Comparison of treatment guidance based on bronchial responsiveness to mannitol, spirometry or exhaled nitric oxide in stable asthmatic childrenReport as inadecuate




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Aim: The goal of this studywas to compare asthma treatment guidance based on bronchial hyper-responsivenessto mannitol, spirometry or exhaled nitricoxide FeNO in stable asthmatic children. Methods: 60 stable allergicasthmatic children aged 7 to 16 years on a low to medium dose treatment with inhaledcorticosteroids ICS were recruited to a double blind randomised controlledtrial. At study entry visit 1, thefollowing was assessed: FeNO, spirometry, bronchial hyper-responsivenessto mannitol MDP- test, quality of life paediatric asthma quality-of-lifequestionnaire; PAQLQ and asthma control asthma control test; ACT. Subjectswere randomly assigned to one of three groups and treatment was modified by ablinded respiratory physician according to the test results of visit 1: ICSdose was doubled when FeNO was >22 ppb group 1, in case of a positiveMDP-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 group3 had a FEV1 < 80% of that predicted and had their ICS-dosedoubled. In group 1, FeNO decreased significantly after the intervention p = 0.005,whereas the self-administered and the interviewer-administered 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 mannitolchallenge nor spirometric results changedsignificantly. In group 2 and group 3, there were no significant changesin none of the assessed parameters. Conclusion: In this small pragmatic doubleblind randomised controlled study, we showed that ICS dose modification basedon FeNO led to increased quality of life and enhanced asthma control, and to areduction in airway inflammation and was superior to treatment modificationsbased on bronchial hyper-responsiveness to mannitol or on FEV1.

KEYWORDS

Exhaled Nitric Oxide; Mannitol; Treatment Guidance; Asthma; Children

Cite this paper

Patrick, L. , Demet, I. , Andreas, J. , Bruno, K. , Heinrich, W. and Alexander, M. 2013 Comparison of treatment guidance based on bronchial responsiveness to mannitol, spirometry or exhaled nitric oxide in stable asthmatic children. Open Journal of Pediatrics, 3, 406-417. doi: 10.4236-ojped.2013.34074.





Author: Lurà Marco Patrick, Inci Demet, Jung Andreas, Knoepfli Bruno, Wildhaber Johannes Heinrich, Moeller Alexander

Source: http://www.scirp.org/



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