哮喘联盟

   摘要
   背景：许多轻度哮喘患者由于支气管舒张试验诊断敏感性低而未得到诊断和治疗。
   目的：探索气道可逆性和呼出气一氧化氮分数（FENO）对怀疑哮喘诊断的患者抗哮喘治疗(antiasthma therapy, RAT)的预测作用。
   方法：本不设盲前瞻性队列研究纳入了存在慢性反复哮喘症状、正常FEV1且支气管舒张试验为阴性的患者，予吸入皮质激素/长效β激动剂（ICS/LABA）治疗4周。RAT阳性定义为吸入类固醇/长效β激动剂（ICS/LABA）治疗后症状改善和FEV1增加超过200 mL。另外19例因肺结节而行肺叶切除术的患者的肺组织也被分析。
   结果：在110例患者中，102例完成了研究。与RAT阴性组相比，RAT阳性组存在更高的FENO，以及吸入支气管扩张剂后用力肺活量（FVC）、第1秒用力呼气容积（FEV1）和用力呼气流量（FEFs）的绝对值改善(Δ)和百分比(Δ%)。RAT阳性组FENO、 ΔFEV1%、ΔFEF25-75%、ΔFEF75%的ROC曲线下面积分别为0.703、0.824、0.736和0.710，截断值分别为33（ppb）、3.50%、15.26%和26.04%。FENO和ΔFEV1%联合模型使曲线下面积增大到0.880。此外，在预测RAT阳性患者的肺组织中，炎性细胞因子水平也高于预测RAT阴性的患者。
   结论：ΔFEV1%联合FENO可预测FEV1正常、舒张试验阴性的患者的哮喘诊断与阳性抗哮喘治疗反应。病理学改变的证据也增加了预测模型的可信度。


 

(马梓文¹ 张红萍¹ 王刚² 四川大学华西医院中西医结合科呼吸病组 610041 摘译)
（The Journal of Allergy and Clinical Immunology: In Practice, Volume 9, Issue 8, 2021, Pages 3098-3108.e4, ISSN 2213-2198,https://doi.org/10.1016/j.jaip.2021.03.015.）

 
 
Spirometric Changes in Bronchodilation Tests as Predictors of Asthma Diagnosis and Treatment Response in Patients with FEV1 ≥ 80% Predicted
 
Huijuan Hao, Wuping Bao, Yishu Xue, Yan Zhou, Zhixuan Huang, Dongning Yin, Yingying Zhang, Pengyu Zhang, Chengjian Lv, Lei Han, Xin Zhou, Junfeng Yin, Min Zhang
 
The Journal of Allergy and Clinical Immunology: In Practice, Volume 9, Issue 8, 2021, Pages 3098-3108.e4, ISSN 2213-2198,https://doi.org/10.1016/j.jaip.2021.03.015.
 
ABSTRACT
Background: Many patients with mild asthma are undiagnosed and untreated due to the low diagnostic sensitivity of bronchodilation test (BDT).
Objective: To investigate whether airway reversibility in BDT and fractional exhaled nitric oxide (Feno) can predict the response to antiasthma therapy (RAT) in patients with suspected asthma.
Methods: This open-label, prospective cohort study included patients with chronic recurrent asthma symptoms, normal FEV1, and negative BDT results. Inhaled corticosteroids and long-acting β agonists were given for 4 weeks. A positive RAT was defined as improved symptoms and an increase of more than 200 mL in FEV1 after inhaled corticosteroid/long-acting β agonist treatment. Lung tissues from another 19 patients who underwent pneumectomy for lung nodules were also analyzed.
Results: Of 110 patients recruited, 102 completed the study. Patients in the positive RAT group had a higher Feno and greater absolute (Δ) and percent (Δ%) improvements in forced vital capacity, FEV1, and forced expiratory flows (FEFs) in BDT than in the negative RAT group. The area under the curves of Feno, ΔFEV1%, ΔFEF25-75% (percent improvement in FEF at 25%-75% of forced vital capacity), and ΔFEF75% (percent improvement in FEF at 75% of forced vital capacity) for positive RAT were 0.703, 0.824, 0.736, and 0.710, with cutoff values of 33 parts per billion and 3.50%, 15.26%, and 26.04%, respectively. A joint model of Feno and ΔFEV1% increased the area under the curve to 0.880. Inflammatory cytokines were higher in the lung tissues of patients with predicted positive RAT than in those with predicted negative RAT.
Conclusions: ΔFEV1% in BDT together with Feno predicted a positive RAT and an asthma diagnosis in patients with a normal FEV1 and negative BDT. Evidence of pathological changes increases the credibility of the predictive model.