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J Allergy Clin Immunol Pract. 2013 Nov-Dec;1(6):639-48.e1-8. doi: 10.1016/j.jaip.2013.07.013. Epub 2013 Oct 9.

Anti-inflammatory treatment of atopic asthma guided by exhaled nitric oxide: a randomized, controlled trial.

Author information

1
Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden. Electronic address: jorgen.syk@ptj.se.
2
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
3
Department of Public Health, Clinical Sciences and Family Medicine, Uppsala University, Uppsala, Sweden.
4
Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
5
Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden.
6
Stress Research Institute, Stockholm University, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
7
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.

Abstract

BACKGROUND:

Atopic asthma is characterized by Th2 cytokine-driven inflammation of the airway mucosa, which is signaled by the fraction of exhaled nitric oxide (FENO).

OBJECTIVE:

We tested whether an FENO-guided anti-inflammatory treatment algorithm could improve asthma-related quality of life and asthma symptom control, and reduce exacerbations in atopic asthmatics within primary care.

METHODS:

Altogether, 187 patients with asthma and who were nonsmokers (age range, 18-64 years) with perennial allergy and who were on regular inhaled corticosteroid treatment were recruited at 17 primary health care centers, randomly assigned to 2 groups and followed up for 1 year. For the controls (n = 88), FENO measurement was blinded to both operator and patient, and anti-inflammatory treatment was adjusted according to usual care. In the active group (n = 93), treatment was adjusted according to FENO. Questionnaires on asthma-related quality of life (Mini Asthma Quality of Life Questionnaire) and asthma control (Asthma Control Questionnaire) were completed, and asthma events were noted.

RESULTS:

The Asthma Control Questionnaire score change over 1 year improved significantly more in the FENO-guided group (-0.17 [interquartile range {IQR}, -0.67 to 0.17] vs 0 [-0.33 to 0.50]; P = .045), whereas the Mini Asthma Quality of Life Questionnaire score did not (0.23 [IQR, 0.07-0.73] vs 0.07 [IQR, -0.20 to 0.80]; P = .197). The change in Asthma Control Questionnaire was clinically important in subpopulations with poor control at baseline (P = .03). Furthermore, the exacerbation rate (exacerbations/patient/y) was reduced by almost 50% in the FENO-guided group (0.22 [CI, 0.14-0.34] vs 0.41 [CI, 0.29-0.58]; P = .024). Mean overall inhaled corticosteroid use was similar in both groups (P = .95).

CONCLUSION:

Use of FENO to guide anti-inflammatory treatment within primary care significantly reduced the exacerbation rate and improved asthma symptom control without increasing overall inhaled corticosteroid use.

KEYWORDS:

Asthma; Atopy; Breath test; Corticosteroid; Exacerbation; F(E)NO; Leukotriene receptor antagonist; Primary care; Quality of life

PMID:
24565712
DOI:
10.1016/j.jaip.2013.07.013
[Indexed for MEDLINE]

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