Conclusion
Our goal was to evaluate the prediction of treatment outcomes in
childhood asthma after six months of medication use based on initial
assessment. Our results show that asthma control (LOAC) was well
predicted, while the prediction quality of lung function- based
treatment outcomes (FEV1, MEF50) was rather low. These results are in
concordance with the GINA control-based management approach, while lung
function may not be the tool of choice to be used in guiding treatment
in children with asthma21. The prediction model for
FENO-based treatment response performed better in almost all aspects
than lung function-related outcomes, which suggests that treatment
success guided by changes in FENO might be a complementary tool in
childhood asthma management21.
Our results also suggest that the current guidelines in asthma
management and current expertise in clinical assessment (assessment of
severity and disease control) are satisfactory in most cases.
Additionally, since total IgE was one of the best predictive variables
for FENO-based outcomes, this indicates that T2-high asthma subtypes in
children respond best to common controller medication. Although machine
learning has shown how treatment outcome prediction can be driven, it
has revealed certain issues that need to be addressed in future studies:
- In respect with asthma chronicity the assessment period of 6 months
may not be enough for valid predictions. Longitudinal and prospective
studies are essential;
- Additional studies involving larger numbers of patients with even more
clinically relevant parameters are required to increase the success of
treatment outcome prediction and in further characterization of
specific disease phenotypes and endotypes.
Recently, much focus has been given to the implementation of precision
medicine in asthma, and experts emphasize that the time for action is
now. The use of big data and machine learning in predicting treatment
success such as the one in this study might enable treatment
optimization and the development of new therapies for each defined
endotype.