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

Pike, K; (2020) Does treatment guided by fractional exhaled nitric oxide improve outcomes in subgroups of children with asthma? European Respiratory Journal , 55 (5) , Article 1901879. 10.1183/13993003.01879-2019. Green open access

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Abstract

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.

Type: Article
Title: Does treatment guided by fractional exhaled nitric oxide improve outcomes in subgroups of children with asthma?
Open access status: An open access version is available from UCL Discovery
DOI: 10.1183/13993003.01879-2019
Publisher version: https://doi.org/10.1183/13993003.01879-2019
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10090233
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