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  • Do changes in spirometric indices and FeNO predict asthma outcomes in children? An individual patient data analysis using results from seven FeNO trials

    Author(s)
    Turner, Stephen
    Fielding, Shona
    Pijnenburg, Marielle
    De Jongste, Johan
    Pike, Katy
    Roberts, Graham
    Petsky, Helen
    Chang, Anne
    Fritsch, Maria
    Frischer, Thomas
    Szefler, Stan
    Gergen, Peter
    Vermeulen, Francoise
    Vael, Robin
    Griffith University Author(s)
    Petsky, Helen
    Year published
    2018
    Metadata
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    Abstract
    Introduction: Guidelines recommend spirometry and/or fractional exhaled nitric oxide (FeNO) as objective measurements to guide asthma management. Our hypothesis was that falling FEV1, FEV1/FVC ratio or FEF25-75 or rising FeNO measurements are associated with future adverse asthma outcomes. Methods: Data were obtained from 7 trials using FeNO to guide asthma treatment. Predictors were change in % FEV1, FEV1/FVC ratio or FEF25-75 and % change in FeNO between baseline and 3 months. Loss of asthma control and asthma attack between 3 and 6 months were the outcomes. A one-stage individual patient data meta-analysis was conducted ...
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    Introduction: Guidelines recommend spirometry and/or fractional exhaled nitric oxide (FeNO) as objective measurements to guide asthma management. Our hypothesis was that falling FEV1, FEV1/FVC ratio or FEF25-75 or rising FeNO measurements are associated with future adverse asthma outcomes. Methods: Data were obtained from 7 trials using FeNO to guide asthma treatment. Predictors were change in % FEV1, FEV1/FVC ratio or FEF25-75 and % change in FeNO between baseline and 3 months. Loss of asthma control and asthma attack between 3 and 6 months were the outcomes. A one-stage individual patient data meta-analysis was conducted using a mixed effects logistic model, including a random effect for study. Results: Data were available in 1112 children (58% male, mean age 12.6 years [SD 3.1]) from seven trials. A reduction of 10% FEV1 was associated with increased risk for future attack (OR 1.28 [1.02, 1.58]) and for loss of control (OR 1.21 [1, 1.45]), and a reduction of 10% FVC with increased risk for future attack (OR 1.40 [1.04, 1.88]). Changes in %FEF25-75 and %FEV1/FVC ratio were not linked to future outcomes. Each 20% increase in FeNO was associated with increased risk for future loss of control (OR 1.041 [1.000, 1.062]). Baseline %FEV1/FVC was associated with increased risk for attack over the next three months (OR per % predicted reduction 1.037 [1.007, 1.067]). Otherwise no measurement at baseline was associated with later outcome. Conclusions: Change in %FEV1 over a three month period may be useful as part of dynamic risk assessment. Whether a large change in FeNO may also be useful for dynamic risk assessment remains uncertain.
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    Conference Title
    European Respiratory Journal
    Volume
    52
    DOI
    https://doi.org/10.1183/13993003.congress-2018.PA5011
    Subject
    Medical and Health Sciences
    Science & Technology
    Life Sciences & Biomedicine
    Respiratory System
    Publication URI
    http://hdl.handle.net/10072/402377
    Collection
    • Conference outputs

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