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dc.contributor.authorSothirajah, Shobana
dc.date.accessioned2008-09-26
dc.date.available2008-09-26
dc.date.issued2008-09-01
dc.identifier.urihttp://hdl.handle.net/2123/3546
dc.descriptionMaster of Science in Medicineen
dc.description.abstractRationale: Asthma management aims to achieve optimal control on the minimal effective dose of medication. We assessed the effectiveness of two algorithms to guide ICS dose in well-controlled patients on ICS+LABA in a double-blind study, comparing dose adjustment guided by exhaled nitric oxide (eNO) to clinical care algorithm(CCA) based on symptoms and lung function. Methods: We randomised non-smoking adult asthmatics on minimum FP dose 100μgs daily +LABA to ICS adjustment using eNO or CCA, assessed over 5 visits during 8 months treatment. Primary endpoints were asthma-free days and asthma related quality of life (QOL). Analysis was by mixed model regression and generalised estimating equations with log link. Results: 69 subjects were randomised (eNO:34, CCA:35) and 58 completed the study. At baseline mean FEV1 was 94% pred., mean eNO (200ml/sec) 7.1 ppb, median ACQ6 score 0.33. Median ICS dose was 500 μg (IQR 100-500) at baseline and 100 μg on both eNO (IQR 100-200) and CCA arms (IQR 100–100) at end of study. There were no significant differences between eNO and CCA groups in asthma-free days (RR=0.92, 95% CI 0.8–1.01), AQL (RRAQL<median = 0.95, 95% CI 0.8–1.1) or exacerbation-free days (HR = 1.03, 95%CI 0.6–1.7). Neither clinic FEV1 (overall mean difference FEV1 % pred. -0.24%, 95% CI -2.2–1.7) nor a.m. PEF (mean difference 1.94 L/min (95% CI -2.9–6.8) were significantly different. Similar proportions of subjects were treated for ≥1 exacerbation (eNO: 50%, 95% CI 32.1–67.9; CCA: 60%, 95% CI 43.9–76.2). Conclusion: Substantial reductions in ICS doses were achieved in well controlled asthmatics on ICS+LABA, with no significant differences in outcomes between eNO or clinically based algorithms.en
dc.publisherUniversity of Sydney.en
dc.publisherFaculty of Medicineen
dc.rightsThe author retains copyright of this thesis.
dc.rights.urihttp://www.library.usyd.edu.au/copyright.html
dc.subjectasthma controlen
dc.subjecteNOen
dc.subjectexhaled nitric oxideen
dc.subjectICSen
dc.subjectinhaled corticosteriodsen
dc.subjectdown titrationen
dc.subjectdose titrationen
dc.subjectairway inflammationen
dc.titleClinical Algorithms for Maintaining Asthma Controlen
dc.typeMasters Thesisen
dc.date.valid2008-01-01en


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