SESSION TITLE: Asthma Outcomes
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Sunday, October 25, 2015 at 07:30 AM - 08:30 AM
PURPOSE: To evaluate the utility of FeNO , a measure of eosinophilic airway inflammation, for family physicians assessing patients with symptomatic asthma.
METHODS: Asthma patients with symptoms despite their usual therapy were seen by their family physicians for management after submitting sputum for analysis of eosinophils, measurement of exhaled nitric oxide (FeNO), spirometry and completion of the Asthma Control Questionnaire(ACQ). The family physician was given the results of spirometry and peak flow (PEF) and the FeNO measurement with an accompanying algorithm to interpret the FeNO result (Taylor DR. Thorax 2006;61:817-27). They were blinded to the sputum eosinophil count. The patients were reassessed after three weeks and medication changes were recorded. The physicians completed a questionnaire evaluating the benefits of FeNO compared to symptoms, PEF/spirometry and how often they would use FeNO to manage asthma exacerbations.
RESULTS: 33 patients(11 M, 22F) were assessed and completed the study. Successful sputum results were obtained in 82%, FeNO in 98%. Visit 1 mean FeNO was 37.4 ppb, eosinophils 10.5%. 15 subjects had >30 ppb FeNO and 17 had a ACQ > 1.5. At visit 2 the mean FeNO was 33.8 (13 had FeNO > 30), eosinophils 7.4% and 8 subjects had an ACQ >1.5. 30/33 had inhaled corticosteroids(ICS) prescribed at baseline but only 22/33 used them regularly. 18/33 had changes made in their ICS therapy: 12 increased their ICS dose, 5/12 were new starts and 6 had a decrease in dose, 4/6 stopped ICS. Overall 54.5% had changes made in their ICS therapy, the FeNO algorithm would have predicted a change in 54-61% of subjects. 42% of physicians found the FeNO extremely or very helpful compared to symptoms alone, only 25% when compared to spirometry or PEF. 52% of physicians would use the FeNO sometimes or often and 17% would use it most of the time (>75%) when treating exacerbations.
CONCLUSIONS: The family physicians found FeNO measurements to be helpful in managing mild exacerbations of asthma, in particlular when compared to the use of symptoms alone. There were actual changes in ICS therapy in over 50% of patients with improvement in symptoms and markers of inflammation. The changes in ICS therapy by physicians correlated with suggested changes by a FeNO algorithm.
CLINICAL IMPLICATIONS: The use of an FeNO is likely to be helpful in addition to clinical evaluation for family physicians to increase or decrease ICS therapy for patients with mild exacerbations of asthma.
DISCLOSURE: The following authors have nothing to disclose: Mark Turner, Susan Attridge
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