Treatment decisions with an exhaled nitric oxide (eNO)-based algorithm vs a symptoms-based algorithm for asthma in pregnancy

Abstract

Introduction: The Managing Asthma in Pregnancy (MAP) Study found an eNO-algorithm reduces exacerbations by 50% compared to a symptoms-algorithm. Aim: To determine differences between algorithm treatment decisions in MAP. Methods: Women with asthma ( 1.5) and decreased for controlled ( 29, decrease when Results: In 220 non-smokers (109 control, 111 eNO), 1006 treatment decisions were made. Significant group differences in treatment decision after the first and second algorithm applications were found. At first change, the eNO group was less likely to have a “no change” decision (52% vs 74%) or decrease LABA (0% vs 6%) and more likely to decrease (9% vs 1%) or increase ICS (19% vs 9%). At second change, groups differed significantly for no (53% eNO bs 71% control), and increase ICS/LABA (13% eNO vs 1% control). The proportion of women on ICS differed between groups after the first change (63% vs 48%, P=0.03); ICS/LABA differed after the second change (39% vs 16%, P=0.0002). Conclusion: Group differences in algorithm treatment decisions were greatest earlier in pregnancy. The eNO algorithm permitted targeted ICS use (with more ICS titration). The increase in women using ICS+/-LABA may have contributed to reduced exacerbations.