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Exhaled nitric oxide monitoring does not reduce exacerbation frequency or inhaled corticosteroid dose in paediatric asthma: a randomised controlled trial

Exhaled nitric oxide monitoring does not reduce exacerbation frequency or inhaled corticosteroid dose in paediatric asthma: a randomised controlled trial
Exhaled nitric oxide monitoring does not reduce exacerbation frequency or inhaled corticosteroid dose in paediatric asthma: a randomised controlled trial
INTRODUCTION: Inhaled corticosteroid therapy (ICS) for asthma is currently modified according to symptoms and lung function. Fractional exhaled nitric oxide (FENO) has been demonstrated to be a non-invasive marker of eosinophilic inflammation. Studies of FENO-driven asthma management show variable success. OBJECTIVES: This study aimed to evaluate whether monitoring FENO can improve outpatient management of children with moderate to severe asthma using a pragmatic design. METHODS: Children aged 6-17 years with moderate to severe asthma were recruited. Their asthma was stabilised before randomisation to FENO-driven therapy or to a standard management group where therapy was driven by conventional markers of asthma control. ICS or long-acting bronchodilator therapies were altered according to FENO levels in combination with reported symptoms in the FENO group. Participants were assessed 2 monthly for 12 months. ICS dose and exacerbation frequency change were compared between groups in an intention to treat analysis. RESULTS: Ninety children were randomised. No difference was found between the two groups in either change in corticosteroid dose or exacerbation frequency. Results were similar in a planned secondary analysis of atopic asthmatics. CONCLUSION: FENO-guided ICS titration does not appear to reduce corticosteroid usage or exacerbation frequency in paediatric outpatients with moderate to severe asthma. This may reflect limitations in FENO-driven management algorithms, as there are now concerns that FENO levels relate to atopy as much as they relate to asthma control.
asthma, exhaled airway markers, paediatric, therapy
1752-6981
Pike, Katharine
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Selby, Anna
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Price, Sophie
cd857310-5efd-4b49-83c1-9bba4cc01011
Warner, John
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Connett, Gary
55d5676c-90d8-46bf-a508-62eded276516
Legg, Julian
d794b6a3-768c-4986-b67f-bf9a30fe228e
Lucas, Jane Sa
5cb3546c-87b2-4e59-af48-402076e25313
Peters, Sheila
121f9ce8-fd95-44f5-9a90-487a1e8e20d4
Buckley, Hannah
96804233-8edb-4296-92cc-868bf0622c61
Magier, Krzysztof
5f8e90c7-9555-44f2-9cb7-31b6d1644d1f
Foote, Keith
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Drew, Kirsty
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Morris, Ruth
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Lancaster, Nikki
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Roberts, Graham
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Pike, Katharine
10be90c8-73de-416e-a2d0-0bb7e7276bd3
Selby, Anna
69fd5ea1-f24a-4a04-ad88-3c0fb947aa88
Price, Sophie
cd857310-5efd-4b49-83c1-9bba4cc01011
Warner, John
2b6d2cd7-30ea-4f2e-ae23-d296703a3f5f
Connett, Gary
55d5676c-90d8-46bf-a508-62eded276516
Legg, Julian
d794b6a3-768c-4986-b67f-bf9a30fe228e
Lucas, Jane Sa
5cb3546c-87b2-4e59-af48-402076e25313
Peters, Sheila
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Buckley, Hannah
96804233-8edb-4296-92cc-868bf0622c61
Magier, Krzysztof
5f8e90c7-9555-44f2-9cb7-31b6d1644d1f
Foote, Keith
7065075e-3ae8-440d-ad60-cbf993f548b9
Drew, Kirsty
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Morris, Ruth
b7cbbd1c-ba42-4140-aa43-140fc0f1d162
Lancaster, Nikki
50ca77ed-f219-44f0-b7ef-9a3e3d68b5ce
Roberts, Graham
ea00db4e-84e7-4b39-8273-9b71dbd7e2f3

Pike, Katharine, Selby, Anna, Price, Sophie, Warner, John, Connett, Gary, Legg, Julian, Lucas, Jane Sa, Peters, Sheila, Buckley, Hannah, Magier, Krzysztof, Foote, Keith, Drew, Kirsty, Morris, Ruth, Lancaster, Nikki and Roberts, Graham (2012) Exhaled nitric oxide monitoring does not reduce exacerbation frequency or inhaled corticosteroid dose in paediatric asthma: a randomised controlled trial. Clinical Respiratory Journal. (doi:10.1111/j.1752-699X.2012.00306.x). (PMID:22747899)

Record type: Article

Abstract

INTRODUCTION: Inhaled corticosteroid therapy (ICS) for asthma is currently modified according to symptoms and lung function. Fractional exhaled nitric oxide (FENO) has been demonstrated to be a non-invasive marker of eosinophilic inflammation. Studies of FENO-driven asthma management show variable success. OBJECTIVES: This study aimed to evaluate whether monitoring FENO can improve outpatient management of children with moderate to severe asthma using a pragmatic design. METHODS: Children aged 6-17 years with moderate to severe asthma were recruited. Their asthma was stabilised before randomisation to FENO-driven therapy or to a standard management group where therapy was driven by conventional markers of asthma control. ICS or long-acting bronchodilator therapies were altered according to FENO levels in combination with reported symptoms in the FENO group. Participants were assessed 2 monthly for 12 months. ICS dose and exacerbation frequency change were compared between groups in an intention to treat analysis. RESULTS: Ninety children were randomised. No difference was found between the two groups in either change in corticosteroid dose or exacerbation frequency. Results were similar in a planned secondary analysis of atopic asthmatics. CONCLUSION: FENO-guided ICS titration does not appear to reduce corticosteroid usage or exacerbation frequency in paediatric outpatients with moderate to severe asthma. This may reflect limitations in FENO-driven management algorithms, as there are now concerns that FENO levels relate to atopy as much as they relate to asthma control.

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e-pub ahead of print date: 2 July 2012
Keywords: asthma, exhaled airway markers, paediatric, therapy
Organisations: Clinical & Experimental Sciences

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Local EPrints ID: 344356
URI: http://eprints.soton.ac.uk/id/eprint/344356
ISSN: 1752-6981
PURE UUID: a453750d-94ff-44fe-a64e-2dc2724b2bc9
ORCID for Gary Connett: ORCID iD orcid.org/0000-0003-1310-3239
ORCID for Graham Roberts: ORCID iD orcid.org/0000-0003-2252-1248

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Date deposited: 19 Oct 2012 16:10
Last modified: 18 Feb 2021 17:04

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Contributors

Author: Katharine Pike
Author: Anna Selby
Author: Sophie Price
Author: John Warner
Author: Gary Connett ORCID iD
Author: Julian Legg
Author: Jane Sa Lucas
Author: Sheila Peters
Author: Hannah Buckley
Author: Krzysztof Magier
Author: Keith Foote
Author: Kirsty Drew
Author: Ruth Morris
Author: Nikki Lancaster
Author: Graham Roberts ORCID iD

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