Abstract
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 language | English |
|---|---|
| Pages (from-to) | 331-341 |
| Number of pages | 11 |
| Journal | Chest |
| Volume | 155 |
| Issue number | 2 |
| Early online date | 22 Oct 2018 |
| DOIs | |
| Publication status | Published - Feb 2019 |
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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 journal › Article
}
TY - JOUR
T1 - Change in FEV1 and FeNO measurements as predictors of future asthma outcomes in children
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
PY - 2019/2
Y1 - 2019/2
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.
KW - asthma
KW - pediatrics
KW - nitric oxide
KW - spirometry
KW - monitoring
KW - child
UR - http://www.scopus.com/inward/record.url?scp=85060296365&partnerID=8YFLogxK
UR - http://www.mendeley.com/research/change-fev-1-feno-measurements-predictors-future-asthma-outcomes-children
U2 - 10.1016/j.chest.2018.10.009
DO - 10.1016/j.chest.2018.10.009
M3 - Article
VL - 155
SP - 331
EP - 341
JO - Chest
JF - Chest
SN - 0012-3692
IS - 2
ER -