Utility of fractional exhaled nitric oxide suppression as a prediction tool for progression to biologic therapy

被引:7
|
作者
Butler, Claire A. [1 ]
McMichael, Alan J. [2 ]
Honeyford, Kirsty [1 ]
Wright, Louise [1 ]
Logan, Jayne [1 ]
Holmes, Joshua [2 ]
Busby, John [2 ]
Hanratty, Catherine E. [1 ]
Yang, Freda [3 ,4 ]
Smith, Steven J. [3 ,4 ]
Murray, Kirsty [3 ,4 ]
Chaudhuri, Rekha [3 ,4 ]
Heaney, Liam G. [1 ,2 ]
机构
[1] Belfast City Hosp, Belfast, Antrim, North Ireland
[2] Queens Univ Belfast, Belfast, Antrim, North Ireland
[3] Gartnavel Royal Hosp, Glasgow, Lanark, Scotland
[4] Univ Glasgow, Glasgow, Lanark, Scotland
基金
英国医学研究理事会;
关键词
CLINICAL-OUTCOMES; ASTHMA; NONADHERENCE;
D O I
10.1183/23120541.00273-2021
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Rationale: The utility of fractional exhaled nitric oxide (F-ENO) suppression (FeNOSuppT) to identify non-adherence to inhaled corticosteroid (ICS) treatment has previously been reported, but whether it can predict clinical outcome remains unclear. Objectives: We examined the utility of FeNOSuppT in prediction of progression to biologic agents or discharge from specialist care. Methods: FeNOSuppT was measured at home using remote monitoring technology of inhaler use alongside daily F-ENO measurement over 7 days. Long-term clinical outcomes in terms of progression to biologic agent or discharge from specialist care were compared for non-suppressors and suppressors. Measurements and main results: Of the 162 subjects, 135 successfully completed the test with 81 (60%) positive F-ENO suppression tests. Subjects with a negative FeNOSuppT were more likely to proceed to biologic therapy (39 of 54 patients, 72%) compared to those with a positive FeNOSuppT (35 of 81 patients, 43%, p=0.001). In subjects with a positive FeNOSuppT, predictors of progression to biologic therapy included higher dose of maintenance steroid at initial assessment and prior intensive care unit admission. These subjects had a significant rise in F-ENO between post-suppression test and follow-up (median, 33 (IQR 25-55) versus 71 (IQR 24-114); p=0.009), which was not explained by altered corticosteroid dose. Conclusions: A negative FeNOSuppT correlates with progression to biologic therapy. A positive FeNOSuppT, with subsequent maintenance of "optimised" F-ENO, predicts a subgroup of patients in whom asthma control is preserved with adherence to high-dose ICS/long-acting beta 2 agonist and who can be discharged from specialist care.
引用
收藏
页码:00273 / 2021
页数:10
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