TY - JOUR
T1 - Does treatment guided by exhaled nitric oxide fraction improve outcomes in subgroups of children with asthma?
AU - Fielding, Shona S.
AU - Pijnenburg, Marielle
AU - de Jongste, Johan
AU - Pike, Katherine
AU - Roberts, Graham
AU - Petsky, Helen
AU - Chang, Anne B.
AU - Fritsch, Maria
AU - Frischer, Thomas
AU - Szefler, Stanley J.
AU - Gergen, Peter
AU - Vermeulen, Francoise
AU - Vael, Robin
AU - Turner, Steve S.
PY - 2020/5/1
Y1 - 2020/5/1
N2 - 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.
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.
UR - http://www.scopus.com/inward/record.url?scp=85085263847&partnerID=8YFLogxK
U2 - 10.1183/13993003.01879-2019
DO - 10.1183/13993003.01879-2019
M3 - Article
C2 - 32165403
AN - SCOPUS:85085263847
SN - 0903-1936
VL - 55
SP - 1
EP - 12
JO - The European respiratory journal
JF - The European respiratory journal
IS - 5
M1 - 1901879
ER -
