呼出气一氧化氮（NO）测定对哮喘管理的指导作用研究
2008/02/05
目前的哮喘指南均建议依据肺功能和症状评估结果调整抗炎治疗，但这两者与哮喘的气道炎症关联并不密切。Dominick等设计本实验以期验证一个新的假说：与传统管理方法相比，以测定哮喘患者呼出气NO的浓度来调整糖皮质激素的剂量可减少哮喘急性发作并使激素的使用更有效。实验采用随机单盲法研究，入选的118位哮喘患者随机分两组，58位依照呼出气NO浓度滴定法治疗（FENO组），60位依照英国胸科学会指南治疗。起先4月每月评估，后8月每2月评估，总共12月疗程。结果以哮喘急性发作的人数来评估、分析两组的治疗方案优劣。结果显示在FENO组，平均每个病人每年的急性发作几率为0.33±0.69，而对照组为0.42±0.79，（两组间差异平均值- 21%，95％CI为-57％－- 43％，p＝0.43）。尽管最后每日吸入糖皮质激素的剂量FENO组少与对照组 (557 vs. 895 mg；两组间差异平均值, 338 mg； 95% CI为- 640 to – 37；p = 0.028)，但吸入糖皮质激素使用总量，FENO组较对照组多11% (95% CI,–17 to 42%; p = 0.40)。
作者由此得到结论，与现有的哮喘指南相比，基于呼出气NO浓度测定调整药物的管理策略在12个月内并不能引起哮喘急性发作次数的大显著下降，也不能使吸入糖皮质激素的总剂量明显减少。
作者由此得到结论，与现有的哮喘指南相比，基于呼出气NO浓度测定调整药物的管理策略在12个月内并不能引起哮喘急性发作次数的大显著下降，也不能使吸入糖皮质激素的总剂量明显减少。
（汪慧英 杭州,浙江大学二院呼吸科 320008 摘译）
（Critical Care Medicine Vol 176：231-237）
The Use of Exhaled Nitric Oxide to Guide Asthma ManagementA Randomized Controlled Trial
American Journal of Respiratory and Critical Care Medicine Vol 176. pp. 231-237,
Institute for Lung Health, Department of Respiratory Medicine and Thoracic Surgery, Glenfield Hospital, Leicester, United Kingdom.
RATIONALE: Current asthma guidelines recommend adjusting antiinflammatory treatment on the basis of the results of lung function tests and symptom assessment, neither of which are closely associated with airway inflammation. OBJECTIVES: We tested the hypothesis that titrating corticosteroid dose using the concentration of exhaled nitric oxide in exhaled breath (Fe(NO)) results in fewer asthma exacerbations and more efficient use of corticosteroids, when compared with traditional management.
METHODS: One hundred eighteen participants with a primary care diagnosis of asthma were randomized to a single-blind trial of corticosteroid therapy based on either Fe(NO) measurements (n = 58) or British Thoracic Society guidelines (n = 60). Participants were assessed monthly for 4 months and then every 2 months for a further 8 months. The primary outcome was the number of severe asthma exacerbations. Analyses were by intention to treat. MEASUREMENTS
AND MAIN RESULTS: The estimated mean (SD) exacerbation frequency was 0.33 per patient per year (0.69) in the Fe(NO) group and 0.42 (0.79) in the control group (mean difference, -21%; 95% confidence interval [CI], -57 to 43%; p = 0.43). Overall the Fe(NO) group used 11% more inhaled corticosteroid (95% CI, -17 to 42%; p = 0.40), although the final daily dose of inhaled corticosteroid was lower in the Fe(NO) group (557 vs. 895 microg; mean difference, 338 microg; 95% CI, -640 to -37; p = 0.028). CONCLUSIONS: An asthma treatment strategy based on the measurement of exhaled nitric oxide did not result in a large reduction in asthma exacerbations or in the total amount of inhaled corticosteroid therapy used over 12 mo, when compared with current asthma guidelines. Clinical trial registered with www.controlled-trials.com (ISRCTN08067387).
PMID: 17496226 [PubMed - indexed for MEDLINE]
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