Biomarker‐guided algorithm reduces noneosinophilic asthma exacerbations in pregnancy

The fractional exhaled nitric oxide (FENO)‐guided algorithm is more effective than a symptom control algorithm in reducing exacerbations during pregnancy among women with noneosinophilic asthma (NEA), a recent study has shown.

“Two applications of the FENO‐guided algorithm, one month apart, were sufficient to achieve beneficial effects in terms of asthma exacerbations, among pregnant women with asthma,” the authors said.

Women with asthma participated in this double-blind parallel group randomized controlled trial and prior to 22 weeks gestation were assigned to treatment adjustment according to a symptom control algorithm (control group) or a FENO-guided algorithm (inhaled corticosteroid [ICS] dose adjusted according to FENO with long-acting beta-agonist [LABA] added for uncontrolled symptoms.

NEA was classified as baseline blood eosinophils <0.26 × 10⁹/L and FENO ≤29 ppb. Exacerbations that required medical intervention were recorded.

A total of 1,006 treatment decisions were carried out among 220 nonsmokers (n=109 control; n=111 FENO), with significant group differences after the first and second algorithm applications. More than half of the women (53 percent) had NEA.

Treatment was better targeted to phenotype in women on a FENO-guided algorithm: ICS use increased in eosinophilic asthma (EA; 48–86 percent), while ICS/LABA increased in NEA (11–30 percent). Exacerbations decreased during pregnancy in NEA, but not EA, in the FENO group (18.9 percent FENO vs 44 percent control; p=0.006).

“This was not the result of ICS overtreatment, since the benefits occurred at a lower median daily ICS dose,” the authors said.