RT Journal Article
SR Electronic
T1 Does treatment guided by exhaled nitric oxide fraction improve outcomes in subgroups of children with asthma?
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1901879
DO 10.1183/13993003.01879-2019
VO 55
IS 5
A1 Shona S. Fielding
A1 Marielle Pijnenburg
A1 Johan de Jongste
A1 Katherine Pike
A1 Graham Roberts
A1 Helen Petsky
A1 Anne B. Chang
A1 Maria Fritsch
A1 Thomas Frischer
A1 Stanley J. Szefler
A1 Peter Gergen
A1 Francoise Vermeulen
A1 Robin Vael
A1 Steve S. Turner
YR 2020
UL http://erj.ersjournals.com/content/55/5/1901879.abstract
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