Boer Suzanne, Honkoop Persijn J, Loijmans Rik J B, Snoeck-Stroband Jiska B, Assendelft Willem J J, Schermer Tjard R J, Sont Jacob K
Dept of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands.
Dept of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.
ERJ Open Res. 2020 Sep 14;6(3). doi: 10.1183/23120541.00351-2019. eCollection 2020 Jul.
The aim of this study was to identify patients who benefit most from exhaled nitric oxide fraction ( )-driven asthma management in primary care, based on prespecified subgroups with different levels of .
We used data from 179 adults with asthma from a 12-month primary care randomised controlled trial with 3-monthly assessments of , asthma control, medication usage, costs of medication, severe asthma exacerbations and quality of life. In the original study, patients were randomised to either a symptom-driven treatment strategy (controlled asthma (Ca) strategy) or a +symptom-driven strategy (FCa). In both groups, patients were categorised by their baseline level of as low (<25 ppb), intermediate (25-50 ppb) and high (>50 ppb). At 12 months, we compared, for each prespecified subgroup, asthma control, asthma-related quality of life, medication usage, and costs of medication between the Ca and FCa strategy.
We found a difference between the Ca and FCa strategy for the mean dosage of beclomethasone strategy of 223 µg (95% CI 6-439), p=0.04) and for the total costs of asthma medication a mean reduction of US$159 (95% CI US$33-285), p=0.03) in patients with a low baseline level. No differences were found for asthma control, severe asthma exacerbations and asthma-related quality of life in patients with a low baseline level. Furthermore, in patients with intermediate or high level of , no differences were found.
In primary care, -driven asthma management is effective in patients with a low level, for whom it is possible to down-titrate medication, while preserving asthma control and quality of life.
本研究的目的是根据呼出一氧化氮分数（）水平不同的预先设定亚组，确定在初级保健中从呼出一氧化氮分数驱动的哮喘管理中获益最大的患者。
我们使用了一项为期12个月的初级保健随机对照试验中179例成年哮喘患者的数据，每3个月评估一次呼出一氧化氮分数、哮喘控制情况、药物使用情况、药物费用、严重哮喘发作和生活质量。在原研究中，患者被随机分配至症状驱动治疗策略（控制哮喘（Ca）策略）或呼出一氧化氮分数+症状驱动策略（FCa）。在两组中，患者根据其基线呼出一氧化氮分数水平分为低（<25 ppb）、中（25 - 50 ppb）和高（>50 ppb）三类。在12个月时，我们比较了每个预先设定的呼出一氧化氮分数亚组中，Ca策略和FCa策略在哮喘控制、哮喘相关生活质量、药物使用和药物费用方面的差异。
我们发现，对于基线呼出一氧化氮分数水平低的患者，Ca策略和FCa策略在倍氯米松平均剂量上存在差异（223 μg，95% CI 6 - 439，p = 0.04），哮喘药物总费用平均降低159美元（95% CI 33 - 285美元，p = 0.03）。对于基线呼出一氧化氮分数水平低的患者，在哮喘控制、严重哮喘发作和哮喘相关生活质量方面未发现差异。此外，在呼出一氧化氮分数水平为中或高的患者中，也未发现差异。
在初级保健中，呼出一氧化氮分数驱动的哮喘管理对呼出一氧化氮分数水平低的患者有效，这些患者可以在维持哮喘控制和生活质量的同时减少药物剂量。
