Exhaled nitric oxide in childhood allergic asthma management: A randomised controlled trial

Peirsman, Eva; Carvelli, T.; Hage, Pierre; Hanssens, Laurence; Pattyn, Luc; Raes, Marc; Sauer, Kate; Vermeulen, Françoise; Desager, Kristine

doi:10.1002/ppul.22873

Cited by 56 publications

(76 citation statements)

References 27 publications

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“…(44) FENO has been shown to correlate with health outcomes in asthma; in one study, the cohort monitored by FENO had an increased use of leukotrienes and inhaled corticosteroids and decreased exacerbation frequency compared with the control group. (45) FENO is promising for use as a potential endpoint for clinical studies of aerosol medications specifically for inflammatory lung disease, especially as reference equations have begun to be generated.…”

Section: Exhaled Nitric Oxidementioning

confidence: 99%

Challenges and Limitations of Testing Efficacy of Aerosol Device Delivery in Young Children

Goralski

Davis

2014

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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An increasing number of medical conditions are chronically or acutely managed with some form of aerosolized therapy. Due to the benefit of directly administering medications to the intended site of action, there is great interest in evaluating treatments for aerosol use. One of the major challenges in selecting and testing new drug-device combinations in children is the uncertainty regarding the appropriate outcome measure to choose. In studies involving adult patients, typically exacerbations of disease or airflow obstruction are assessed as endpoints in drug trials or device assessment. However, in young children, choosing endpoints to assess efficacy is difficult due to the potential lack of sensitive, noninvasive endpoints that are easily performed across sites. In this review, we discuss the challenges and limitations of selecting clinical endpoints for drug-device trials in the youngest population, with a focus on novel emerging technologies. This article provides an overview of preschool and infant pulmonary function testing, multiple-breath washout, imaging techniques including computed tomography and magnetic resonance imaging, flexible bronchoscopy in children, mucociliary clearance scans, and exhaled breath condensate.

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Section: Exhaled Nitric Oxidementioning

confidence: 99%

Challenges and Limitations of Testing Efficacy of Aerosol Device Delivery in Young Children

Goralski

Davis

2014

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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“…The baseline daily ICS dosage of 320 mg was near the plateau of doseresponse curve, allowing little room for improvement on the daily symptoms and lung function. 3 Add-on LTRA to ICS also offers little additional benefit on asthma control and FEV 1 . 4 On the other hand, it has been shown that enhanced adherence to ICS may result in elevation of the threshold of asthma exacerbation.…”

mentioning

confidence: 97%

“…1 The authors aimed to employ fractional exhaled nitric oxide (FeNO), a surrogate marker for eosinophilic airway inflammation, in guiding drug treatment for children with mild to severe persistent asthma. Patients were allocated into the clinical group or the FeNO group.…”

mentioning

confidence: 99%

Fractional exhaled nitric oxide-guided algorithm for children with asthma

Lee¹

2014

Pediatr Pulmonol.

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Fractional exhaled nitric oxide (FeNO) is a surrogate marker of eosinophilic airway inflammation in asthma. The randomized controlled parallel study published by Peirsman et al combined GINA guidelines and FeNO level in guiding drug treatment in children with mild to severe asthma. Their target was to control the FeNO level below 20 ppb. The FeNO group resulted in increasing the dosage of inhaled corticosteroid and the usage of leukotriene receptor antagonist. However, the study was not truly randomized and drug adherence was not reported. The FeNO-guided algorithm failed to improve the primary outcome, the symptom-free days, but did result in decreasing the number of acute exacerbations and unscheduled contacts. Unfortunately the authors did not demonstrate a persistent and significant difference in FeNO levels between both groups. As the final FeNO levels were not reported, it remains unclear whether their target was met.

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“…FeNO testing has shown its value in identifying individuals who respond to inhaled corticosteroids [7][8] and biologic therapy [9] and has acted as a complement to conventional monitoring of asthma in children and adults in several randomized controlled clinical trials [10][11][12][13][14][15][16]. Moreover, in 2014, the National Institute for Health and Care Excellence (NICE) recommended FeNO testing to help diagnose asthma in adults and children when diagnosis is unclear.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness and Budget Impact of Routine Use of Fractional Exhaled Nitric Oxide Monitoring for the Management of Adult Asthma Patients in Spain

Sabatelli

Seppälä

Sastre

et al. 2017

J Investig Allergol Clin Immunol

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Objectives: Fractional exhaled nitric oxide (FeNO) is a marker for type 2 airway inflammation. The objective of this study was to evaluate the cost-effectiveness and budget impact of FeNO monitoring for management of adult asthma in Spain. Methods: A cost-effectiveness analysis model was used to evaluate the effect on costs of adding FeNO monitoring to asthma management. Over a 1-year period, the model estimated the incremental cost per quality-adjusted life year and incremental number of exacerbations avoided when FeNO monitoring was added to standard guideline-driven asthma care compared with standard care alone. Univariate and multivariate sensitivity analyses were applied to explore uncertainty in the model. A budget impact model was used to examine the impact of FeNO monitoring on primary care costs across the Spanish health system. Results: The results showed that adding FeNO to standard asthma care saved €62.53 per patient-year in the adult population and improved quality-adjusted life years by 0.026 per patient-year. The budget impact analysis revealed a potential net yearly saving of €129 million if FeNO monitoring had been used in primary care settings in Spain. Conclusions: The present economic model shows that adding FeNO to the treatment algorithm can considerably reduce costs and improve quality of life when used to manage asthma in combination with current treatment guidelines. Key words: Asthma management. Biomarker. Budget impact. Cost-effectiveness. FeNO. Guidelines. Exhaled nitric oxide. ResumenObjetivos: La fracción exhalada del óxido nítrico (FeNO) es un marcador de la inflamación bronquial de tipo Th-2. El objetivo de este estudio ha sido evaluar el coste-efectividad e impacto presupuestario de la monitorización del FeNO en el manejo del asma del adulto en España. Métodos: Se ha utilizado un modelo de análisis de coste-efectividad para evaluar los resultados económicos cuando se utilizó el FeNO en el manejo del asma durante un año. El modelo estimó el incremento de coste por calidad de vida ajustada por año (QALY) y el número de exacerbaciones evitadas cuando se añadió el FeNO a la guía habitual de tratamiento del asma en comparación con la guía habitual. Se aplicó un análisis univariante y multivariante para valorar la posible incertidumbre del modelo. Se utilizó un modelo de impacto presupuestario para evaluar el impacto económico de la introducción de la monitorización con el FeNO en consultas de atención primaria del estado español y teniendo en cuenta el sistema sanitario español. Resultados: Se ha demostrado que el añadir el FeNO al tratamiento habitual del asma ahorra 62,53€ por paciente por año en adultos con asma y mejoró la QALYs en 0,026 por paciente y año. El análisis económico resultó en un ahorro estimado de 129 millones de euros netos por año en consultas de atención primaria. Conclusiones: El modelo económico utilizado ha mostrado que el añadir el FeNO al algoritmo habitual de tratamiento del asma conlleva a un importante ahorro en recursos económicos y un aumento d...

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Exhaled nitric oxide in childhood allergic asthma management: A randomised controlled trial

Abstract: FeNO measurements in childhood asthma management did not improve the proportion of symptom-free days, but did result in fewer asthma exacerbations associated with an increased leukotriene receptor antagonist use and an augmentation of the inhaled corticosteroid doses.

Cited by 56 publications

References 27 publications

Challenges and Limitations of Testing Efficacy of Aerosol Device Delivery in Young Children

Challenges and Limitations of Testing Efficacy of Aerosol Device Delivery in Young Children

Fractional exhaled nitric oxide-guided algorithm for children with asthma

Cost-effectiveness and Budget Impact of Routine Use of Fractional Exhaled Nitric Oxide Monitoring for the Management of Adult Asthma Patients in Spain

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