真实世界的临床实践中FeNO检测改变了哮喘治疗
2018/05/03
摘要
背景：仅通过临床测量而进行的哮喘评估通常无法检测潜在的气道炎症反应。呼出气一氧化氮（FeNO）是一种公认的哮喘2型气道炎症反应生物标记。FeNO的测量对于糖皮质激素敏感型哮喘患者的评估和管理而言具有工具性作用。
目的：确定FeNO测量在真实世界临床实践中对哮喘管理的影响。
方法：来自美国337个机构的临床医生对7901名哮喘患者进行了临床评估并记录了测量FeNO之前及之后的治疗计划。气道炎症情况根据临床医生通常的诊疗规程，包括临床检验、肺功能以及症状等分为低，中，高三级。临床医生记录哮喘药物治疗计划，用于指示何时开始治疗，维持治疗以及停药。测量FeNO之后，记录基于FeNO值的治疗方案中的任何变化（例如，启用新的药物或改变现有药物的剂量或停止使用当前药物）
结果：仅在56%的病例中，临床评估与FeNO测量值一致。低炎症反应患者同高炎症反应患者相比，其FeNO测量更为频繁（64% vs 34%）。根据FeNO测量值，临床医生在31%病例中调整了治疗计划，90%病例中调整了吸入性糖皮质激素剂量。在66%的高炎症反应患者中，吸入性糖皮质激素开始使用或增加剂量。然而，仅在9%的低炎症反应患者中，吸入性糖皮质激素开始减少剂量或停止使用。
结论：测量FeNO使临床医生能够评估潜在的气道炎症，与单独的哮喘的实际临床评估相比更能指导对其治疗计划的重大修订。
Measurement of fractional exhaled nitric oxide in real-world clinical practice alters asthma treatment decisions.
Nicola A. Hanania, et al.
Abstract
BACKGROUND：Assessment of asthma using clinical measures alone often fails to detect underlying airway inflammation. Fractional exhaled nitric oxide (FeNO) is a recognized biomarker of type 2 airway inflammation in asthma. Measurement of FeNO is instrumental in the assessment and management of patients with corticosteroidsensitive asthma.
OBJECTIVE：To determine the impact of measuring FeNO on asthma management in real-world clinical practices.
METHODS：Clinicians from 337 US practices performed a clinical assessment and recorded treatment plans before and after measuring FeNO in 7901 patients with asthma. Airway inflammation was classified as low, intermediate, or high according to the clinician's usual procedures, including clinical examination, spirometry, and symptoms. Clinicians recorded asthma medication plans, indicating medications to be initiated, continued, or stopped. FeNO measurement was performed, followed by documentation of any change(s) in the treatment plans based on the FeNO value (eg, initiating new medications or changing the dose of or discontinuing existing medications).
RESULTS：Clinical assessment was concordant with FeNO measurement in only 56% of cases, matching FeNO more frequently in patients with low inflammation (64%) vs high inflammation (34%). Following FeNO measurement, clinicians modified their treatment plan in 31%, altering prescriptions for inhaled corticosteroids in 90% of cases. Inhaled corticosteroids were initiated or their dose increased in 66% of patients with high inflammation, but were discontinued or their dose decreased in only 9% of
patients with low inflammation.
CONCLUSIONS：Measurement of FeNO enabled clinicians to assess underlying airway inflammation leading to a significant revision of their treatment plans compared to real-world clinical assessment of asthma alone.
背景：仅通过临床测量而进行的哮喘评估通常无法检测潜在的气道炎症反应。呼出气一氧化氮（FeNO）是一种公认的哮喘2型气道炎症反应生物标记。FeNO的测量对于糖皮质激素敏感型哮喘患者的评估和管理而言具有工具性作用。
目的：确定FeNO测量在真实世界临床实践中对哮喘管理的影响。
方法：来自美国337个机构的临床医生对7901名哮喘患者进行了临床评估并记录了测量FeNO之前及之后的治疗计划。气道炎症情况根据临床医生通常的诊疗规程，包括临床检验、肺功能以及症状等分为低，中，高三级。临床医生记录哮喘药物治疗计划，用于指示何时开始治疗，维持治疗以及停药。测量FeNO之后，记录基于FeNO值的治疗方案中的任何变化（例如，启用新的药物或改变现有药物的剂量或停止使用当前药物）
结果：仅在56%的病例中，临床评估与FeNO测量值一致。低炎症反应患者同高炎症反应患者相比，其FeNO测量更为频繁（64% vs 34%）。根据FeNO测量值，临床医生在31%病例中调整了治疗计划，90%病例中调整了吸入性糖皮质激素剂量。在66%的高炎症反应患者中，吸入性糖皮质激素开始使用或增加剂量。然而，仅在9%的低炎症反应患者中，吸入性糖皮质激素开始减少剂量或停止使用。
结论：测量FeNO使临床医生能够评估潜在的气道炎症，与单独的哮喘的实际临床评估相比更能指导对其治疗计划的重大修订。
（复旦大学附属中山医院 呼吸内科 罗锦龙 摘译 杨冬 审校）
（Ann Allergy Asthma Immunol, 2018 Feb 2）
（Ann Allergy Asthma Immunol, 2018 Feb 2）
Measurement of fractional exhaled nitric oxide in real-world clinical practice alters asthma treatment decisions.
Nicola A. Hanania, et al.
Abstract
BACKGROUND：Assessment of asthma using clinical measures alone often fails to detect underlying airway inflammation. Fractional exhaled nitric oxide (FeNO) is a recognized biomarker of type 2 airway inflammation in asthma. Measurement of FeNO is instrumental in the assessment and management of patients with corticosteroidsensitive asthma.
OBJECTIVE：To determine the impact of measuring FeNO on asthma management in real-world clinical practices.
METHODS：Clinicians from 337 US practices performed a clinical assessment and recorded treatment plans before and after measuring FeNO in 7901 patients with asthma. Airway inflammation was classified as low, intermediate, or high according to the clinician's usual procedures, including clinical examination, spirometry, and symptoms. Clinicians recorded asthma medication plans, indicating medications to be initiated, continued, or stopped. FeNO measurement was performed, followed by documentation of any change(s) in the treatment plans based on the FeNO value (eg, initiating new medications or changing the dose of or discontinuing existing medications).
RESULTS：Clinical assessment was concordant with FeNO measurement in only 56% of cases, matching FeNO more frequently in patients with low inflammation (64%) vs high inflammation (34%). Following FeNO measurement, clinicians modified their treatment plan in 31%, altering prescriptions for inhaled corticosteroids in 90% of cases. Inhaled corticosteroids were initiated or their dose increased in 66% of patients with high inflammation, but were discontinued or their dose decreased in only 9% of
patients with low inflammation.
CONCLUSIONS：Measurement of FeNO enabled clinicians to assess underlying airway inflammation leading to a significant revision of their treatment plans compared to real-world clinical assessment of asthma alone.
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