Biomarker‐guided management reduces exacerbations in non‐eosinophilic asthma in pregnancy: A secondary analysis of a randomized controlled trial. Issue 7 (26th October 2019)

• Record Type: Journal Article
• Authors: Murphy, Vanessa E.; Porsbjerg, Celeste M.; Robijn, Annelies L.; Gibson, Peter G.
• Is Part Of: Respirology. Volume 25:Issue 7(2020)
• Page Start: 719
• Page End: 725
• Publication Date: 2019-10-26
• Subjects: asthma -- eosinophils -- nitric oxide -- phenotype -- pregnancy; Respiratory organs -- Diseases -- Periodicals; Respiratory organs -- Periodicals; 612.2
• DOI: 10.1111/resp.13713
• Languages: English
• ISSNs: 1323-7799

Abstract

ABSTRACT: Background and objective: The aim of this secondary analysis of a randomized controlled trial (RCT) of asthma management in pregnancy was to determine the treatment decision differences between a symptom control algorithm and a fractional exhaled nitric oxide (FENO)‐guided algorithm, and whether the approach was effective in non‐eosinophilic asthma (NEA). Methods: In this double‐blind parallel group RCT, women with asthma were randomized prior to 22 weeks gestation to treatment adjustment according to a symptom control algorithm (control group), or a FENO‐guided algorithm (inhaled corticosteroid (ICS) dose adjusted according to FENO with long‐acting beta‐agonist (LABA) added for uncontrolled symptoms). NEA was classified as baseline blood eosinophils <0.26 × 10 9 /L and FENO ≤29 ppb. Exacerbations requiring medical intervention were recorded. Results: Among 220 non‐smokers ( n = 109 control, n = 111 FENO), 1006 treatment decisions were made, with significant group differences after the first and second algorithm applications. 53% of women had NEA. Treatment was better targeted to phenotype in the FENO group: ICS use increased in eosinophilic asthma (EA, 48–86%), while ICS/LABA increased in NEA (11–30%). Fewer women in the FENO group had exacerbations during pregnancy in NEA only (18.9% FENO vs 44% control, P = 0.006). Conclusion: The FENO algorithm was more effective in treating NEA, resulting in reduced exacerbations, compared to a symptom control algorithm. This was not the result of ICS overtreatment, since the benefits occurred at a lower median daily ICS dose. Two applications of the FENO‐guided algorithm, one month apart, were sufficient to achieve beneficial effects in terms of asthma exacerbations, among pregnant women with asthma. Abstract : This study shows that a FENO‐guided algorithm for asthma treatment adjustment in pregnancy better targets treatment to phenotype than a symptom control algorithm, with reduced exacerbations in non‐eosinophilic asthma. See related Editorial