Utility of exhaled nitric oxide to guide mild asthma treatment in atopic patients and its correlation with asthma control test score: a randomized controlled trial.
Adolescent
Adult
Female
Humans
Male
Middle Aged
Young Adult
Administration, Inhalation
Adrenal Cortex Hormones
/ therapeutic use
Anti-Asthmatic Agents
/ therapeutic use
Asthma
/ diagnosis
Breath Tests
Budesonide
/ therapeutic use
Fractional Exhaled Nitric Oxide Testing
Nitric Oxide
/ analysis
Prospective Studies
Respiratory Function Tests
Asthma
Asthma control test
Atopy
Fractional exhaled nitric oxide (FeNO)
Journal
BMC pulmonary medicine
ISSN: 1471-2466
Titre abrégé: BMC Pulm Med
Pays: England
ID NLM: 100968563
Informations de publication
Date de publication:
29 Aug 2024
29 Aug 2024
Historique:
received:
01
04
2024
accepted:
16
08
2024
medline:
31
8
2024
pubmed:
31
8
2024
entrez:
29
8
2024
Statut:
epublish
Résumé
Fractional exhaled nitric oxide (FeNO) is used for the diagnosis and monitoring of asthma, although its utility to guide treatment and its correlation with other tools is still under discussion. We study the possibility to withdraw inhaled corticosteroid treatment in atopic patients with mild asthma based on the FeNO level, as well as to study its correlation with other clinical control tools. Prospective and randomized study including atopic patients aged 18 to 65 with mild asthma, stable, on low-dose inhaled corticosteroid (ICS) treatment, who had their treatment withdrawn based on a FeNO level of 40 ppb. Patients were randomized into two groups: control group (treatment with ICS was withdrawn regardless of FeNO level) and experimental group (according to the FeNO levels, patients were assigned to one of two groups: FeNO > 40 ppb on treatment with budesonide 200 mcg every 12 h and SABA on demand; FeNO ≤ 40 ppb only with SABA on demand). Follow-up was conducted for one year, during which medical assessment was performed with FeNO measurements, asthma control test (ACT), lung function tests (FEV1, FEV1/FVC, PEF, and RV/TLC), and recording of the number of exacerbations. Ninety-two patients were included, with a mean age of 39.92 years (SD 13.99); 46 patients were assigned to the control group, and 46 patients to the experimental group. The number of exacerbations was similar between the groups (p = 0.301), while the time to the first exacerbation was significantly shorter in the control group (30.86 vs. 99.00 days), p < 0.001, 95% CI (43.332-92.954). Lung function tests (FEV1, FEV1/FVC, PEF, and RV/TLC) showed no differences between the groups (p > 0.05). Both FeNO and ACT showed significant changes in the groups in which ICS was withdrawn (p < 0.05 for both parameters). A significant negative correlation was observed between FeNO and ACT (r = -0.139, p = 0.008). In atopic patients with mild asthma, withdrawal of ICS based on an FeNO of 40 ppb led to worsened symptoms but without changes in lung function tests or an increase in exacerbations. There was a negative correlation between FeNO values and symptomatic control measured by the ACT. Clinical Trial Number: 2012-000372-42. Start Date: 2012-07-23. Trial registered prospectively ( https://www.clinicaltrialsregister.eu/ctr-search/search?query=2012-000372-42 ). This study adheres to CONSORT guidelines of randomised control trials.
Sections du résumé
BACKGROUND
BACKGROUND
Fractional exhaled nitric oxide (FeNO) is used for the diagnosis and monitoring of asthma, although its utility to guide treatment and its correlation with other tools is still under discussion. We study the possibility to withdraw inhaled corticosteroid treatment in atopic patients with mild asthma based on the FeNO level, as well as to study its correlation with other clinical control tools.
METHODS
METHODS
Prospective and randomized study including atopic patients aged 18 to 65 with mild asthma, stable, on low-dose inhaled corticosteroid (ICS) treatment, who had their treatment withdrawn based on a FeNO level of 40 ppb. Patients were randomized into two groups: control group (treatment with ICS was withdrawn regardless of FeNO level) and experimental group (according to the FeNO levels, patients were assigned to one of two groups: FeNO > 40 ppb on treatment with budesonide 200 mcg every 12 h and SABA on demand; FeNO ≤ 40 ppb only with SABA on demand). Follow-up was conducted for one year, during which medical assessment was performed with FeNO measurements, asthma control test (ACT), lung function tests (FEV1, FEV1/FVC, PEF, and RV/TLC), and recording of the number of exacerbations.
RESULTS
RESULTS
Ninety-two patients were included, with a mean age of 39.92 years (SD 13.99); 46 patients were assigned to the control group, and 46 patients to the experimental group. The number of exacerbations was similar between the groups (p = 0.301), while the time to the first exacerbation was significantly shorter in the control group (30.86 vs. 99.00 days), p < 0.001, 95% CI (43.332-92.954). Lung function tests (FEV1, FEV1/FVC, PEF, and RV/TLC) showed no differences between the groups (p > 0.05). Both FeNO and ACT showed significant changes in the groups in which ICS was withdrawn (p < 0.05 for both parameters). A significant negative correlation was observed between FeNO and ACT (r = -0.139, p = 0.008).
CONCLUSIONS
CONCLUSIONS
In atopic patients with mild asthma, withdrawal of ICS based on an FeNO of 40 ppb led to worsened symptoms but without changes in lung function tests or an increase in exacerbations. There was a negative correlation between FeNO values and symptomatic control measured by the ACT.
TRIAL REGISTRATION
BACKGROUND
Clinical Trial Number: 2012-000372-42. Start Date: 2012-07-23. Trial registered prospectively ( https://www.clinicaltrialsregister.eu/ctr-search/search?query=2012-000372-42 ). This study adheres to CONSORT guidelines of randomised control trials.
Identifiants
pubmed: 39210358
doi: 10.1186/s12890-024-03227-y
pii: 10.1186/s12890-024-03227-y
pmc: PMC11360837
doi:
Substances chimiques
Adrenal Cortex Hormones
0
Anti-Asthmatic Agents
0
Budesonide
51333-22-3
Nitric Oxide
31C4KY9ESH
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
421Informations de copyright
© 2024. The Author(s).
Références
J Asthma. 2013 Sep;50(7):718-21
pubmed: 23638898
Eur Respir J. 2017 Apr 26;49(4):
pubmed: 28446552
Pediatr Allergy Immunol. 2005 Feb;16(1):52-8
pubmed: 15693912
Arch Bronconeumol. 2010 Jul;46(7):370-7
pubmed: 20605310
Eur Respir J. 2003 Sep;22(3):470-7
pubmed: 14516137
Ann Allergy Asthma Immunol. 2021 Jul;127(1):123-130.e1
pubmed: 33819615
Eur Respir J. 2020 May 21;55(5):
pubmed: 32139458
Am J Respir Crit Care Med. 2001 Oct 15;164(8 Pt 1):1376-81
pubmed: 11704581
Thorax. 2002 May;57(5):383-7
pubmed: 11978911
J Korean Med Sci. 2015 Oct;30(10):1459-65
pubmed: 26425043
Thorax. 1998 Feb;53(2):91-5
pubmed: 9624291
J Asthma Allergy. 2016 Sep 14;9:163-170
pubmed: 27695350
Lung India. 2017 Mar-Apr;34(2):132-137
pubmed: 28360460
Thorax. 2011 Jun;66(6):514-20
pubmed: 21474498
Thorax. 2018 Dec;73(12):1110-1119
pubmed: 29858277
J Allergy Clin Immunol. 2009 Oct;124(4):719-23.e1
pubmed: 19767070
JAMA. 2012 Sep 12;308(10):987-97
pubmed: 22968888
Lancet. 2008 Sep 20;372(9643):1065-72
pubmed: 18805335
J Asthma. 2011 Nov;48(9):901-6
pubmed: 21923284
Allergy. 2007 Feb;62(2):207-8
pubmed: 17298431
Ann Allergy Asthma Immunol. 2008 Aug;101(2):124-9
pubmed: 18727466
Am J Respir Crit Care Med. 2005 Apr 15;171(8):912-30
pubmed: 15817806
Respir Med. 2013 Nov;107(11):1667-74
pubmed: 24025779
J Allergy Clin Immunol. 2020 Dec;146(6):1217-1270
pubmed: 33280709
Chest. 2003 Oct;124(4):1325-33
pubmed: 14555562
J Allergy Clin Immunol. 2003 Nov;112(5):883-92
pubmed: 14610474
J Thorac Dis. 2020 May;12(5):2197-2209
pubmed: 32642125
Breathe (Sheff). 2019 Dec;15(4):306-316
pubmed: 31803265
Med J Armed Forces India. 2022 Oct;78(4):443-447
pubmed: 36267510
Ann Allergy Asthma Immunol. 2008 Dec;101(6):608-13
pubmed: 19119704
Eur Respir J. 2005 Nov;26(5):948-68
pubmed: 16264058
J Asthma. 2007 Dec;44(10):867-72
pubmed: 18097865
J Allergy Clin Immunol. 2015 Mar;135(3):682-8.e11
pubmed: 25174865
Am J Respir Crit Care Med. 2007 Aug 1;176(3):231-7
pubmed: 17496226
J Immunol. 2005 Nov 15;175(10):6531-6
pubmed: 16272307
J Allergy Clin Immunol. 2013 Mar;131(3):695-703
pubmed: 23058645
Clin Exp Allergy. 2004 Feb;34(2):221-6
pubmed: 14987301
Respir Med. 2017 Mar;124:44-48
pubmed: 28284320
J Asthma. 2013 Aug;50(6):600-5
pubmed: 23521185
J Allergy Clin Immunol Pract. 2013 Nov-Dec;1(6):639-48.e1-8
pubmed: 24565712
Allergol Int. 2013 Sep;62(3):343-9
pubmed: 23880616
Am J Respir Crit Care Med. 2011 Sep 1;184(5):602-15
pubmed: 21885636
J Asthma. 2009 Nov;46(9):955-60
pubmed: 19905926
Allergol Int. 2013 Mar;62(1):91-8
pubmed: 23093793
Clin Respir J. 2009 Jul;3(3):143-51
pubmed: 20298397
Clin Exp Allergy. 1999 Sep;29(9):1276-80
pubmed: 10469038
Respir Med. 2002 Mar;96(3):150-4
pubmed: 11905549
Allergy Rhinol (Providence). 2014 Jan;5(3):157-61
pubmed: 25565052
Chest. 2006 Nov;130(5):1319-25
pubmed: 17099006
Respir Med. 2019 Aug;155:54-57
pubmed: 31299469
Respiration. 2010;80(2):120-6
pubmed: 19776554
J Allergy Clin Immunol. 2009 Jan;123(1):67-73.e3
pubmed: 19062085
Eur Respir J. 2006 Nov;28(5):939-44
pubmed: 16870665
Eur Respir J. 2020 Mar 26;55(3):
pubmed: 31949116
Clin Chest Med. 2006 Mar;27(1):71-85, vi
pubmed: 16543053
N Engl J Med. 2005 May 26;352(21):2163-73
pubmed: 15914548
Cochrane Database Syst Rev. 2016 Sep 01;9:CD011440
pubmed: 27580628
Respir Med. 1997 Nov;91 Suppl A:11-2
pubmed: 9474360