Change in FEV1 and FeNO measurements as predictors of future asthma outcomes in children

Shona Fielding; Mariëlle Pijnenburg; Johan C.  de Jongste; Katharine C Pike; Graham Roberts; Helen  Petsky; Anne B  Chang; Maria  Fritsch; Thomas Frischer; Stanley Szefler; Peter  Gergen; Francoise  Vermeulen; Robin  Vael; Steve Turner

doi:10.1016/j.chest.2018.10.009

Change in FEV₁ and FeNO measurements as predictors of future asthma outcomes in children

Shona Fielding, Mariëlle Pijnenburg, Johan C. de Jongste, Katharine C Pike, Graham Roberts, Helen Petsky, Anne B Chang, Maria Fritsch, Thomas Frischer, Stanley Szefler, Peter Gergen, Francoise Vermeulen, Robin Vael, Steve Turner^* (Corresponding Author)

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

48 Citations (Scopus)

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Abstract

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 randomised controlled trials where FeNO was used to guide asthma treatment, and where spirometric indices were also measured. Change in %FEV1 and % change in FeNO between baseline and three months were related to having poor asthma control and to having an asthma exacerbation between three and six months after baseline.

Results
Data were available from 1112 children (mean age 12.6 years, mean %FEV1 94%). A 10% reduction in %FEV1 between baseline and three 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 1, 45] six months after baseline. A 50% increase in FeNO between baseline and three months was associated with 11% increase in odds for poor asthma control six months after baseline [95% CI 0, 16]. Baseline FeNO and %FEV1 were not related to asthma outcomes at three months.

Conclusions
Repeated measurements of %FEV1 which 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 since large changes were associated with small changes in outcome risk.

Original language	English
Pages (from-to)	331-341
Number of pages	11
Journal	Chest
Volume	155
Issue number	2
Early online date	22 Oct 2018
DOIs	https://doi.org/10.1016/j.chest.2018.10.009
Publication status	Published - Feb 2019

Bibliographical note

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 data collection took place in the remaining institutions.

Additional information: The e-Appendix and e-Tables can be found in the Supplemental Materials section of the online article.

Keywords

asthma
pediatrics
nitric oxide
spirometry
monitoring
child

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Accepted author manuscript, 894 KBLicence: CC BY-NC-ND

Cite this

@article{b5d7675497d6421483da1f7f38c010c4,

title = "Change in FEV1 and FeNO measurements as predictors of future asthma outcomes in children",

abstract = "BackgroundRepeated 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.MethodsA one-stage individual patient data meta-analysis used data from seven randomised controlled trials where FeNO was used to guide asthma treatment, and where spirometric indices were also measured. Change in %FEV1 and % change in FeNO between baseline and three months were related to having poor asthma control and to having an asthma exacerbation between three and six months after baseline.ResultsData were available from 1112 children (mean age 12.6 years, mean %FEV1 94%). A 10% reduction in %FEV1 between baseline and three 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 1, 45] six months after baseline. A 50% increase in FeNO between baseline and three months was associated with 11% increase in odds for poor asthma control six months after baseline [95% CI 0, 16]. Baseline FeNO and %FEV1 were not related to asthma outcomes at three months.ConclusionsRepeated measurements of %FEV1 which 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 since large changes were associated with small changes in outcome risk.",

keywords = "asthma, pediatrics, nitric oxide, spirometry, monitoring, child",

author = "Shona Fielding and Mari{\"e}lle Pijnenburg and {de Jongste}, {Johan C.} and Pike, {Katharine C} and Graham Roberts and Helen Petsky and Chang, {Anne B} and Maria Fritsch and Thomas Frischer and Stanley Szefler and Peter Gergen and Francoise Vermeulen and Robin Vael and Steve Turner",

note = "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 data collection took place in the remaining institutions. Additional information: The e-Appendix and e-Tables can be found in the Supplemental Materials section of the online article.",

year = "2019",

month = feb,

doi = "10.1016/j.chest.2018.10.009",

language = "English",

volume = "155",

pages = "331--341",

journal = "Chest",

issn = "0012-3692",

publisher = "American College of Chest Physicians",

number = "2",

}

TY - JOUR

T1 - Change in FEV1 and FeNO measurements as predictors of future asthma outcomes in children

AU - Fielding, Shona

AU - Pijnenburg, Mariëlle

AU - de Jongste, Johan C.

AU - Pike, Katharine C

AU - Roberts, Graham

AU - Petsky, Helen

AU - Chang, Anne B

AU - Fritsch, Maria

AU - Frischer, Thomas

AU - Szefler, Stanley

AU - Gergen, Peter

AU - Vermeulen, Francoise

AU - Vael, Robin

AU - Turner, Steve

N1 - 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 data collection took place in the remaining institutions. Additional information: The e-Appendix and e-Tables can be found in the Supplemental Materials section of the online article.

PY - 2019/2

Y1 - 2019/2

N2 - BackgroundRepeated 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.MethodsA one-stage individual patient data meta-analysis used data from seven randomised controlled trials where FeNO was used to guide asthma treatment, and where spirometric indices were also measured. Change in %FEV1 and % change in FeNO between baseline and three months were related to having poor asthma control and to having an asthma exacerbation between three and six months after baseline.ResultsData were available from 1112 children (mean age 12.6 years, mean %FEV1 94%). A 10% reduction in %FEV1 between baseline and three 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 1, 45] six months after baseline. A 50% increase in FeNO between baseline and three months was associated with 11% increase in odds for poor asthma control six months after baseline [95% CI 0, 16]. Baseline FeNO and %FEV1 were not related to asthma outcomes at three months.ConclusionsRepeated measurements of %FEV1 which 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 since large changes were associated with small changes in outcome risk.

AB - BackgroundRepeated 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.MethodsA one-stage individual patient data meta-analysis used data from seven randomised controlled trials where FeNO was used to guide asthma treatment, and where spirometric indices were also measured. Change in %FEV1 and % change in FeNO between baseline and three months were related to having poor asthma control and to having an asthma exacerbation between three and six months after baseline.ResultsData were available from 1112 children (mean age 12.6 years, mean %FEV1 94%). A 10% reduction in %FEV1 between baseline and three 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 1, 45] six months after baseline. A 50% increase in FeNO between baseline and three months was associated with 11% increase in odds for poor asthma control six months after baseline [95% CI 0, 16]. Baseline FeNO and %FEV1 were not related to asthma outcomes at three months.ConclusionsRepeated measurements of %FEV1 which 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 since large changes were associated with small changes in outcome risk.

KW - asthma

KW - pediatrics

KW - nitric oxide

KW - spirometry

KW - monitoring

KW - child

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UR - http://www.mendeley.com/research/change-fev-1-feno-measurements-predictors-future-asthma-outcomes-children

U2 - 10.1016/j.chest.2018.10.009

DO - 10.1016/j.chest.2018.10.009

M3 - Article

SN - 0012-3692

VL - 155

SP - 331

EP - 341

JO - Chest

JF - Chest

IS - 2

ER -

Change in FEV₁ and FeNO measurements as predictors of future asthma outcomes in children

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Stephen Turner

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Change in FEV1 and FeNO measurements as predictors of future asthma outcomes in children

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Bibliographical note

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Stephen Turner

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Change in FEV₁ and FeNO measurements as predictors of future asthma outcomes in children