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Reducing Asthma Attacks in Children using Exhaled Nitric Oxide as a biomarker to inform treatment strategy: a
S Turner1, S C Cotton2, C D Emele2
1Child Health, University of Aberdeen, Aberdeen, UK. s.w.turner@abdn.ac.uk.
Insights
Fractional exhaled nitric oxide (FeNO) monitoring may help guide childhood asthma treatment. This study investigates if FeNO-guided care reduces asthma attacks in children compared to standard symptom-based management.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Respiratory Medicine
Background:
- Childhood asthma is a prevalent condition with no current validated objective tests for treatment guidance.
- Asthma management in children often relies on subjective symptom assessment.
- Fractional exhaled nitric oxide (FeNO) is a potential biomarker for airway inflammation.
Purpose of the Study:
- To test the hypothesis that adding FeNO monitoring to standard care reduces asthma exacerbations in children.
- To evaluate FeNO as an objective index for guiding and stratifying pediatric asthma treatment.
- To compare asthma exacerbation rates between FeNO-guided and symptom-guided treatment groups.
Main Methods:
- Multi-center, randomized controlled trial involving children aged 6-16 years with asthma.
- Participants received either symptom-based care or asthma treatment guided by FeNO levels and symptoms.
- Primary outcome was asthma exacerbations requiring oral corticosteroids over 12 months; secondary outcomes included attack frequency, control scores, and quality of life.
Main Results:
- This section is not available in the provided abstract.
- Further analysis is required to determine the primary and secondary outcomes.
- The study is designed to collect data on exacerbations, asthma control, and quality of life.
Conclusions:
- This study aims to determine if FeNO monitoring offers an objective method for asthma treatment management in children.
- Findings could lead to improved, personalized asthma care strategies for pediatric patients.
- The research will assess the clinical utility of FeNO in reducing asthma-related morbidity.
Background:
Childhood asthma is a common condition. Currently there is no validated objective test which can be used to guide asthma treatment in children. This study tests the hypothesis that the addition of fractional exhaled nitric oxide (FENO) monitoring in addition to standard care reduces the number of exacerbations (or attacks) in children with asthma.
Methods:
This is a multi-centre, randomised controlled study. Children will be included of age 6-16 years who have a diagnosis of asthma, currently use inhaled corticosteroids (ICSs) and have had an exacerbation in the previous 12 months. Exclusion criteria include being unable to provide FENO measurement at baseline assessment, having another chronic respiratory condition and being currently treated with maintenance oral steroids. Participants will be recruited in both primary and secondary care settings and will be randomised to either receive asthma treatment guided by FENO plus symptoms (FENO group) or asthma treatment guided by symptoms only (standard care group). Within the FENO group, different treatment decisions will be made dependent on changes in FENO. Participants will attend assessments 3, 6, 9 and 12 months post randomisation. The primary outcome is asthma exacerbation requiring prescription and/or use of an oral corticosteroid over 12 months as recorded by the participant/parent or in general practitioner records. Secondary outcomes include time to first attack, number of attacks, asthma control score and quality of life. Adherence to ICS treatment is objectively measured by an electronic logging device. Participants are invited to participate in a "phenotyping" assessment where skin prick reactivity and bronchodilator response are determined and a saliva sample is collected for DNA extraction. Qualitative interviews will be held with participants and research nurses. A health economic evaluation will take place.
Discussion:
This study will evaluate whether FENO can provide an objective index to guide and stratify asthma treatment in children.
Trial Registration:
ISRCTN, ISRCTN67875351. Registered on 12 April 2017. Prospectively registered.
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