Comparison of treatment guidance based on bronchial responsiveness to mannitol, spirometry or exhaled nitric oxide in stable asthmatic children

Lurà Marco Patrick,Jung Andreas,Moeller Alexander,Inci Demet,Knoepfli Bruno,Wildhaber Johannes Heinrich

doi:10.4236/ojped.2013.34074

Abstract

Aim: The goal of this study was to compare asthma treatment guidance based on bronchial hyper-responsiveness to mannitol, spirometry or exhaled nitric oxide (FeNO) in stable asthmatic children. Methods: 60 stable allergic asthmatic children aged 7 to 16 years on a low to medium dose treatment with inhaled corticosteroids (ICS) were recruited to a double blind randomised controlled trial. At study entry (visit 1), the following was assessed: FeNO, spirometry, bronchial hyper-responsiveness to mannitol (MDP- test), quality of life (paediatric asthma quality-of-life questionnaire; PAQLQ) and asthma control (asthma control test; ACT). Subjects were randomly assigned to one of three groups and treatment was modified by a blinded respiratory physician according to the test results of visit 1: ICS dose was doubled when FeNO was >22 ppb (group 1), in case of a positive MDP-test (group 2) or when FEV1 was 22 ppb, 8 children out of 16 (50%) in group 2 showed a positive MDP-test and 3 children out of 16 (18.7%) in group 3 had a FEV1 inistered PAQLQ (p = 0.02 resp. p = 0.033) as well as the ACT (p = 0.031) increased. Neither the number of children with a positive mannitol challenge nor spirometric results changed significantly. In group 2 and group 3, there were no significant changes in none of the assessed parameters. Conclusion: In this small pragmatic double blind randomised controlled study, we showed that ICS dose modification based on FeNO led to increased quality of life and enhanced asthma control, and to a reduction in airway inflammation and was superior to treatment modifications based on bronchial hyper-responsiveness to mannitol or on FEV1.

Highlights

The goal of asthma management as described in national and international guidelines is optimal asthma control [1]
In this small pragmatic double blind randomised controlled study, we showed that inhaled corticosteroids (ICS) dose modification based on fractional exhaled nitric oxide (FeNO) led to increased quality of life and enhanced asthma control, and to a reduction in airway inflammation and was superior to treatment modifications based on bronchial hyper-responsiveness to mannitol or on FEV1
Twelve subjects were excluded from the final analyses for the following reasons: five individuals experienced an exacerbation of their asthma due to acute viral airway infection, five others did not adhere to the treatment recommendations and two were lost for follow-up

Summary

Introduction

The goal of asthma management as described in national and international guidelines is optimal asthma control [1]. Up to 80% of children suffer from occasional asthma symptoms, more than 40% from limitation in their physical activity and/or nocturnal awakening, and for more than 50%, parents are worried about their asthmatic child [5]. The reasons for this lack in achieving asthma control are likely to be multiple, one being that objective parameters of disease activity are not evaluated on a regular base to guide therapy [2]. Several instruments have been developed to evaluate asthma control including the Asthma Control Questionnaire (ACQ) [6], the Asthma Control Scoring System (ACSS) [7], and the OPEN ACCESS. Patrick et al / Open Journal of Pediatrics 3 (2013) 406-417

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