小气道功能异常：过敏性鼻炎和过敏性哮喘之间的联系
2018/05/03
摘要
研究发现哮喘存在气道反应异常和小气道中一氧化氮（NO）产生过多。如果同“同一气道，同一疾病”的概念相符，那么在患有过敏性鼻炎的患者的外周气道中也应该检测到这种功能障碍。我们研究了在过敏性鼻炎患者的远端气道中是否存在外周气道反应性和NO过量产生。我们测量了31例过敏性哮喘患者，23例过敏性鼻炎患者以及 24名对照者的痰诱导前后的呼出气一氧化氮（FeNO），氦气（He）和六氟化硫（SF6）单呼吸冲刷试验（SBWT）III期的斜率（S）。 SBWT对发生在肺周围的气道口径变化敏感。FeNO下降在哮喘和鼻炎中比对照组更显着（分别为-55.1％和-50.0％，相对于对照组的-40.8％）（p值分别为p = 0.007和p = 0.029）。 所有组SSF6和SHe均增加。 在鼻炎（p = 0.004）和哮喘（p <0.001）中SHe变化（ΔSHe）>ΔSSF6，而在对照组中ΔSSF6=ΔSHe（p = 0.431）。本研究提示过敏性鼻炎患者外周气道功能障碍与哮喘患者非常相似。此外，过敏性鼻炎中升高的NO大部分似乎源于外周气道。
Small airways dysfunction: the link between allergic rhinitis and allergic asthma.
Haccuria A et al.
Abstract
Abnormal airway reactivity and overproduction of nitric oxide (NO) occurring in small airways have been found in asthma. If the "one airway, one disease" concept is consistent, such dysfunctions should also be detected in the peripheral airways of patients suffering from allergic rhinitis.We investigated whether peripheral airway reactivity and NO overproduction could be documented in distal airways in patients with allergic rhinitis. Exhaled NO fraction (FeNO) and the slope (S) of phase III of the single-breath washout test (SBWT) of helium (He) and sulfur hexafluoride (SF6) were measured in 31 patients with allergic asthma, 23 allergic rhinitis patients and 24 controls, before and after sputum induction. SBWT is sensitive to airway calibre change occurring in the lung periphery.The FeNO decrease was more significant in asthma and rhinitis than in controls (-55.1% and -50.0%, respectively, versus -40.8%) (p=0.007 and
p=0.029, respectively). SSF6 and SHe increased in all groups. Change in SHe (ΔSHe) > ΔSSF6 was observed in rhinitis (p=0.004) and asthma (p<0.001), whereas ΔSSF6 = ΔSHe in controls (p=0.431).This study provides evidence of peripheral airway dysfunction in patients with allergic rhinitis quite similar to that described in asthma. Furthermore, a large proportion of the increased NO production reported in allergic rhinitis appears to originate in the peripheral airways.
研究发现哮喘存在气道反应异常和小气道中一氧化氮（NO）产生过多。如果同“同一气道，同一疾病”的概念相符，那么在患有过敏性鼻炎的患者的外周气道中也应该检测到这种功能障碍。我们研究了在过敏性鼻炎患者的远端气道中是否存在外周气道反应性和NO过量产生。我们测量了31例过敏性哮喘患者，23例过敏性鼻炎患者以及 24名对照者的痰诱导前后的呼出气一氧化氮（FeNO），氦气（He）和六氟化硫（SF6）单呼吸冲刷试验（SBWT）III期的斜率（S）。 SBWT对发生在肺周围的气道口径变化敏感。FeNO下降在哮喘和鼻炎中比对照组更显着（分别为-55.1％和-50.0％，相对于对照组的-40.8％）（p值分别为p = 0.007和p = 0.029）。 所有组SSF6和SHe均增加。 在鼻炎（p = 0.004）和哮喘（p <0.001）中SHe变化（ΔSHe）>ΔSSF6，而在对照组中ΔSSF6=ΔSHe（p = 0.431）。本研究提示过敏性鼻炎患者外周气道功能障碍与哮喘患者非常相似。此外，过敏性鼻炎中升高的NO大部分似乎源于外周气道。
（复旦大学附属中山医院 呼吸内科 罗锦龙 摘译 杨冬 审校）
（Eur Respir J. 2018 Feb 21;51(2)）
（Eur Respir J. 2018 Feb 21;51(2)）
Small airways dysfunction: the link between allergic rhinitis and allergic asthma.
Haccuria A et al.
Abstract
Abnormal airway reactivity and overproduction of nitric oxide (NO) occurring in small airways have been found in asthma. If the "one airway, one disease" concept is consistent, such dysfunctions should also be detected in the peripheral airways of patients suffering from allergic rhinitis.We investigated whether peripheral airway reactivity and NO overproduction could be documented in distal airways in patients with allergic rhinitis. Exhaled NO fraction (FeNO) and the slope (S) of phase III of the single-breath washout test (SBWT) of helium (He) and sulfur hexafluoride (SF6) were measured in 31 patients with allergic asthma, 23 allergic rhinitis patients and 24 controls, before and after sputum induction. SBWT is sensitive to airway calibre change occurring in the lung periphery.The FeNO decrease was more significant in asthma and rhinitis than in controls (-55.1% and -50.0%, respectively, versus -40.8%) (p=0.007 and
p=0.029, respectively). SSF6 and SHe increased in all groups. Change in SHe (ΔSHe) > ΔSSF6 was observed in rhinitis (p=0.004) and asthma (p<0.001), whereas ΔSSF6 = ΔSHe in controls (p=0.431).This study provides evidence of peripheral airway dysfunction in patients with allergic rhinitis quite similar to that described in asthma. Furthermore, a large proportion of the increased NO production reported in allergic rhinitis appears to originate in the peripheral airways.
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室内过敏原减少在哮喘管理中的有效性：一项系统评价
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吸气和呼气 CT 之间的流明区域变化作为衡量哮喘严重后果的指标
