| Autor: |
Stan Szefler, Thomas Frischer, Helen L. Petsky, Shona Fielding, Katy Pike, Maria Fritsch, Françoise Vermeulen, Johan C. de Jongste, Stephen Turner, Robin Vael, Peter J. Gergen, Anne B. Chang, Marielle W. Pijnenburg, Graham Roberts |
| Rok vydání: |
2018 |
| Předmět: |
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| Zdroj: |
Paediatric respiratory epidemiology. |
| DOI: |
10.1183/13993003.congress-2018.pa5011 |
| Popis: |
Introduction: Guidelines recommend spirometry and/or fractional exhaled nitric oxide (FeNO) as objective measurements to guide asthma management. Our hypothesis was that falling FEV1, FEV1/FVC ratio or FEF25-75 or rising FeNO measurements are associated with future adverse asthma outcomes. Methods: Data were obtained from 7 trials using FeNO to guide asthma treatment. Predictors were change in % FEV1, FEV1/FVC ratio or FEF25-75 and % change in FeNO between baseline and 3 months. Loss of asthma control and asthma attack between 3 and 6 months were the outcomes. A one-stage individual patient data meta-analysis was conducted using a mixed effects logistic model, including a random effect for study. Results: Data were available in 1112 children (58% male, mean age 12.6 years [SD 3.1]) from seven trials. A reduction of 10% FEV1 was associated with increased risk for future attack (OR 1.28 [1.02, 1.58]) and for loss of control (OR 1.21 [1, 1.45]), and a reduction of 10% FVC with increased risk for future attack (OR 1.40 [1.04, 1.88]). Changes in %FEF25-75 and %FEV1/FVC ratio were not linked to future outcomes. Each 20% increase in FeNO was associated with increased risk for future loss of control (OR 1.041 [1.000, 1.062]). Baseline %FEV1/FVC was associated with increased risk for attack over the next three months (OR per % predicted reduction 1.037 [1.007, 1.067]). Otherwise no measurement at baseline was associated with later outcome. Conclusions: Change in %FEV1 over a three month period may be useful as part of dynamic risk assessment. Whether a large change in FeNO may also be useful for dynamic risk assessment remains uncertain. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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