Management based on exhaled nitric oxide levels adjusted for atopy reduces asthma exacerbations in children: A dual centre randomized controlled trial

Petsky, H.L., Li, A.M., Au, C.T., Kynaston, J.A., Turner, C. and Chang, A.B. (2014) Management based on exhaled nitric oxide levels adjusted for atopy reduces asthma exacerbations in children: A dual centre randomized controlled trial. Pediatric Pulmonology, 50 6: 535-543. doi:10.1002/ppul.23064


Author Petsky, H.L.
Li, A.M.
Au, C.T.
Kynaston, J.A.
Turner, C.
Chang, A.B.
Title Management based on exhaled nitric oxide levels adjusted for atopy reduces asthma exacerbations in children: A dual centre randomized controlled trial
Journal name Pediatric Pulmonology   Check publisher's open access policy
ISSN 8755-6863
1099-0496
Publication date 2014
Sub-type Article (original research)
DOI 10.1002/ppul.23064
Open Access Status
Volume 50
Issue 6
Start page 535
End page 543
Total pages 9
Place of publication Hoboken, NJ, U.S.A.
Publisher John Wiley & Sons, Inc.
Collection year 2015
Language eng
Subject 2740 Pulmonary and Respiratory Medicine
2735 Pediatrics, Perinatology, and Child Health
Abstract While several randomized control trials (RCTs) have evaluated the use of fractional exhaled nitric oxide (FeNO) to improve asthma outcomes, none used FeNO cut-offs adjusted for atopy, a determinant of FeNO levels. In a dual center RCT, we assessed whether a treatment strategy based on FeNO levels, adjusted for atopy, reduces asthma exacerbations compared with the symptoms-based management (controls). Children with asthma from hospital clinics of two hospitals were randomly allocated to receive an a-priori determined treatment hierarchy based on symptoms or FeNO levels. There was a 2-week run-in period and they were then reviewed 10 times over 12-months. The primary outcome was the number of children with exacerbations over 12-months. Sixty-three children were randomized (FeNO=31, controls=32); 55 (86%) completed the study. Although we did achieve our planned sample size, significantly fewer children in the FeNO group (6 of 27) had an asthma exacerbation compared to controls (15 of 28), P=0.021; number to treat for benefit=4 (95% CI 3-24). There was no difference between groups for any secondary outcomes (quality of life, symptoms, FEV1). The final daily inhaled corticosteroids (ICS) dose was significantly (P=0.037) higher in the FeNO group (median 400μg, IQR 250-600) compared to the controls (200, IQR100-400). Taking atopy into account when using FeNO to tailor asthma medications is likely beneficial in reducing the number of children with severe exacerbations at the expense of increased ICS use. However, the strategy is unlikely beneficial for improving asthma control. A larger study is required to confirm or refute our findings. Pediatr Pulmonol.
Keyword Asthma
Atopy
FeNO
Pediatrics
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

 
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