FeNO guided primary care interventions in patients with high SABA use

<bold>Introduction:</bold> High short-acting beta agonists (SABA) use is associated with uncontrolled asthma. Fractional exhaled nitric oxide (FeNO) indicates airway inflammation. Both are easy to measure in primary care. As such, using FeNO, high SABA users with clinical need for initiating inhaled corticosteroids (ICS), increasing ICS dose or enhancing ICS adherence can be proactively identified. <bold>Aim:</bold> To explore the value of FeNO guided interventions in asthma patients selected by pharmacists based on high SABA use. <bold>Methods:</bold> Multi-center pre-post intervention study in 2 Dutch community pharmacies, led by respiratory pharmacists, in collaboration with primary care colleagues. Asthma patients 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 prompted 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 was at 3 and 6 months. FeNO and ACQ differences between baseline and 6 months were compared using 2-sided paired samples T-tests. <bold>Results:</bold> 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 and up to 16 SABA devices per patient were dispensed. Mean baseline FeNO was 39.9 (SD: 34.7) ppb, mean ACQ 1.23 (SD: 1.05) and mean TAI-10: 45.0 (SD: 5.7). At 6-months follow-up, mean FeNO and ACQ decreased significantly (both p<0.05) to 26.5 ppb and 0.74, respectively. <bold>Conclusion:</bold> By providing high SABA users with FeNO guided interventions, both inflammation and asthma control could be reduced.