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Does treatment guided by exhaled nitric oxide fraction improve outcomes in subgroups of children with asthma?

Does treatment guided by exhaled nitric oxide fraction improve outcomes in subgroups of children with asthma?
Does treatment guided by exhaled nitric oxide fraction improve outcomes in subgroups of children with asthma?

Introduction: Exhaled nitric oxide fraction (F ENO), a biomarker of eosinophilic airway inflammation, may be useful to guide asthma treatment. F ENO-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 F ENO 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, F ENO-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 F ENO (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 F ENO 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.

0903-1936
1-12
Fielding, Shona S.
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Pijnenburg, Marielle
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de Jongste, Johan
3902188e-c058-4f21-a024-148fa9c3c346
Pike, Katherine
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Roberts, Graham
ea00db4e-84e7-4b39-8273-9b71dbd7e2f3
Petsky, Helen
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Chang, Anne B.
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Fritsch, Maria
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Frischer, Thomas
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Szefler, Stanley J.
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Gergen, Peter
fa2bb4bb-c97e-47cb-af11-be85da2af9d4
Vermeulen, Francoise
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Vael, Robin
bd841c51-c08f-41c7-830b-86e28f6cbc12
Turner, Steve S.
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Fielding, Shona S.
f1c3725b-26a5-48fd-86d0-4d92e386e5c8
Pijnenburg, Marielle
5fa69ab2-4a84-44f5-bc82-ea852e382cc7
de Jongste, Johan
3902188e-c058-4f21-a024-148fa9c3c346
Pike, Katherine
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 J.
fe2da620-7a3c-4bef-9450-303925b19c8f
Gergen, Peter
fa2bb4bb-c97e-47cb-af11-be85da2af9d4
Vermeulen, Francoise
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Vael, Robin
bd841c51-c08f-41c7-830b-86e28f6cbc12
Turner, Steve S.
db854915-7aa0-4c38-b2f7-9ec23b1d2828

Fielding, Shona S., Pijnenburg, Marielle, de Jongste, Johan, Pike, Katherine, Roberts, Graham, Petsky, Helen, Chang, Anne B., Fritsch, Maria, Frischer, Thomas, Szefler, Stanley J., Gergen, Peter, Vermeulen, Francoise, Vael, Robin and Turner, Steve S. (2020) Does treatment guided by exhaled nitric oxide fraction improve outcomes in subgroups of children with asthma? The European respiratory journal, 55 (5), 1-12, [1901879]. (doi:10.1183/13993003.01879-2019).

Record type: Article

Abstract

Introduction: Exhaled nitric oxide fraction (F ENO), a biomarker of eosinophilic airway inflammation, may be useful to guide asthma treatment. F ENO-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 F ENO 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, F ENO-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 F ENO (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 F ENO 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.

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More information

Accepted/In Press date: 17 February 2020
e-pub ahead of print date: 12 March 2020
Published date: 1 May 2020
Additional Information: Funding Information: Conflict of interest: S. Fielding has nothing to disclose. M. Pijnenburg has nothing to disclose. J. de Jongste has nothing to disclose. K. Pike has nothing to disclose. G. Roberts has nothing to disclose. H. Petsky has nothing to disclose. A.B. Chang reports grants (project, Centre for Research Excellence and practitioner fellowship) from the National Health and Medical Research Council, Australia during the conduct of the study; and other potential conflict from being an author in UpToDate and USA Chest Chronic Cough Guidelines outside the submitted work. M. Fritsch has nothing to disclose. T. Frischer has nothing to disclose. S.J. Szefler has nothing to disclose. P. Gergen has nothing to disclose. F. Vermeulen has nothing to disclose. R. Vael has nothing to disclose. S.S. Turner has nothing to disclose. Publisher Copyright: Copyright © ERS 2020
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Identifiers

Local EPrints ID: 441780
URI: http://eprints.soton.ac.uk/id/eprint/441780
DOI: doi:10.1183/13993003.01879-2019
ISSN: 0903-1936
PURE UUID: f82ec894-e4bc-4dd3-b0ab-143d3409ec1a
ORCID for Graham Roberts: ORCID iD orcid.org/0000-0003-2252-1248

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Date deposited: 26 Jun 2020 16:45
Last modified: 17 Mar 2024 03:01

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Contributors

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

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