期刊
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE
卷 1, 期 6, 页码 639-U152出版社
ELSEVIER
DOI: 10.1016/j.jaip.2013.07.013
关键词
Asthma; Atopy; Breath test; FENO; Quality of life; Exacerbation; Corticosteroid; Leukotriene receptor antagonist; Primary care
资金
- Stockholm county council (PickUp)
- Centre for Allergy Research, Karolinska Institutet
- Research Foundation of the Swedish Asthma and Allergy Association
- Aerocrine AB (NIOX MINO instruments)
- Phadia AB (ImmunoCAP Rapid)
- Meda AB (Buventol Easyhaler)
- MSD Sweden (small grant)
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. (C) 2013 American Academy of Allergy, Asthma & Immunology
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