TITLE:
Comparison of treatment guidance based on bronchial responsiveness to mannitol, spirometry or exhaled nitric oxide in stable asthmatic children
AUTHORS:
Lurà Marco Patrick, Inci Demet, Jung Andreas, Knoepfli Bruno, Wildhaber Johannes Heinrich, Moeller Alexander
KEYWORDS:
Exhaled Nitric Oxide; Mannitol; Treatment Guidance; Asthma; Children
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.3 No.4,
December
20,
2013
ABSTRACT: Aim: The goal of this study
was to compare asthma treatment guidance based on bronchial hyper-responsiveness
to mannitol, spirometry or exhaled nitric
oxide (FeNO) in stable asthmatic children. Methods: 60 stable allergic
asthmatic children aged 7 to 16 years on a low to medium dose treatment with inhaled
corticosteroids (ICS) were recruited to a double blind randomised controlled
trial. At study entry (visit 1), the
following was assessed: FeNO, spirometry, bronchial hyper-responsiveness
to mannitol (MDP-test), quality of life (paediatric asthma quality-of-life
questionnaire; PAQLQ) and asthma control (asthma control test; ACT). Subjects
were randomly assigned to one of three groups and treatment was modified by a
blinded respiratory physician according to the test results of visit 1: ICS
dose was doubled when FeNO was >22 ppb (group 1), in case of a positive
MDP-test (group 2) or when FEV1 was 22 ppb, 8 children out of 16 (50%)
in group 2 showed a positive MDP-test and 3 children out of 16 (18.7%) in group
3 had a FEV1 inistered PAQLQ (p = 0.02 resp. p = 0.033) as well as the ACT (p =
0.031) increased. Neither the number of children with a positive mannitol
challenge nor spirometric results changed
significantly. In group 2 and group 3, there were no significant changes
in none of the assessed parameters. Conclusion: In this small pragmatic double
blind randomised controlled study, we showed that ICS dose modification based
on FeNO led to increased quality of life and enhanced asthma control, and to a
reduction in airway inflammation and was superior to treatment modifications
based on bronchial hyper-responsiveness to mannitol or on FEV1.