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

Helen L Petsky, Chris J Cates, Kayleigh M Kew and Anne B Chang
Thorax Epub ahead of print: 01 June 2018.
doi: 10.1136/thoraxjnl-2018-211540

Personalising treatment of asthmatic patients is based on objective airway inflammation, which will be predominantly eosinophilic or non-eosinophilic (including neutrophilic). For both, inhaled corticosteroids (ICS) are the major preventer therapy to control asthma symptoms, with greater effectiveness seen in patients with eosinophilic inflammation.

Petsky and colleagues have previously published a systematic review on the analysis of objective airway inflammation. This updated review examines three recent related Cochrane reviews, and evaluates the efficacy of tailoring asthma medications based on fractional exhaled nitric oxide (FeNO) or sputum eosinophils in comparison with controls (clinical symptoms with or without spirometry/peak flow).

The 16 studies included seven (adult) of FeNO-based management and six (adult) of sputum-based management. Eosinophil-based asthma therapy decreases asthma exacerbations in adults, with no significant impact on asthma control or lung function. In children, treatment based on FeNO levels decreases asthma exacerbations, at the expense of increased ICS doses. There is insufficient evidence to advocate their use in routine clinical practice. In future, meta-analyses based on individual patient data of all studies may further inform the efficacy of strategies based on airway eosinophilic markers.

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