呼出气一氧化氮在重度哮喘管理中的临床应用
2020/04/07
摘要
哮喘是气道慢性炎症类疾病，，影响了全球超过3.5亿人，并给医疗保健和整个社会带来沉重负担。大约5%-10%的哮喘患者被诊断为严重哮喘，通常与病情加重引起的住院率、发病率和死亡率升高，以及与哮喘关联的医保花费增加相关。一氧化氮（NO）是免疫反应的重要调节剂，是哮喘中过度产生的气道炎症产物。呼出气一氧化氮测定主要用作对吸入性糖皮质激素（ICSs）的反应的预测指标，以监测初始接受ICS治疗的患者的依从性并作为诊断工具。在英国，国家优化卫生与保健研究所（NICE）指南建议使用FeNO初步诊断疑似哮喘患者。在美国，美国胸科学会(ATS)指南建议将FeNO作为哮喘急性发作的预测因素，FeNO水平越高，发作次数越高。此外，更高水平的FeNO已显示出与肺功能的减退相关。FeNO监测是一种具有成本效益的方法，当FeNO与标准评估方法结合使用时，已证明可以改善哮喘患者管理。最近的证据表明，FeNO可能用于替代生物标志物，以评估和管理重度哮喘和预测对某些生物疗法的反应性。
Clinical utility of fractional exhaled nitric oxide in severe asthma management.
Menzies-Gow A, Mansur AH, Brightling CE,
Abstract
Asthma is a chronic inflammatory disease of the airways, affecting over 350 million people worldwide and placing a significant burden on healthcare providers and wider society. Approximately 5-10% of asthma patients are diagnosed with severe asthma and typically are associated with increased risk of hospitalisation from exacerbations, increased morbidity, mortality and higher asthma-associated healthcare costs. Nitric oxide (NO) is an important regulator of immune responses and is a product of inflammation in the airways that is over-produced in asthma. Fractional exhaled NO is predominantly used as a predictor of response to inhaled corticosteroids (ICSs), to monitor adherence and as a diagnostic tool in ICS-naïve patients. In the UK, the National Institute for Health and Care Excellence (NICE) guidelines recommend the use of for the initial diagnosis of patients with suspected asthma. In the USA, American Thoracic Society (ATS) guidelines recommend as part of the initial diagnosis of asthma and for monitoring of airway inflammation. has also been shown to be a predictive factor for asthma exacerbations, with higher levels being associated with a greater number of exacerbations. In addition, higher levels of have been shown to be associated with a decline in lung function. testing is a cost-effective procedure and has been shown to improve patient management when combined with standard assessment methods. Recent evidence suggests that may also be useful as a surrogate biomarker for the assessment and management of severe asthma and to predict responsiveness to some biological therapies.
哮喘是气道慢性炎症类疾病，，影响了全球超过3.5亿人，并给医疗保健和整个社会带来沉重负担。大约5%-10%的哮喘患者被诊断为严重哮喘，通常与病情加重引起的住院率、发病率和死亡率升高，以及与哮喘关联的医保花费增加相关。一氧化氮（NO）是免疫反应的重要调节剂，是哮喘中过度产生的气道炎症产物。呼出气一氧化氮测定主要用作对吸入性糖皮质激素（ICSs）的反应的预测指标，以监测初始接受ICS治疗的患者的依从性并作为诊断工具。在英国，国家优化卫生与保健研究所（NICE）指南建议使用FeNO初步诊断疑似哮喘患者。在美国，美国胸科学会(ATS)指南建议将FeNO作为哮喘急性发作的预测因素，FeNO水平越高，发作次数越高。此外，更高水平的FeNO已显示出与肺功能的减退相关。FeNO监测是一种具有成本效益的方法，当FeNO与标准评估方法结合使用时，已证明可以改善哮喘患者管理。最近的证据表明，FeNO可能用于替代生物标志物，以评估和管理重度哮喘和预测对某些生物疗法的反应性。
(中日友好医院呼吸与危重症医学科 张清 摘译 林江涛 审校)
(Eur. Respir. J. 2020 Mar;55(3) DOI: 10.1183/13993003.01633-2019)
(Eur. Respir. J. 2020 Mar;55(3) DOI: 10.1183/13993003.01633-2019)
Clinical utility of fractional exhaled nitric oxide in severe asthma management.
Menzies-Gow A, Mansur AH, Brightling CE,
Abstract
Asthma is a chronic inflammatory disease of the airways, affecting over 350 million people worldwide and placing a significant burden on healthcare providers and wider society. Approximately 5-10% of asthma patients are diagnosed with severe asthma and typically are associated with increased risk of hospitalisation from exacerbations, increased morbidity, mortality and higher asthma-associated healthcare costs. Nitric oxide (NO) is an important regulator of immune responses and is a product of inflammation in the airways that is over-produced in asthma. Fractional exhaled NO is predominantly used as a predictor of response to inhaled corticosteroids (ICSs), to monitor adherence and as a diagnostic tool in ICS-naïve patients. In the UK, the National Institute for Health and Care Excellence (NICE) guidelines recommend the use of for the initial diagnosis of patients with suspected asthma. In the USA, American Thoracic Society (ATS) guidelines recommend as part of the initial diagnosis of asthma and for monitoring of airway inflammation. has also been shown to be a predictive factor for asthma exacerbations, with higher levels being associated with a greater number of exacerbations. In addition, higher levels of have been shown to be associated with a decline in lung function. testing is a cost-effective procedure and has been shown to improve patient management when combined with standard assessment methods. Recent evidence suggests that may also be useful as a surrogate biomarker for the assessment and management of severe asthma and to predict responsiveness to some biological therapies.
