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Boer, S.; Honkoop, P.J.; Loijmans, R.J.B.; Snoeck-Stroband, J.B.; Assendelft, W.J.J.; Schermer, T.R.J.; Sont, J.K. (2020)

Personalised exhaled nitric oxygen fraction (F-ENO)-driven asthma management in primary care: a F-ENO subgroup analysis of the ACCURATE trial

Article / Letter to editor
Background: The aim of this study was to identify patients who benefit most from exhaled nitric oxide fraction (F-ENO)-driven asthma management in primary care, based on prespecified subgroups with different levels of F-ENO.Methods: We used data from 179 adults with asthma from a 12-month primary care randomised controlled trial with 3-monthly assessments of F-ENO, 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 F-ENO+symptomdriven strategy (FCa). In both groups, patients were categorised by their baseline level of F-ENO as low (<25 ppb), intermediate (25-50 ppb) and high (>50 ppb). At 12 months, we compared, for each prespecified F-ENO 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...Show moreBackground: The aim of this study was to identify patients who benefit most from exhaled nitric oxide fraction (F-ENO)-driven asthma management in primary care, based on prespecified subgroups with different levels of F-ENO.Methods: We used data from 179 adults with asthma from a 12-month primary care randomised controlled trial with 3-monthly assessments of F-ENO, 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 F-ENO+symptomdriven strategy (FCa). In both groups, patients were categorised by their baseline level of F-ENO as low (<25 ppb), intermediate (25-50 ppb) and high (>50 ppb). At 12 months, we compared, for each prespecified F-ENO 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 mu g (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 F-ENO level. No differences were found for asthma control, severe asthma exacerbations and asthma-related quality of life in patients with a low baseline F-ENO level. Furthermore, in patients with intermediate or high level of F-ENO, no differences were found.Conclusions: In primary care, F-ENO-driven asthma management is effective in patients with a low F-ENO level, for whom it is possible to down-titrate medication, while preserving asthma control and quality of life.Show less
All authors
Boer, S.; Honkoop, P.J.; Loijmans, R.J.B.; Snoeck-Stroband, J.B.; Assendelft, W.J.J.; Schermer, T.R.J.; Sont, J.K.
Date
2020-07-01
Journal
ERJ Open Research
Volume
6
Issue
3
DOI
doi:10.1183/23120541.00351-2019
Link
https://openres.ersjournals.com/content/6/3/00351-2019