseline and three months were related to having poor asthma control and to having an asthma exacerbation between three and six months after baseline.

Results
Data were available from 1112 children (mean age 12.6 years, mean %FEV1 94%). A 10% reduction in %FEV1 between baseline and three months was associated with 28% increased odds for asthma exacerbation [95% CI 3, 58] and with 21% increased odds for having poor asthma control [95% CI 1, 45] six months after baseline. A 50% increase in FeNO between baseline and three months was associated with 11% increase in odds for poor asthma control six months after baseline [95% CI 0, 16]. Baseline FeNO and %FEV1 were not related to asthma outcomes at three months.

Conclusions
Repeated measurements of %FEV1 which are typically within the “normal” range add to clinical risk assessment of future asthma outcomes in children. The role of repeated FeNO measurements is less certain since large changes were associated with small changes in outcome risk.
Original languageEnglish
Pages (from-to)331-341
Number of pages11
JournalChest
Volume155
Issue number2
Early online date22 Oct 2018
DOIs
Publication statusPublished - Feb 2019

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Nitric Oxide
Asthma
Spirometry
Meta-Analysis
Reference Values
Randomized Controlled Trials

Keywords

  • asthma
  • pediatrics
  • nitric oxide
  • spirometry
  • monitoring
  • child

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine

Cite this

Change in FEV1 and FeNO measurements as predictors of future asthma outcomes in children. / Fielding, Shona; Pijnenburg, Mariëlle; de Jongste, Johan C. ; Pike, Katharine C; Roberts, Graham; Petsky, Helen ; Chang, Anne B ; Fritsch, Maria ; Frischer, Thomas; Szefler, Stanley; Gergen, Peter ; Vermeulen, Francoise ; Vael, Robin ; Turner, Steve (Corresponding Author).

In: Chest, Vol. 155, No. 2, 02.2019, p. 331-341.

Research output: Contribution to journalArticle

Fielding, S, Pijnenburg, M, de Jongste, JC, Pike, KC, Roberts, G, Petsky, H, Chang, AB, Fritsch, M, Frischer, T, Szefler, S, Gergen, P, Vermeulen, F, Vael, R & Turner, S 2019, 'Change in FEV1 and FeNO measurements as predictors of future asthma outcomes in children' Chest, vol. 155, no. 2, pp. 331-341. https://doi.org/10.1016/j.chest.2018.10.009
Fielding, Shona ; Pijnenburg, Mariëlle ; de Jongste, Johan C. ; Pike, Katharine C ; Roberts, Graham ; Petsky, Helen ; Chang, Anne B ; Fritsch, Maria ; Frischer, Thomas ; Szefler, Stanley ; Gergen, Peter ; Vermeulen, Francoise ; Vael, Robin ; Turner, Steve. / Change in FEV1 and FeNO measurements as predictors of future asthma outcomes in children. In: Chest. 2019 ; Vol. 155, No. 2. pp. 331-341.
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abstract = "BackgroundRepeated measurements of spirometry and fractional exhaled nitric oxide (FeNO) are recommended as part of the management of childhood asthma, but the evidence base for such recommendations is small. We tested the hypothesis that reducing spirometric indices or increasing FeNO will predict poor future asthma outcomes.MethodsA one-stage individual patient data meta-analysis used data from seven randomised controlled trials where FeNO was used to guide asthma treatment, and where spirometric indices were also measured. Change in {\%}FEV1 and {\%} change in FeNO between baseline and three months were related to having poor asthma control and to having an asthma exacerbation between three and six months after baseline.ResultsData were available from 1112 children (mean age 12.6 years, mean {\%}FEV1 94{\%}). A 10{\%} reduction in {\%}FEV1 between baseline and three months was associated with 28{\%} increased odds for asthma exacerbation [95{\%} CI 3, 58] and with 21{\%} increased odds for having poor asthma control [95{\%} CI 1, 45] six months after baseline. A 50{\%} increase in FeNO between baseline and three months was associated with 11{\%} increase in odds for poor asthma control six months after baseline [95{\%} CI 0, 16]. Baseline FeNO and {\%}FEV1 were not related to asthma outcomes at three months.ConclusionsRepeated measurements of {\%}FEV1 which are typically within the “normal” range add to clinical risk assessment of future asthma outcomes in children. The role of repeated FeNO measurements is less certain since large changes were associated with small changes in outcome risk.",
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AU - Fielding, Shona

AU - Pijnenburg, Mariëlle

AU - de Jongste, Johan C.

AU - Pike, Katharine C

AU - Roberts, Graham

AU - Petsky, Helen

AU - Chang, Anne B

AU - Fritsch, Maria

AU - Frischer, Thomas

AU - Szefler, Stanley

AU - Gergen, Peter

AU - Vermeulen, Francoise

AU - Vael, Robin

AU - Turner, Steve

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N2 - BackgroundRepeated measurements of spirometry and fractional exhaled nitric oxide (FeNO) are recommended as part of the management of childhood asthma, but the evidence base for such recommendations is small. We tested the hypothesis that reducing spirometric indices or increasing FeNO will predict poor future asthma outcomes.MethodsA one-stage individual patient data meta-analysis used data from seven randomised controlled trials where FeNO was used to guide asthma treatment, and where spirometric indices were also measured. Change in %FEV1 and % change in FeNO between baseline and three months were related to having poor asthma control and to having an asthma exacerbation between three and six months after baseline.ResultsData were available from 1112 children (mean age 12.6 years, mean %FEV1 94%). A 10% reduction in %FEV1 between baseline and three months was associated with 28% increased odds for asthma exacerbation [95% CI 3, 58] and with 21% increased odds for having poor asthma control [95% CI 1, 45] six months after baseline. A 50% increase in FeNO between baseline and three months was associated with 11% increase in odds for poor asthma control six months after baseline [95% CI 0, 16]. Baseline FeNO and %FEV1 were not related to asthma outcomes at three months.ConclusionsRepeated measurements of %FEV1 which are typically within the “normal” range add to clinical risk assessment of future asthma outcomes in children. The role of repeated FeNO measurements is less certain since large changes were associated with small changes in outcome risk.

AB - BackgroundRepeated measurements of spirometry and fractional exhaled nitric oxide (FeNO) are recommended as part of the management of childhood asthma, but the evidence base for such recommendations is small. We tested the hypothesis that reducing spirometric indices or increasing FeNO will predict poor future asthma outcomes.MethodsA one-stage individual patient data meta-analysis used data from seven randomised controlled trials where FeNO was used to guide asthma treatment, and where spirometric indices were also measured. Change in %FEV1 and % change in FeNO between baseline and three months were related to having poor asthma control and to having an asthma exacerbation between three and six months after baseline.ResultsData were available from 1112 children (mean age 12.6 years, mean %FEV1 94%). A 10% reduction in %FEV1 between baseline and three months was associated with 28% increased odds for asthma exacerbation [95% CI 3, 58] and with 21% increased odds for having poor asthma control [95% CI 1, 45] six months after baseline. A 50% increase in FeNO between baseline and three months was associated with 11% increase in odds for poor asthma control six months after baseline [95% CI 0, 16]. Baseline FeNO and %FEV1 were not related to asthma outcomes at three months.ConclusionsRepeated measurements of %FEV1 which are typically within the “normal” range add to clinical risk assessment of future asthma outcomes in children. The role of repeated FeNO measurements is less certain since large changes were associated with small changes in outcome risk.

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KW - nitric oxide

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KW - monitoring

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