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Managing Asthma in Pregnancy (MAP) trial: FENO levels and childhood asthma
- Source :
- Journal of Allergy and Clinical Immunology. 142:1765-1772.e4
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Background The single-center double-blind, randomized controlled Managing Asthma in Pregnancy (MAP) trial in Newcastle, Australia, compared a treatment algorithm using the fraction of exhaled nitric oxide (FENO) in combination with asthma symptoms (FENO group) against a treatment algorithm using clinical symptoms only (clinical group) in pregnant asthmatic women (Australian New Zealand Clinical Trials Registry, no. 12607000561482). The primary outcome was a 50% reduction in asthma exacerbations during pregnancy in the FENO group. However, the effect of FENO-guided management on the development of asthma in the offspring is unknown. Objective We sought to investigate the effect of FENO-guided asthma management during pregnancy on asthma incidence in childhood. Methods A total of 179 mothers consented to participate in the Growing into Asthma (GIA) double-blind follow-up study with the primary aim to determine the effect of FENO-guided asthma management on childhood asthma incidence. Results A total of 140 children (78%) were followed up at 4 to 6 years of age. FENO-guided as compared to symptoms-only approach significantly reduced doctor-diagnosed asthma (25.9% vs 43.2%; odds ratio [OR], 0.46, 95% CI, 0.22-0.96; P = .04). Furthermore, frequent wheeze (OR, 0.27; 95% CI, 0.09-0.87; P = .03), use of short-acting β-agonists (OR, 0.49; 95% CI, 0.25-0.97; P = .04), and emergency department visits for asthma (OR, 0.17; 95% CI, 0.04-0.76; P = .02) in the past 12 months were less common in children born to mothers from the FENO group. Doctor-diagnosed asthma was associated with common risk alleles for early onset asthma at gene locus 17q21 ( P = .01 for rs8069176; P = .03 for rs8076131), and higher airways resistance ( P = .02) and FENO levels ( P = .03). A causal mediation analysis suggested natural indirect effects of FENO-guided asthma management on childhood asthma through "any use" and "time to first change in dose" of inhaled corticosteroids during the MAP trial (OR: 0.83; 95% CI: 0.59-0.99, and OR: 0.90; 95% CI: 0.70-1.03, respectively). Conclusions FENO-guided asthma management during pregnancy prevented doctor-diagnosed asthma in the offspring at preschool age, in part mediated through changes in use and dosing of inhaled corticosteroids during the MAP trial.
- Subjects :
- medicine.medical_specialty
Immunology
Nitric Oxide
law.invention
03 medical and health sciences
0302 clinical medicine
Double-Blind Method
Randomized controlled trial
Adrenal Cortex Hormones
Pregnancy
Interquartile range
law
Internal medicine
Wheeze
medicine
Humans
Immunology and Allergy
Anti-Asthmatic Agents
030212 general & internal medicine
Child
Asthma
business.industry
Incidence (epidemiology)
Odds ratio
Adrenergic beta-Agonists
medicine.disease
respiratory tract diseases
Breath Tests
030228 respiratory system
Exhalation
Child, Preschool
Exhaled nitric oxide
Female
medicine.symptom
business
Subjects
Details
- ISSN :
- 00916749
- Volume :
- 142
- Database :
- OpenAIRE
- Journal :
- Journal of Allergy and Clinical Immunology
- Accession number :
- edsair.doi.dedup.....bbbd36ed51214de57ee6933b9a9ca1f5