PT  - JOURNAL ARTICLE
AU  - Shona S. Fielding
AU  - Marielle Pijnenburg
AU  - Johan de Jongste
AU  - Katherine Pike
AU  - Graham Roberts
AU  - Helen Petsky
AU  - Anne B. Chang
AU  - Maria Fritsch
AU  - Thomas Frischer
AU  - Stanley J. Szefler
AU  - Peter Gergen
AU  - Francoise Vermeulen
AU  - Robin Vael
AU  - Steve S. Turner
TI  - Does treatment guided by exhaled nitric oxide fraction improve outcomes in subgroups of children with asthma?
AID  - 10.1183/13993003.01879-2019
DP  - 2020 May 01
TA  - European Respiratory Journal
PG  - 1901879
VI  - 55
IP  - 5
4099  - http://erj.ersjournals.com/content/55/5/1901879.short
4100  - http://erj.ersjournals.com/content/55/5/1901879.full
SO  - Eur Respir J2020 May 01; 55
AB  - 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.Some children with asthma may have better outcomes than others if their treatment is guided by exhaled nitric oxide http://bit.ly/2VahxJV