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Management Based on Exhaled Nitric Oxide Levels Adjusted for Atopy Reduces Asthma Exacerbations in Children: A Dual Centre Randomized Controlled Trial

Petsky, Helen L., Li, Albert M., Au, Chun T., Kynaston, Jennifer A., Turner, Catherine and Chang, Anne B. (2015). 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.

Document type: Journal Article
Citation counts: Altmetric Score Altmetric Score is 4
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IRMA ID 11436xPUB41
Title Management Based on Exhaled Nitric Oxide Levels Adjusted for Atopy Reduces Asthma Exacerbations in Children: A Dual Centre Randomized Controlled Trial
Author Petsky, Helen L.
Li, Albert M.
Au, Chun T.
Kynaston, Jennifer A.
Turner, Catherine
Chang, Anne B.
Journal Name Pediatric Pulmonology
Publication Date 2015
Volume Number 50
Issue Number 6
ISSN 8755-6863   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84929270129
Start Page 535
End Page 543
Total Pages 9
Place of Publication United States
Publisher John Wiley & Sons, Inc.
Field of Research MEDICAL AND HEALTH SCIENCES
HERDC Category C1 - Journal Article (DIISR)
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 400 µg, 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.
DOI http://dx.doi.org/10.1002/ppul.23064   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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