Change in FEV1 and FENO measurements as predictors of future asthma outcomes in children

Shona Fielding, Marielle Pijnenburg, Johan C. de Jongste, Katharine C. Pike, Graham Roberts, Helen Petsky, Anne B. Chang, Maria Fritsch, Thomas Frischer, Stanley Szefler, Peter Gergen, Francoise Vermeulen, Robin Vael, Steve Turner

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Repeated measurements of spirometry and fractional exhalednitric 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 randomized controlled trials in which Feno was used to guide asthma treatment; spirometric indices were also measured. Change in %FEV1 and %change in Feno between baseline and 3 months were related to having poor asthma control and to having an asthma exacerbation between 3 and 6 months after baseline.


Results: Data were available from 1,112 children (mean age, 12.6years; mean %FEV1, 94%). A 10% reduction in %FEV1 between baseline and 3 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) 6months after baseline. A 50% increase in Feno between baseline and 3 months was associated with 11% increase in odds for poor asthma control 6 months after baseline (95% CI, 0-16). Baseline Feno and %FEV1 were not related to asthma outcomes at 3 months.


Conclusions: Repeated measurements of %FEV1 that 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 because large changes were associated with small changes in outcome risk.

LanguageEnglish
Pages331-341
Number of pages11
JournalChest
Volume155
Issue number2
Early online date22 Oct 2018
DOIs
Publication statusPublished - 1 Feb 2019

Fingerprint

Asthma
Oxides
Spirometry
Meta-Analysis
Reference Values
Randomized Controlled Trials

Cite this

Fielding, S., Pijnenburg, M., de Jongste, J. C., Pike, K. C., Roberts, G., Petsky, H., ... Turner, S. (2019). Change in FEV1 and FENO measurements as predictors of future asthma outcomes in children. Chest, 155(2), 331-341. https://doi.org/10.1016/j.chest.2018.10.009
Fielding, Shona ; Pijnenburg, Marielle ; 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. / Change in FEV1 and FENO measurements as predictors of future asthma outcomes in children. In: Chest. 2019 ; Vol. 155, No. 2. pp. 331-341.
@article{9c4c013e494b4f14aa108b0fa44b31f5,
title = "Change in FEV1 and FENO measurements as predictors of future asthma outcomes in children",
abstract = "Background: Repeated measurements of spirometry and fractional exhalednitric 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 randomized controlled trials in which Feno was used to guide asthma treatment; spirometric indices were also measured. Change in {\%}FEV1 and {\%}change in Feno between baseline and 3 months were related to having poor asthma control and to having an asthma exacerbation between 3 and 6 months after baseline.Results: Data were available from 1,112 children (mean age, 12.6years; mean {\%}FEV1, 94{\%}). A 10{\%} reduction in {\%}FEV1 between baseline and 3 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) 6months after baseline. A 50{\%} increase in Feno between baseline and 3 months was associated with 11{\%} increase in odds for poor asthma control 6 months after baseline (95{\%} CI, 0-16). Baseline Feno and {\%}FEV1 were not related to asthma outcomes at 3 months.Conclusions: Repeated measurements of {\%}FEV1 that 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 because large changes were associated with small changes in outcome risk.",
keywords = "asthma, child, monitoring, nitric oxide, spirometry",
author = "Shona Fielding and Marielle Pijnenburg and {de Jongste}, {Johan C.} and Pike, {Katharine C.} and Graham Roberts and Helen Petsky and Chang, {Anne B.} and Maria Fritsch and Thomas Frischer and Stanley Szefler and Peter Gergen and Francoise Vermeulen and Robin Vael and Steve Turner",
year = "2019",
month = "2",
day = "1",
doi = "10.1016/j.chest.2018.10.009",
language = "English",
volume = "155",
pages = "331--341",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "2",

}

Fielding, S, Pijnenburg, M, de Jongste, JC, Pike, KC, Roberts, G, Petsky, H, Chang, AB, Fritsch, M, Frischer, T, Szefler, S, Gergen, P, Vermeulen, F, Vael, R & Turner, S 2019, 'Change in FEV1 and FENO measurements as predictors of future asthma outcomes in children', Chest, vol. 155, no. 2, pp. 331-341. https://doi.org/10.1016/j.chest.2018.10.009

Change in FEV1 and FENO measurements as predictors of future asthma outcomes in children. / Fielding, Shona; Pijnenburg, Marielle; 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.

In: Chest, Vol. 155, No. 2, 01.02.2019, p. 331-341.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Change in FEV1 and FENO measurements as predictors of future asthma outcomes in children

AU - Fielding, Shona

AU - Pijnenburg, Marielle

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 - 2019/2/1

Y1 - 2019/2/1

N2 - Background: Repeated measurements of spirometry and fractional exhalednitric 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 randomized controlled trials in which Feno was used to guide asthma treatment; spirometric indices were also measured. Change in %FEV1 and %change in Feno between baseline and 3 months were related to having poor asthma control and to having an asthma exacerbation between 3 and 6 months after baseline.Results: Data were available from 1,112 children (mean age, 12.6years; mean %FEV1, 94%). A 10% reduction in %FEV1 between baseline and 3 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) 6months after baseline. A 50% increase in Feno between baseline and 3 months was associated with 11% increase in odds for poor asthma control 6 months after baseline (95% CI, 0-16). Baseline Feno and %FEV1 were not related to asthma outcomes at 3 months.Conclusions: Repeated measurements of %FEV1 that 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 because large changes were associated with small changes in outcome risk.

AB - Background: Repeated measurements of spirometry and fractional exhalednitric 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 randomized controlled trials in which Feno was used to guide asthma treatment; spirometric indices were also measured. Change in %FEV1 and %change in Feno between baseline and 3 months were related to having poor asthma control and to having an asthma exacerbation between 3 and 6 months after baseline.Results: Data were available from 1,112 children (mean age, 12.6years; mean %FEV1, 94%). A 10% reduction in %FEV1 between baseline and 3 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) 6months after baseline. A 50% increase in Feno between baseline and 3 months was associated with 11% increase in odds for poor asthma control 6 months after baseline (95% CI, 0-16). Baseline Feno and %FEV1 were not related to asthma outcomes at 3 months.Conclusions: Repeated measurements of %FEV1 that 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 because large changes were associated with small changes in outcome risk.

KW - asthma

KW - child

KW - monitoring

KW - nitric oxide

KW - spirometry

UR - http://www.scopus.com/inward/record.url?scp=85060296365&partnerID=8YFLogxK

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

T2 - Chest

JF - Chest

SN - 0012-3692

IS - 2

ER -

Fielding S, Pijnenburg M, de Jongste JC, Pike KC, Roberts G, Petsky H et al. Change in FEV1 and FENO measurements as predictors of future asthma outcomes in children. Chest. 2019 Feb 1;155(2):331-341. https://doi.org/10.1016/j.chest.2018.10.009