以呼出气体中NO含量为指标指导慢性支气管哮喘治疗
2007/04/13
本研究目的为观察呼出气体中NO含量在哮喘激素调整中的作用。试验募集了97例慢性哮喘患者，试验组仅以呼出气体中NO含量为调整激素用量指标：NO>15 ppb时，激素用量上调。对照组用药按GINA方案进行。在为期一年的试验中，试验组激素用量明显较对照组低，但哮喘发作次数、肺功能、痰液嗜酸粒细胞数均无明显差异。
本研究结论为：依据呼出气体中NO为指标调整激素用量可明显降低激素的使用。
（刘颖格 第四军医大学西京医院呼吸科 710032 摘译）
(N Engl J Med 2005;352:2163-2173)
Use oFexhaled Nitric Oxide Measurements to Guide
Treatment in Chronic Asthma
Andrew D. Smith, M.B., Ch.B., Jan O. Cowan, Karen P. Brassett, G. Peter Herbison, M.Sc., and D. Robin Taylor, M.D.
background
International guidelines for the treatment of asthma recommend adjusting the dose of inhaled corticosteroids on the basis of symptoms, bronchodilator requirements, and the results of pulmonary-function tests. Measurements of the fraction oFexhaled nitric oxide (Fe NO ) constitute a noninvasive marker that may be a useful alternative for the adjustment of inhaled-corticosteroid treatment.
methods
In a single-blind, placebo-controlled trial, we randomly assigned 97 patients with asthma who had been regularly receiving treatment with inhaled corticosteroids to have their corticosteroid dose adjusted, in a stepwise fashion, on the basis oFeither Fe NO measurements or an algorithm based on conventional guidelines. After the optimal dose was determined (phase 1), patients were followed up for 12 months (phase 2). The primary outcome was the frequency oFexacerbations of asthma; the secondary outcome was the mean daily dose of inhaled corticosteroid.
results
Forty-six patients in the Fe NO group and 48 in the group whose asthma was treated according to conventional guidelines (the control group) completed the study. The final mean daily doses of fluticasone, the inhaled corticosteroid that was used, were 370 μg per day for the Fe NO group (95 percent confidence interval, 263 to 477) and 641 μg per day for the control group (95 percent confidence interval, 526 to 756; P=0.003), a difference of 270 μg per day (95 percent confidence interval, 112 to 430). The rates oFexacerbation were 0.49 episode per patient per year in the Fe NO group (95 percent confidence interval, 0.20 to 0.78) and 0.90 in the control group (95 percent confidence interval, 0.31 to 1.49), representing a nonsignificant reduction of 45.6 percent (95 percent confidence interval for mean difference, 78.6 percent to 54.5 percent) in the Fe NO group. There were no significant differences in other markers of asthma control, use of oral prednisone, pulmonary function, or levels of airway inflammation (sputum eosinophils).
conclusions
With the use of Fe NO measurements, maintenance doses of inhaled corticosteroids may be significantly reduced without compromising asthma control.
N Engl J Med 2005;352:2163-73.
