利用呼出气一氧化氮指导治疗是否能改善哮喘患儿亚组的预后?

2020/04/07

   摘要
   前言:呼出气一氧化氮(FENO)是嗜酸性气道炎症的生物标志物,可用于指导哮喘治疗。与标准治疗相比,利用FENO指导治疗在某些亚组中可能更有效地改善了哮喘患者的预后。
   方法:利用来自7个使用FENO指导哮喘治疗的随机临床试验(RCT)的数据进行单个患者数据分析。 描述RCT中5个亚组之间的哮喘急性发作和控制不佳次数,以及首次急性加重和控制不佳的时间。
   结果:共计1112名入组RCT。在未使用白三烯受体拮抗剂(LTRA)治疗组中,而不是使用LTRA治疗的患者中,FENO指导治疗与病情加重风险降低(OR值0.68,95%CI 0.49-0.94),首次急性加重出现时间较长(HR 0.76 [0.57,0.99])及控制不佳的临界风险降低(OR 0.70 [0.49,1.00])具有相关性。与肥胖儿童相比,非肥胖儿童在FENO指导进行治疗发生哮喘控制不佳的可能性较小(OR 0.69 [0.48,0.99]),出现控制不佳时间更长(HR 0.77 [0.61,0.99])。
   结论:与标准做法相比,FENO指导哮喘治疗对于未接受LTRA治疗且非肥胖的患者,可能更有效地达到较好的哮喘预后。

 
(中日友好医院呼吸与危重症医学科 张鑫 摘译 林江涛 审校)
(Eur Respir J. 2020 Mar 12. pii: 1901879. doi: 10.1183/13993003.01879-2019. [Epub ahead of print])

 
 
 
Does treatment guided by fractional exhaled nitric oxide improve outcomes in subgroups of children with asthma?
 
Fielding SS1, Pijnenburg M2, de Jongste J2, Pike K3,4, Roberts G3, Petsky H5, Chang AB6,7, Fritsch M8, Frischer T8, Szefler SJ9, Gergen P10, Vermeulen F11, Vael R12, Turner SS13.
 
Abstract
INTRODUCTION:Fractional exhaled nitric oxide (FENO), a biomarker of eosinophilic airway inflammation, may be useful to guide asthma treatment. FENO guided treatment may be more effective in certain subgroups for improving asthma outcomes compared to standard treatment.
METHODS:An individual patient data analysis was performed using data from seven randomised clinical trials (RCT) which used FENO to guide asthma treatment. The incidence of an asthma exacerbation and loss of control, and the time to first exacerbation and loss of control were described between five subgroups of RCT participants.
RESULTS:Data were available in 1112 RCT participants. Among those not treated with Leukotriene Receptor Antagonist (LTRA), but not among those who were treated with LTRA, FENO guided treatment was associated with reduced exacerbation risk (odds ratio (OR) 0.68 [95% CI 0.49, 0.94]), longer time to first exacerbation (hazard ratio (HR) 0.76 [0.57, 0.99]) and borderline reduced risk for loss of control (OR 0.70 [0.49, 1.00]). Non-obese children, compared to obese children, were less likely to lose asthma control when treatment was guided by FENO (OR 0.69 [0.48, 0.99]) and time to loss of control was longer (HR 0.77 [0.61, 0.99]).
CONCLUSIONS:Asthma treatment guided by FENO may be more effective in achieving better asthma outcomes for patients who are not treated with LTRA and who are not obese compared to standard practice.




上一篇: 基于人群的病例发现以确诊未诊断为哮喘或COPD的患者
下一篇: 呼出气一氧化氮在重度哮喘管理中的临床应用

用户登录