Abstract
Asthma is characterised by inflammation and respiratory symptoms. Current asthma treatment is based on severity of asthma symptoms only. Exhaled nitric oxide fraction (FeNO) is not recommended by the Global Initiative for Asthma guidelines. The aim was to compare the usefulness of a FeNO guided versus symptom-based treatment in achieving improved asthma control assessed by airway hyperresponsiveness (AHR).
80 asthmatic patients were included in a double-blinded, parallel, randomised controlled trial with follow-up visits after 8, 24 and 36 weeks. Treatment was tailored using either a FeNO or Asthma Control Questionnaire (ACQ) based algorithm. Inclusion criteria were asthma symptoms and a provocative dose causing a 15% fall in forced expiratory volume in 1 s <635 mg mannitol. At each visit AHR, FeNO, ACQ and blood tests were performed.
No differences between the two groups were found at inclusion. AHR from 8 to 24 weeks was improved in the FeNO group compared to the ACQ group (response dose ratio (RDR) geometric mean (95% CI): 0.02 (0.01–0.04) versus 0.05 (0.03–0.07), respectively, p=0.015). AHR to mannitol at 36 weeks showed no differences between the two groups (mean difference RDR (95% CI): −0.02 (−0.05–0.02), p=0.3). Total doses of inhaled steroid and number of exacerbations were similar (p>0.05).
When using FeNO as a treatment management tool, lowering of airway responsiveness occurred earlier than using ACQ. However, airway responsiveness and asthma control after 9 months were similar.
Abstract
Asthma management using FeNO provides faster asthma control but is similar to symptom-based management after 9 months http://ow.ly/DGNf30lqGJm
Footnotes
This study is registered at www.ClinicalTrials.gov with identifier number NCT01978678. Individual de-identified participant data will not be shared. No additional documents will be available for this trial at any time.
Conflict of interest: K.F. Bernholm, A.S. Homøe, H. Meteran, C.B. Jensen, C. Porsbjerg and V. Backer have nothing to disclose.
- Received November 15, 2017.
- Accepted August 3, 2018.
- Copyright ©ERS 2018
This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.