Asthma and lower airway diseaseSymptom- and fraction of exhaled nitric oxide–driven strategies for asthma control: A cluster-randomized trial in primary care
Section snippets
Methods
This was an entirely investigator-designed and investigator-driven study. A detailed description of study procedures, sample size calculation, and measurements has been published elsewhere.22
Recruitment and baseline characteristics
Fig 1 provides the flowchart of the study. Between September 2009 and January 2012, 611 asthmatic patients participated, of whom 219 (in 44 clusters) were allocated to the PCa strategy, 203 (43 clusters) to the Ca strategy, and 189 (44 clusters) to the FCa strategy. All initially started general practices (clusters) completed the study.
Participants' baseline characteristics were similar for the 3 strategies (Table II). Table E2 in this article's Online Repository at www.jacionline.org shows a
Discussion
In this pragmatic cluster-randomized trial in patients with mild to moderately severe asthma in primary care, we found that a treatment approach aiming at PCa instead of Ca significantly decreases asthma medication use and associated costs, whereas asthma control, quality of life, and severe exacerbation rates remain similar. However, a strategy aiming at Ca that is additionally driven by a Feno measurement seems to be the preferred strategy because it also reduces asthma medication use and
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Supported by the Netherlands Organisation for Health Research and Development (ZON-MW, sub-programme Effects & Costs 80-82310-98-8627), and by the Netherlands Asthma Foundation (NAF 3.4.07.044). Aerocrine (Solna, Sweden) provided 20 of a total of 40 fraction of exhaled nitric oxide meters for free.
Disclosure of potential conflict of interest: This study was funded by the Netherlands Organization for Health Research and Development and the Netherlands Asthma Foundation and received nonfinancial support from Aerocrine. J. B. Snoeck-Stroband holds stock in Grace Bros and has received consultancy fees from AstraZeneca, GlaxoSmithKline, and Novartis, as well as grant funding from ACME Pharmaceutical. J. K. Sont has received research grants from Boehringer Ingelheim, GlaxoSmithKline, Chiesi, and Fonds NutsOhra (1101-081), as well as nonfinancial support from AstraZeneca (3.4.07.044). The rest of the authors declare that they have no other relevant conflicts of interest.