Biomarker-guided management reduces exacerbations in non-eosinophilic asthma in pregnancy: A secondary analysis of a randomized controlled trial.
Respirology
; 25(7): 719-725, 2020 07.
Article
em En
| MEDLINE
| ID: mdl-31656059
ABSTRACT
BACKGROUND AND OBJECTIVE:
The aim of this secondary analysis of a randomized controlled trial (RCT) of asthma management in pregnancy was to determine the treatment decision differences between a symptom control algorithm and a fractional exhaled nitric oxide (FENO)-guided algorithm, and whether the approach was effective in non-eosinophilic asthma (NEA).METHODS:
In this double-blind parallel group RCT, women with asthma were randomized prior to 22 weeks gestation to treatment adjustment according to a symptom control algorithm (control group), or a FENO-guided algorithm (inhaled corticosteroid (ICS) dose adjusted according to FENO with long-acting beta-agonist (LABA) added for uncontrolled symptoms). NEA was classified as baseline blood eosinophils <0.26 × 109 /L and FENO ≤29 ppb. Exacerbations requiring medical intervention were recorded.RESULTS:
Among 220 non-smokers (n = 109 control, n = 111 FENO), 1006 treatment decisions were made, with significant group differences after the first and second algorithm applications. 53% of women had NEA. Treatment was better targeted to phenotype in the FENO group ICS use increased in eosinophilic asthma (EA, 48-86%), while ICS/LABA increased in NEA (11-30%). Fewer women in the FENO group had exacerbations during pregnancy in NEA only (18.9% FENO vs 44% control, P = 0.006).CONCLUSION:
The FENO algorithm was more effective in treating NEA, resulting in reduced exacerbations, compared to a symptom control algorithm. This was not the result of ICS overtreatment, since the benefits occurred at a lower median daily ICS dose. Two applications of the FENO-guided algorithm, one month apart, were sufficient to achieve beneficial effects in terms of asthma exacerbations, among pregnant women with asthma.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Complicações na Gravidez
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Eosinofilia Pulmonar
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Asma
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Broncodilatadores
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Corticosteroides
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Óxido Nítrico
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article
País de afiliação:
Austrália