Chest
Original Research: AsthmaChange in FEV1 and Feno Measurements as Predictors of Future Asthma Outcomes in Children
Section snippets
Study Design
Authors of published RCTs in which measurements of Feno were used to guide asthma treatment in children18 were invited to provide anonymized data for IPD.19 The outcomes were asthma exacerbation (defined as a prescription of prednisolone during the follow-up period and derived using data provided by study authors) and poor asthma control (defined by per trial protocol by symptom score, and including FEV1 cutoff values in some trials11, 12, 16 but not including an asthma exacerbation).
Study Subjects
Data from seven pediatric RCTs were analyzed (Table 1)11, 12, 13, 14, 15, 16, 17; data from an eighth RCT could not be obtained.25 Details of population inclusion and exclusion criteria are presented in e-Appendix 1. The IPD included data on 1,112 participants. In two studies,14, 17 spirometry was measured at baseline and at 12 months only, and change in %FEV1 between baseline and 3 months could not be calculated. There was a predominance of male participants (58%) and mean (SD) age was 12.6
Discussion
This study sought to understand the relationship between changes in spirometric measurements and Feno and future asthma outcomes. The first finding was that, independent of all factors that might influence treatment decisions, falling %FEV1 (even within the range of 80% to 120% commonly considered as “normal”) was associated with increased odds for future asthma exacerbation and having uncontrolled asthma. A second finding was that an absolute change in Feno (Table 4) did not predict outcomes,
Acknowledgments
Author contributions: S. T. conceived the idea for the study, wrote the first draft of the manuscript, and is the guarantor of the study. S. T. and S. F. designed the study. All authors other than S. T. and S. F. contributed data for the analysis. S. F. undertook the analysis. All authors made contributions to the final manuscript.
Financial/nonfinancial disclosure: None declared.
Other contributions: The individual patient data analysis was carried out at the University of Aberdeen. Original
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2022, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Also in a US study, spirometry results influenced management decisions of pediatric pulmonologists in 15% of evaluated visits, contributing to stepping up 75% of them.30 According to asthma guidelines, lung function should be regularly assessed to adjust treatment,1-3 because poor lung function has been associated with a greater risk for asthma exacerbations31-33 and for persistent airflow limitation.34-36 Asthma management guidelines should consider current prescribing practices of pediatric pulmonologists when advising on asthma treatment adjustments.
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FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.