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

Change in FEV1 and FeNO measurements as predictors of future asthma outcomes in children
Change in FEV1 and FeNO measurements as predictors of future asthma outcomes in children
Background: repeated measurements of spirometry and fractional exhaled nitric 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 randomised controlled trials where FeNO was used to guide asthma treatment, and where spirometric indices were also measured. Change in %FEV1 and % change in FeNO between baseline and three months were related to having poor asthma control and to having an asthma exacerbation between three and six months after baseline.

Results: data were available from 1112 children (mean age 12.6 years, mean %FEV1 94%). A 10% reduction in %FEV1 between baseline and three 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] six months after baseline. A 50% increase in FeNO between baseline and three months was associated with 11% increase in odds for poor asthma control six months after baseline [95% CI 0, 16]. Baseline FeNO and %FEV1 were not related to asthma outcomes at three months.

Conclusions: repeated measurements of %FEV1 which 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 since large changes were associated with small changes in outcome risk.
asthma, child, monitoring, nitric oxide, spirometry
0012-3692
331-341
Fielding, Shona
f1c3725b-26a5-48fd-86d0-4d92e386e5c8
Pijnenburg, Marielle
5fa69ab2-4a84-44f5-bc82-ea852e382cc7
de Jongste, Johan C.
3902188e-c058-4f21-a024-148fa9c3c346
Pike, Katharine
10be90c8-73de-416e-a2d0-0bb7e7276bd3
Roberts, Graham
ea00db4e-84e7-4b39-8273-9b71dbd7e2f3
Petsky, Helen
a41e62d7-b4c2-42f5-a8a9-777c165f30d0
Chang, Anne B.
4fd39b50-d44b-4207-83da-73e7f9ae9901
Fritsch, Maria
583f8ce1-9d26-4124-ae85-ca256846c81b
Frischer, Thomas
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Szefler, Stanley
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Gergen, Peter
dd919292-0edb-4092-b7ce-7c9dd853c447
Vermeulen, Francoise
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Vael, Robin
bd841c51-c08f-41c7-830b-86e28f6cbc12
Turner, Steve
5ece7027-a2ba-4cd7-a710-6f4b823dba9a
Fielding, Shona
f1c3725b-26a5-48fd-86d0-4d92e386e5c8
Pijnenburg, Marielle
5fa69ab2-4a84-44f5-bc82-ea852e382cc7
de Jongste, Johan C.
3902188e-c058-4f21-a024-148fa9c3c346
Pike, Katharine
10be90c8-73de-416e-a2d0-0bb7e7276bd3
Roberts, Graham
ea00db4e-84e7-4b39-8273-9b71dbd7e2f3
Petsky, Helen
a41e62d7-b4c2-42f5-a8a9-777c165f30d0
Chang, Anne B.
4fd39b50-d44b-4207-83da-73e7f9ae9901
Fritsch, Maria
583f8ce1-9d26-4124-ae85-ca256846c81b
Frischer, Thomas
f3996d47-99b5-4a51-af3b-28f0d5bbf72e
Szefler, Stanley
1face3a3-8b0a-4285-942a-070a634d00d9
Gergen, Peter
dd919292-0edb-4092-b7ce-7c9dd853c447
Vermeulen, Francoise
11ed1ab4-dec2-47e2-a69b-466935da046e
Vael, Robin
bd841c51-c08f-41c7-830b-86e28f6cbc12
Turner, Steve
5ece7027-a2ba-4cd7-a710-6f4b823dba9a

Fielding, Shona, Pijnenburg, Marielle, de Jongste, Johan C., Pike, Katharine, Roberts, Graham, Petsky, Helen, Chang, Anne B., Fritsch, Maria, Frischer, Thomas, Szefler, Stanley, Gergen, Peter, Vermeulen, Francoise, Vael, Robin and Turner, Steve (2019) Change in FEV1 and FeNO measurements as predictors of future asthma outcomes in children. Chest, 155 (2), 331-341. (doi:10.1016/j.chest.2018.10.009).

Record type: Article

Abstract

Background: repeated measurements of spirometry and fractional exhaled nitric 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 randomised controlled trials where FeNO was used to guide asthma treatment, and where spirometric indices were also measured. Change in %FEV1 and % change in FeNO between baseline and three months were related to having poor asthma control and to having an asthma exacerbation between three and six months after baseline.

Results: data were available from 1112 children (mean age 12.6 years, mean %FEV1 94%). A 10% reduction in %FEV1 between baseline and three 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] six months after baseline. A 50% increase in FeNO between baseline and three months was associated with 11% increase in odds for poor asthma control six months after baseline [95% CI 0, 16]. Baseline FeNO and %FEV1 were not related to asthma outcomes at three months.

Conclusions: repeated measurements of %FEV1 which 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 since large changes were associated with small changes in outcome risk.

Text
Chest 05-09-18 - Accepted Manuscript
Restricted to Repository staff only until 22 October 2019.
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More information

Submitted date: 1 October 2018
e-pub ahead of print date: 22 October 2018
Published date: February 2019
Keywords: asthma, child, monitoring, nitric oxide, spirometry

Identifiers

Local EPrints ID: 423849
URI: https://eprints.soton.ac.uk/id/eprint/423849
ISSN: 0012-3692
PURE UUID: db2f830e-1668-4b7f-87bd-75cff37d8a95

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Date deposited: 03 Oct 2018 16:30
Last modified: 08 May 2019 16:30

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Contributors

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

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