- Title
- Biomarker-guided management reduces exacerbations in non-eosinophilic asthma in pregnancy: a secondary analysis of a randomized controlled trial
- Creator
- Murphy, Vanessa E.; Porsbjerg, Celeste M.; Robijn, Annelies L.; Gibson, Peter G.
- Relation
- NHMRC.455592 http://purl.org/au-research/grants/nhmrc/455592
- Relation
- Respirology Vol. 25, Issue 7, p. 719-725
- Publisher Link
- http://dx.doi.org/10.1111/resp.13713
- Publisher
- Wiley-Blackwell Asia
- Resource Type
- journal article
- Date
- 2020
- Description
- 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 × 109/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.
- Subject
- asthma; eosinophils; nitric oxide; phenotype; pregnancy; Sustainable Development Goals; SDG 7
- Identifier
- http://hdl.handle.net/1959.13/1431677
- Identifier
- uon:38984
- Identifier
- ISSN:1323-7799
- Rights
- This is the peer reviewed version of the following article Murphy, Vanessa E.; Porsbjerg, Celeste M.; Robijn, Annelies L.; Gibson, Peter G. “Biomarker-guided management reduces exacerbations in non-eosinophilic asthma in pregnancy: a secondary analysis of a randomized controlled trial”. Respirology Vol. 25, Issue 7, p. 719-725 (2020), which has been published in final form at http://dx.doi.org/10.1111/resp.13713 This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of SelfArchived Versions.
- Language
- eng
- Full Text
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