A systematic review and meta-analysis: tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils)
Helen L. Petsky,Christopher J Cates,Toby J Lasserson,Albert M. Li,Catherine Turner,Jennifer A. Kynaston,Anne B. Chang +6 more
Reads0
Chats0
TLDR
It was concluded that tailoring of asthma treatment based on sputum eosinophils is effective in decreasing asthma exacerbations and there is insufficient justification to advocate the routine use of eitherSputum analysis or FeNO in everyday clinical practice.Abstract:
* Article free to read on publisher website ABSTRACT: Asthma severity and control can be measured both subjectively and objectively. Traditionally asthma treatments have been individualised using symptoms and spirometry/peak flow. Increasingly treatment tailored in accordance with inflammatory markers (sputum eosinophil counts or fractional exhaled nitric oxide (FeNO) data) is advocated as an alternative strategy. The objective of this review was to evaluate the efficacy of tailoring asthma interventions based on inflammatory markers (sputum analysis and FeNO) in comparison with clinical symptoms (with or without spirometry/peak flow) for asthma-related outcomes in children and adults. Cochrane Airways Group Specialised Register of Trials, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and reference lists of articles were searched. The last searches were in February 2009. All randomised controlled comparisons of adjustment of asthma treatment based on sputum analysis or FeNO compared with traditional methods (primarily clinical symptoms and spirometry/peak flow) were selected. Results of searches were reviewed against predetermined criteria for inclusion. Relevant studies were selected, assessed and data extracted independently by at least two people. The trial authors were contacted for further information. Data were analysed as 'intervention received' and sensitivity analyses performed. Six (2 adults and 4 children/adolescent) studies utilising FeNO and three adult studies utilising sputum eosinophils were included. These studies had a degree of clinical heterogeneity including definition of asthma exacerbations, duration of study and variations in cut-off levels for percentage of sputum eosinophils and FeNO to alter management in each study. Adults who had treatment adjusted according to sputum eosinophils had a reduced number of exacerbations compared with the control group (52 vs. 77 patients with >=1 exacerbation in the study period; p=0.0006). There was no significant difference in exacerbations between groups for FeNO compared with controls. The daily dose of inhaled corticosteroids at the end of the study was decreased in adults whose treatment was based on FeNO in comparison with the control group (mean difference -450.03 mug, 95% CI -676.73 to -223.34; p<0.0001). However, children who had treatment adjusted according to FeNO had an increase in their mean daily dose of inhaled corticosteroids (mean difference 140.18 mug, 95% CI 28.94 to 251.42; p=0.014). It was concluded that tailoring of asthma treatment based on sputum eosinophils is effective in decreasing asthma exacerbations. However, tailoring of asthma treatment based on FeNO levels has not been shown to be effective in improving asthma outcomes in children and adults. At present, there is insufficient justification to advocate the routine use of either sputum analysis (due to technical expertise required) or FeNO in everyday clinical practice.read more
Citations
More filters
Journal ArticleDOI
International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma
Kian Fan Chung,Sally E. Wenzel,Jan Brozek,Andrew Bush,Mario Castro,Peter J. Sterk,Ian M. Adcock,Eric D. Bateman,Elisabeth H. Bel,Eugene R. Bleecker,Louis-Philippe Boulet,Christopher E. Brightling,Pascal Chanez,Sven-Erik Dahlén,Ratko Djukanovic,Urs Frey,Mina Gaga,Peter G. Gibson,Qutayba Hamid,Nizar N. Jajour,Thais Mauad,Ronald L. Sorkness,W. Gerald Teague +22 more
TL;DR: Recommendations and guidelines on the evaluation and treatment of severe asthma in children and adults and coordinated research efforts for improved phenotyping will provide safe and effective biomarker-driven approaches to severe asthma therapy are provided.
Journal ArticleDOI
An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications.
Raed A. Dweik,Peter B. Boggs,Serpil C. Erzurum,Charles G. Irvin,Margaret W. Leigh,Jon O. Lundberg,Anna-Carin Olin,Alan L. Plummer,D. Robin Taylor +8 more
TL;DR: Recommendations to develop evidence-based guidelines for the interpretation of Fe(NO) measurements that incorporate evidence that has accumulated over the past decade are provided.
Journal ArticleDOI
Blood eosinophil count and prospective annual asthma disease burden: a UK cohort study
David Price,Anna Rigazio,Jonathan D. Campbell,Eugene R. Bleecker,Christopher Corrigan,Mike Thomas,Sally E. Wenzel,Andrew M. Wilson,Mary Buatti Small,Gokul Gopalan,Valerie L. Ashton,Anne Burden,Elizabeth V. Hillyer,Marjan Kerkhof,Ian D. Pavord +14 more
TL;DR: Patients with asthma and blood eosinophil counts greater than 400 cells per μL experience more severe exacerbations and have poorer asthma control, and a count-response relation exists between blood eOSinophils counts and asthma-related outcomes.
Journal ArticleDOI
External validation of blood eosinophils, FE NO and serum periostin as surrogates for sputum eosinophils in asthma
Ariane H. Wagener,S.B. de Nijs,René Lutter,Ana R. Sousa,Els J.M. Weersink,E.H.D. Bel,P. J. Sterk +6 more
TL;DR: In patients with mild to moderate asthma, as well as patients with more severe asthma, blood eos inophils had the highest accuracy in the identification of sputum eosinophilia in asthma.
Journal ArticleDOI
Allergen-induced asthmatic responses modified by a GATA3-specific DNAzyme.
Norbert Krug,Jens M. Hohlfeld,Anne-Marie Kirsten,Oliver Kornmann,Kai Michael Beeh,Dominik Kappeler,Stephanie Korn,Stanislav Ignatenko,Wolfgang Timmer,Cordelia Rogon,Jana Zeitvogel,Nan Zhang,Joachim Bille,Ursula Homburg,Agnieszka Turowska,Claus Bachert,Thomas Werfel,Roland Buhl,Jonas Renz,Holger Garn,Harald Renz +20 more
TL;DR: Treatment with SB010 significantly attenuated both late and early asthmatic responses after allergen provocation in patients with allergic asthma, and biomarker analysis showed an attenuation of Th2-regulated inflammatory responses.
References
More filters
Journal ArticleDOI
The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration
Alessandro Liberati,Douglas G. Altman,Jennifer Tetzlaff,Cynthia D. Mulrow,Peter C Gøtzsche,John P. A. Ioannidis,Mike Clarke,Philip J. Devereaux,Jos Kleijnen,David Moher +9 more
TL;DR: The meaning and rationale for each checklist item is explained, and an example of good reporting is included and, where possible, references to relevant empirical studies and methodological literature are included.
Journal ArticleDOI
Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial.
Ruth H. Green,Christopher E. Brightling,S McKenna,Beverley Hargadon,Debbie Parker,Peter Bradding,Andrew J. Wardlaw,Ian D. Pavord +7 more
TL;DR: A treatment strategy directed at normalisation of the induced sputum eosinophil count reduces asthma exacerbations and admissions without the need for additional anti-inflammatory treatment.
Journal ArticleDOI
An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice.
Helen K. Reddel,D. Robin Taylor,Eric D. Bateman,Louis-Philippe Boulet,Homer A. Boushey,William W. Busse,Thomas B. Casale,Pascal Chanez,Paul L. Enright,Peter G. Gibson,Johan C. de Jongste,Huib A. M. Kerstjens,Stephen C. Lazarus,Mark L Levy,Paul M. O'Byrne,Martyn R Partridge,Ian D. Pavord,Malcolm R. Sears,Peter J. Sterk,Stuart W. Stoloff,Sean D. Sullivan,Stanley J. Szefler,Mike Thomas,Sally E. Wenzel +23 more
TL;DR: New definitions for asthma control, severity, and exacerbations are developed, based on current treatment principles and clinical and research relevance, to provide a basis for a multicomponent assessment of asthma by clinicians, researchers, and other relevant groups in the design, conduct, and evaluation of clinical trials, and in clinical practice.
Journal ArticleDOI
Use of exhaled nitric oxide measurements to guide treatment in chronic asthma.
TL;DR: With the use of FE(NO) measurements, maintenance doses of inhaled corticosteroids may be significantly reduced without compromising asthma control.