Abstract
Background The aim of this study was to identify patients who benefit most from exhaled nitric oxide fraction (FENO)-driven asthma management in primary care, based on prespecified subgroups with different levels of FENO.
Methods We used data from 179 adults with asthma from a 12-month primary care randomised controlled trial with 3-monthly assessments of FENO, asthma control, medication usage, costs of medication, severe asthma exacerbations and quality of life. In the original study, patients were randomised to either a symptom-driven treatment strategy (controlled asthma (Ca) strategy) or a FENO+symptom-driven strategy (FCa). In both groups, patients were categorised by their baseline level of FENO as low (<25 ppb), intermediate (25–50 ppb) and high (>50 ppb). At 12 months, we compared, for each prespecified FENO subgroup, asthma control, asthma-related quality of life, medication usage, and costs of medication between the Ca and FCa strategy.
Results We found a difference between the Ca and FCa strategy for the mean dosage of beclomethasone strategy of 223 µg (95% CI 6–439), p=0.04) and for the total costs of asthma medication a mean reduction of US$159 (95% CI US$33–285), p=0.03) in patients with a low baseline FENO level. No differences were found for asthma control, severe asthma exacerbations and asthma-related quality of life in patients with a low baseline FENO level. Furthermore, in patients with intermediate or high level of FENO, no differences were found.
Conclusions In primary care, FENO-driven asthma management is effective in patients with a low FENO level, for whom it is possible to down-titrate medication, while preserving asthma control and quality of life.
Abstract
In primary care, FENO-driven asthma management is effective in patients with a low FENO, for whom it is possible to down-titrate medication while preserving asthma control and quality of life https://bit.ly/2wC25N7d
Footnotes
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Author contributions: S. Boer analysed and interpreted the data, and wrote the manuscript. J.K. Sont and P.J. Honkoop were major contributors to the analysis and writing the manuscript. J.K. Sont and P.J. Honkoop contributed substantially to the conception and design of the original study (ACCURATE) and the acquisition of data, as well as R.J.B. Loijmans, J.B. Snoek-Stroband, W.J.J. Assendelft and T.R.J. Schermer. All authors provided critical revision of the article and provided final approval of the version to publish.
This Asthma Control Cost-Utility Randomized Trial Evaluation (ACCURATE) is registered at www.trialregister.nl with identifier number NL1658 (NTR1756). The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Conflict of interest: S. Boer has nothing to disclose.
Conflict of interest: P.J. Honkoop has nothing to disclose.
Conflict of interest: R.J.B. Loijmans has nothing to disclose.
Conflict of interest: J.B. Snoeck-Stroband has nothing to disclose.
Conflict of interest: W.J.J. Assendelft has nothing to disclose.
Conflict of interest: T.R.J. Schermer reports projects grants for the study from the Netherlands Organisation for Health Research and Development, and the Dutch Lung Foundation, during the conduct of the study.
Conflict of interest: J.K. Sont reports an unrestricted research grant from GSK Netherlands outside the submitted work.
- Received January 7, 2020.
- Accepted March 24, 2020.
- Copyright ©ERS 2020
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