Abstract
Introduction Exhaled nitric oxide fraction (FENO), a biomarker of eosinophilic airway inflammation, may be useful to guide asthma treatment. FENO-guided treatment may be more effective in certain subgroups for improving asthma outcomes compared to standard treatment.
Methods An individual patient data analysis was performed using data from seven randomised clinical trials (RCTs) which used FENO to guide asthma treatment. The incidence of an asthma exacerbation and loss of control, and the time to first exacerbation and loss of control were described between five subgroups of RCT participants.
Results Data were available in 1112 RCT participants. Among those not treated with leukotriene receptor antagonists (LTRA), but not among those who were treated with LTRA, FENO-guided treatment was associated with reduced exacerbation risk (OR 0.68, 95% CI 0.49–0.94), longer time to first exacerbation (hazard ratio (HR) 0.76, 95% CI 0.57–0.99) and borderline reduced risk for loss of control (OR 0.70, 95% CI 0.49–1.00). Nonobese children, compared to obese children, were less likely to lose asthma control when treatment was guided by FENO (OR 0.69, 95% CI 0.48–0.99) and time to loss of control was longer (HR 0.77, 95% CI 0.61–0.99).
Conclusions Asthma treatment guided by FENO may be more effective in achieving better asthma outcomes for patients who are not treated with LTRA and who are not obese, compared to standard practice.
Methods An individual patient data analysis was performed using data from seven randomised clinical trials (RCTs) which used FENO to guide asthma treatment. The incidence of an asthma exacerbation and loss of control, and the time to first exacerbation and loss of control were described between five subgroups of RCT participants.
Results Data were available in 1112 RCT participants. Among those not treated with leukotriene receptor antagonists (LTRA), but not among those who were treated with LTRA, FENO-guided treatment was associated with reduced exacerbation risk (OR 0.68, 95% CI 0.49–0.94), longer time to first exacerbation (hazard ratio (HR) 0.76, 95% CI 0.57–0.99) and borderline reduced risk for loss of control (OR 0.70, 95% CI 0.49–1.00). Nonobese children, compared to obese children, were less likely to lose asthma control when treatment was guided by FENO (OR 0.69, 95% CI 0.48–0.99) and time to loss of control was longer (HR 0.77, 95% CI 0.61–0.99).
Conclusions Asthma treatment guided by FENO may be more effective in achieving better asthma outcomes for patients who are not treated with LTRA and who are not obese, compared to standard practice.
| Original language | English |
|---|---|
| Article number | 1901879 |
| Number of pages | 12 |
| Journal | European Respiratory Journal |
| Volume | 55 |
| Issue number | 5 |
| Early online date | 21 May 2020 |
| DOIs | |
| Publication status | Published - May 2020 |
Bibliographical note
Funding Information:Conflict of interest: S. Fielding has nothing to disclose. M. Pijnenburg has nothing to disclose. J. de Jongste has nothing to disclose. K. Pike has nothing to disclose. G. Roberts has nothing to disclose. H. Petsky has nothing to disclose. A.B. Chang reports grants (project, Centre for Research Excellence and practitioner fellowship) from the National Health and Medical Research Council, Australia during the conduct of the study; and other potential conflict from being an author in UpToDate and USA Chest Chronic Cough Guidelines outside the submitted work. M. Fritsch has nothing to disclose. T. Frischer has nothing to disclose. S.J. Szefler has nothing to disclose. P. Gergen has nothing to disclose. F. Vermeulen has nothing to disclose. R. Vael has nothing to disclose. S.S. Turner has nothing to disclose.
Keywords
- asthma
- child
- monitoring
- nitrous oxide
- OBESITY
- MANAGEMENT
- THERAPY
- AIRWAY
- STEROIDS
- INFLAMMATION
- EXACERBATION
- CHILDHOOD ASTHMA
Access to Document
- Fielding_etal_ERJ_AAM
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