Clinical effects of FeNO guided primary care interventions in patients with high SABA use

Introduction: Many patients with asthma rely on short-acting beta agonists (SABA) resulting in high levels of uncontrolled disease. Using fractional exhaled nitric oxide (FeNO), high SABA users with clinical need for initiating inhaled corticosteroids (ICS), increasing ICS dose or enhancing adherence to ICS can be identified. In the Netherlands, asthma is generally treated in primary care and a complete overview of medication history is available in the electronic pharmacy dispense system. We aimed to explore the value of using FeNO guided interventions in asthma patients selected by pharmacists based on high SABA use. Method: Multi-center pre-post intervention study performed in two Dutch community pharmacies, led by respiratory pharmacists, in collaboration with primary care colleagues. Patients with a clinical asthma diagnosis, aged 18-40 years and SABA overuse were invited for FeNO measurement, and Asthma Control Questionnaire (ACQ) and Test of Adherence to Inhalers (TAI) were administered. This was followed by tailormade interventions (inhaler technique/adherence feedback, (re)start/increase ICS dose, asthma self-management plan, stop smoking advice and/or referral to GP). Follow-up visits with the same measurements were at 3 months and 6 months. FeNO and ACQ differences between baseline and 6 months were compared using 2-sided paired samples T-tests. Results: In total, 34 patients (mean age: 28.5 years; 52.9% male; 14.7% smoker) were included and completed follow-up. At baseline, 20.6% used no ICS, 14.7% used ICS on-demand only and up to 16 devices SABA per patient were dispensed. Mean baseline FeNO was 39.9 (SD: 34.7) ppb, ACQ 1.23 (SD: 1.05) and TAI-10: 45.0 (SD: 5.7). At 6-months follow-up, FeNO and ACQ decreased significantly (both p<0.05) to 26.5 ppb and 0.74, respectively (Figure 1). Discussion: By targeting high SABA users using electronic pharmacy records, in combination with FeNO guided interventions, both inflammation and asthma control could be reduced. Larger, controlled studies are recommended.