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Tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils): a systematic review and meta-analysis.

Petsky, HL; Cates, CJ; Kew, KM; Chang, AB (2018) Tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils): a systematic review and meta-analysis. Thorax, 73 (12). pp. 1110-1119. ISSN 1468-3296 https://doi.org/10.1136/thoraxjnl-2018-211540
SGUL Authors: Cates, Christopher Joseph

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Abstract

BACKGROUND: Asthma guidelines guide health practitioners to adjust treatments to the minimum level required for asthma control. As many people with asthma have an eosinophilic endotype, tailoring asthma medications based on airway eosinophilic levels (sputum eosinophils or exhaled nitric oxide, FeNO) may improve asthma outcomes. OBJECTIVE: To synthesise the evidence from our updated Cochrane systematic reviews, for tailoring asthma medication based on eosinophilic inflammatory markers (sputum analysis and FeNO) for improving asthma-related outcomes in children and adults. DATA SOURCES: Cochrane reviews with standardised searches up to February 2017. STUDY SELECTION: The Cochrane reviews included randomised controlled comparisons of tailoring asthma medications based on sputum analysis or FeNO compared with controls (primarily clinical symptoms and/or spirometry/peak flow). RESULTS: The 16 included studies of FeNO-based management (seven in adults) and 6 of sputum-based management (five in adults) were clinically heterogeneous. On follow-up, participants randomised to the sputum eosinophils strategy (compared with controls) were significantly less likely to have exacerbations (62 vs 82/100 participants with ≥1 exacerbation; OR 0.36, 95% CI 0.21 to 0.62). For the FeNO strategy, the respective numbers were adults OR 0.60 (95% CI 0.43 to 0.84) and children 0.58 (95% CI 0.45 to 0.75). However, there were no significant group differences for either strategy on daily inhaled corticosteroids dose (at end of study), asthma control or lung function. CONCLUSION: Adjusting treatment based on airway eosinophilic markers reduced the likelihood of asthma exacerbations but had no significant impact on asthma control or lung function.

Item Type: Article
Additional Information: This article has been accepted for publication in Thorax following peer review. The definitive copyedited, typeset version Petsky HL, Cates CJ, Kew KM, et al Tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils): a systematic review and meta-analysis Thorax 2018;73:1110-1119 is available online at: http://dx.doi.org/10.1136/thoraxjnl-2018-211540
Keywords: asthma, exhaled airway markers, paediatric asthma, pulmonary eosinophilia, Respiratory System, 1103 Clinical Sciences
SGUL Research Institute / Research Centre: Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: Thorax
ISSN: 1468-3296
Language: eng
Dates:
DateEvent
December 2018Published
1 June 2018Published Online
14 May 2018Accepted
Publisher License: Publisher's own licence
Projects:
Project IDFunderFunder ID
10058213National Health and Medical Research Councilhttp://dx.doi.org/10.13039/501100000925
13/89/14Programme Grants for Applied ResearchUNSPECIFIED
PubMed ID: 29858277
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/109882
Publisher's version: https://doi.org/10.1136/thoraxjnl-2018-211540

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