Abstract
Introduction Fractional exhaled nitric oxide (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 (RCT) 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 Antagonist (LTRA), but not among those who were treated with LTRA, FENO guided treatment was associated with reduced exacerbation risk (odds ratio (OR) 0.68 [95% CI 0.49, 0.94]), longer time to first exacerbation (hazard ratio (HR) 0.76 [0.57, 0.99]) and borderline reduced risk for loss of control (OR 0.70 [0.49, 1.00]). Non-obese children, compared to obese children, were less likely to lose asthma control when treatment was guided by FENO (OR 0.69 [0.48, 0.99]) and time to loss of control was longer (HR 0.77 [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.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Fielding has nothing to disclose.
Conflict of interest: Dr. Pijnenburg has nothing to disclose.
Conflict of interest: Dr. de Jongste has nothing to disclose.
Conflict of interest: Dr. Pike has nothing to disclose.
Conflict of interest: Dr. Roberts has nothing to disclose.
Conflict of interest: Dr. Petsky has nothing to disclose.
Conflict of interest: Dr. 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.
Conflict of interest: Dr. Fritsch has nothing to disclose.
Conflict of interest: Dr. Fritscher has nothing to disclose.
Conflict of interest: Dr. Szefler has nothing to disclose.
Conflict of interest: Dr. Gergen has nothing to disclose.
Conflict of interest: Dr. Vermeulen has nothing to disclose.
Conflict of interest: Dr. Vael has nothing to disclose.
Conflict of interest: Dr. Turner has nothing to disclose.
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- Received September 22, 2019.
- Accepted February 17, 2020.
- Copyright ©ERS 2020
