Change in FEV1 and FENO Measurements as Predictors of Future Asthma Outcomes in Children

被引:48
作者
Fielding, Shona [1 ]
Pijnenburg, Marielle [2 ]
de Jongste, Johan C. [2 ]
Pike, Katharine C. [3 ,4 ]
Roberts, Graham [3 ]
Petsky, Helen [5 ]
Chang, Anne B. [5 ,6 ]
Fritsch, Maria [7 ]
Frischer, Thomas [7 ]
Szefler, Stanley [8 ]
Gergen, Peter [9 ]
Vermeulen, Francoise [10 ]
Vael, Robin [11 ]
Turner, Steve [12 ]
机构
[1] Univ Aberdeen, Inst Appl Hlth Sci, Med Stat Team, Aberdeen, Scotland
[2] Sophia Childrens Univ Hosp, Dept Paediat Resp Med & Allergol, Erasmus MC, Rotterdam, Netherlands
[3] Univ Southampton, Clin & Expt Sci Acad Unit, Southampton, Hants, England
[4] UCL, Resp Crit Care & Anaesthesia Grp, Inst Child Hlth, London, England
[5] Queensland Univ Technol, Dept Resp & Sleep Med, Lady Cilento Childrens Hosp, Brisbane, Qld, Australia
[6] Charles Darwin Univ, Child Hlth Div, Menzies Sch Hlth Res, Darwin, NT, Australia
[7] Univ Childrens Hosp, Dept Gen Paediat, Vienna, Austria
[8] Univ Colorado, Breathing Inst, Childrens Hosp Colorado, Dept Pediat,Sch Med, Aurora, CO USA
[9] NIAID, 9000 Rockville Pike, Bethesda, MD 20892 USA
[10] Univ Libre Bruxelles, Dept Pediat, Hop Erasme, Brussels, Belgium
[11] Antwerp Univ Hosp, Dept Paediat, Antwerp, Belgium
[12] Univ Aberdeen, Dept Child Hlth, Royal Aberdeen Childrens Hosp, Aberdeen AB25 2ZG, Scotland
关键词
asthma; child; monitoring; nitric oxide; spirometry; EXHALED NITRIC-OXIDE; MANAGEMENT; EXACERBATIONS; SPIROMETRY; SYMPTOMS; RISK;
D O I
10.1016/j.chest.2018.10.009
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
BACKGROUND: Repeated measurements of spirometry and fractional exhaled nitric oxide (FENO) are recommended as part of the management of childhood asthma, but the evidence base for such recommendations is small. We tested the hypothesis that reducing spirometric indices or increasing FENO will predict poor future asthma outcomes. METHODS: A one-stage individual patient data meta-analysis used data from seven randomized controlled trials in which FENO was used to guide asthma treatment; spirometric indices were also measured. Change in %FEV1 and % change in FENO between baseline and 3 months were related to having poor asthma control and to having an asthma exacerbation between 3 and 6 months after baseline. RESULTS: Data were available from 1,112 children (mean age, 12.6 years; mean %FEV1, 94%). A 10% reduction in %FEV1 between baseline and 3 months was associated with 28% increased odds for asthma exacerbation (95% CI, 3-58) and with 21% increased odds for having poor asthma control (95% CI, 0-45) 6 months after baseline. A 50% increase in FENO between baseline and 3 months was associated with 11% increase in odds for poor asthma control 6 months after baseline (95% CI, 0-16). Baseline FENO and %FEV1 were not related to asthma outcomes at 3 months. CONCLUSION: Repeated measurements of %FEV1 that are typically within the "normal" range add to clinical risk assessment of future asthma outcomes in children. The role of repeated FENO measurements is less certain because large changes were associated with small changes in outcome risk.
引用
收藏
页码:331 / 341
页数:11
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