Children born to women with asthma whose condition was managed based on the fraction of exhaled nitric oxide, or FENO, in addition to their asthma symptoms as opposed to asthma symptoms only were more than 50% less likely to have diagnosed asthma in early childhood, according to results of a double-blind, randomized clinical trial.
“Asthma during pregnancy may shape the child’s future asthma risk trajectory via an interaction between heritability and in utero exposures at the feto-maternal interface,” Matthew Morten, PhD, a research associate at the University of Newcastle School of Medicine and Public Health, and colleagues wrote. “Notably, very common exposures such as asthma medications and exacerbations during pregnancy have not been investigated for an association with the child’s asthma risk.”
The Managing Asthma in Pregnancy (MAP) trial included 179 pregnant women in Newcastle, Australia. The trial compared the efficacy of a treatment algorithm that combined the assessment of clinical symptoms of asthma with FENO against a symptoms-only approach to asthma management.
Follow-up information was collected for 78% of children aged between 4 and 6 years.
Children whose mothers received FENO-guided treatment were less likely to have diagnosed asthma compared with children whose mothers received treatment based only on symptoms (25.9% vs. 43.2%; OR = 0.46; 95% CI, 0.22-0.96). When the researchers examined health care outcomes in the past 12 months, children of mothers receiving FENO-guided treatment were also less likely to have frequent wheeze (OR = 0.27; 95% CI, 0.09-0.87), require short-acting beta-agonists (OR = 0.49; 95% CI, 0.25-0.97) and to have lower ED use (OR = 0.17; 95% CI, 0.04-0.76).
Morten and colleagues found that FENO-guided asthma management also had a “natural indirect effect” on any use of inhaled corticosteroids, or ICS (OR = 0.83; 95% CI, 0.59-0.99), and the time when the first change in dosing occurred (OR = 0.9; 95% CI, 0.7-1.03) for children with asthma.
The researchers noted that FENO-guided asthma management may have promoted more appropriate ICS use among pregnant women in the study, which therefore had an effect on the incidence childhood asthma.
“Importantly, our results provide long-term child health outcomes to further support the clinical consensus that the benefits of ICS therapy in pregnancy, when guided by FENO levels and clinical symptoms, largely outweigh their potential risks,” the researchers wrote. – by Katherine Bortz
Disclosures: Morten reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.