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The Role of FeNO in Cough Management: A Randomised Controlled Trial
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A1368 - The Role of FeNO in Cough Management: A Randomised Controlled Trial
Author Block: D. B. Price1, R. Buhl2, A. Chan3, D. Freeman4, E. Gardener1, C. Godley5, K. Gruffydd-Jones6, L. McGarvey7, K. Ohta8, D. Ryan9, J. Syk10, N. Tan11, T. Tan12, M. Thomas13, S. Yang1, P. R. Konduru14, M. Ngantcha1, M. Stagno d’Alcontres1, T. S. Lapperre12; 1Observational and Pragmatic Research Institute, Singapore, Singapore, 2Mainz University Hospital, Mainz, Germany, 3Singapore General Hospital, Singapore, Singapore, 4Mundesley Medical Centre, Norfolk, United Kingdom, 5Avondale Medical Practice, Strathaven, United Kingdom, 6Box Surgery, Box, United Kingdom, 7Queen’s University Belfast, Belfast, United Kingdom, 8National Hospital Organization Tokyo National Hospital, Tokyo, Japan, 9Usher Institute of Population Health Sciences and Informatics, Edinburgh, United Kingdom, 10Karolinska Institutet, Stockholm, Sweden, 11SingHealth Polyclinics, Singapore, Singapore, 12National University of Singapore, Singapore, Singapore, 13University of Southampton, Southampton, United Kingdom, 14Optimum Patient Care, Cambridge, United Kingdom.
Background: Fractional exhaled nitric oxide (FeNO) is useful in predicting treatment response in asthma, but it is unknown whether it is a useful baseline measure in patients with cough symptoms and previously undiagnosed asthma.
Aims and objectives: To estimate the interaction between baseline FeNO and treatment effect, in terms of cough symptoms, in patients with non-specific respiratory symptoms.
Methods: This was a multi-centre, randomised controlled trial, where patients in UK and Singapore were randomised to receive either extrafine inhaled corticosteroids (ICS, 200 µg beclomethasone bid) or placebo for a 4-week period. NIOX VERO (Circassia) was used to measure baseline FeNO. The primary endpoint was change in Asthma Control Questionnaire score. This work presents the results for a secondary endpoint: change in Visual Analogue Scale (VAS) Cough.
Results: The predominant baseline symptom of the study sample (n=257) was cough, present in 85% of patients. We found that higher FeNO was associated with a greater treatment effect. For every 10 ppb increase in baseline FeNO, the change in VAS Cough was 3.115 (95% confidence interval [CI], 0.579-5.651) greater in the extrafine ICS arm versus placebo. In a univariable prediction model of the extrafine ICS arm, patients with baseline FeNO >50 ppb were over twice as likely to improve in VAS Cough by ≥20 as patients with FeNO ≤50 ppb (unadjusted odds ratio, 2.37 [95% CI, 1.01-5.55]).
Conclusions: FeNO measurement is a simple, near patient, quantitative and non-invasive diagnostic tool for patients with cough symptoms: treatment with ICS may be successful in patients found to have high FeNO. Further research is needed to establish cut-points for recommendation.
Author Block: D. B. Price1, R. Buhl2, A. Chan3, D. Freeman4, E. Gardener1, C. Godley5, K. Gruffydd-Jones6, L. McGarvey7, K. Ohta8, D. Ryan9, J. Syk10, N. Tan11, T. Tan12, M. Thomas13, S. Yang1, P. R. Konduru14, M. Ngantcha1, M. Stagno d’Alcontres1, T. S. Lapperre12; 1Observational and Pragmatic Research Institute, Singapore, Singapore, 2Mainz University Hospital, Mainz, Germany, 3Singapore General Hospital, Singapore, Singapore, 4Mundesley Medical Centre, Norfolk, United Kingdom, 5Avondale Medical Practice, Strathaven, United Kingdom, 6Box Surgery, Box, United Kingdom, 7Queen’s University Belfast, Belfast, United Kingdom, 8National Hospital Organization Tokyo National Hospital, Tokyo, Japan, 9Usher Institute of Population Health Sciences and Informatics, Edinburgh, United Kingdom, 10Karolinska Institutet, Stockholm, Sweden, 11SingHealth Polyclinics, Singapore, Singapore, 12National University of Singapore, Singapore, Singapore, 13University of Southampton, Southampton, United Kingdom, 14Optimum Patient Care, Cambridge, United Kingdom.
Background: Fractional exhaled nitric oxide (FeNO) is useful in predicting treatment response in asthma, but it is unknown whether it is a useful baseline measure in patients with cough symptoms and previously undiagnosed asthma.
Aims and objectives: To estimate the interaction between baseline FeNO and treatment effect, in terms of cough symptoms, in patients with non-specific respiratory symptoms.
Methods: This was a multi-centre, randomised controlled trial, where patients in UK and Singapore were randomised to receive either extrafine inhaled corticosteroids (ICS, 200 µg beclomethasone bid) or placebo for a 4-week period. NIOX VERO (Circassia) was used to measure baseline FeNO. The primary endpoint was change in Asthma Control Questionnaire score. This work presents the results for a secondary endpoint: change in Visual Analogue Scale (VAS) Cough.
Results: The predominant baseline symptom of the study sample (n=257) was cough, present in 85% of patients. We found that higher FeNO was associated with a greater treatment effect. For every 10 ppb increase in baseline FeNO, the change in VAS Cough was 3.115 (95% confidence interval [CI], 0.579-5.651) greater in the extrafine ICS arm versus placebo. In a univariable prediction model of the extrafine ICS arm, patients with baseline FeNO >50 ppb were over twice as likely to improve in VAS Cough by ≥20 as patients with FeNO ≤50 ppb (unadjusted odds ratio, 2.37 [95% CI, 1.01-5.55]).
Conclusions: FeNO measurement is a simple, near patient, quantitative and non-invasive diagnostic tool for patients with cough symptoms: treatment with ICS may be successful in patients found to have high FeNO. Further research is needed to establish cut-points for recommendation.
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