急诊室离线式测定呼出一氧化氮与随后急性哮喘控制关系的研究
2009/02/16
背景：很少有研究对急性哮喘中呼出的一氧化氮量进行评估。
目的：评价在急性哮喘治疗中呼出一氧化氮浓度(FENO)和呼气峰流速(PEF)时程(β2-受体激动剂以及类固醇)变化，并评估FENO能否预测随后的哮喘控制状态。
方法：三个急诊室的65名支气管哮喘患者(3 4 ±10岁)参加了本次前瞻性研究。
结果：16例被排除(100毫升/s FE(NO 0.1) 时的离线FE(NO)测量失败，n＝4例，提前结束）。其余的49例患者在知情同意后，在第2小时(H2)和第6小时(H6)进行FE(NO 0.1)和PEF测量。随后通过其中27例患者的哮喘控制日记获得当他们被送进医院（9例）或出院（18例）后的哮喘控制情况。只有2位患者在知情同意后没有测量FE(NO)（均值[四分位数]，49[26-78]ppb）。与PEF不同，治疗并未减轻患者的平均FE(NO 0.1)值。呼出的一氧化氮和PEF变化无显着关系。FE(NO 0.1)[H0-H6]在住院患者(减少8+/-20ppb)与出院患者(增加5+/-20ppb，P= 0.04)中是不同的。这种FE(NO 0.1)值变化与日记评分(控制以后1周)有关，FE(NO 0.1)早期增加预示更好的哮喘控制状态。尽管如此，一氧化氮呼出和PEFR均不能很好地预测哮喘控制状态。
结论：几乎所有急性哮喘患者都可观察到FE(NO)增加，其后6小时内增加与之后1周较好的哮喘控制状态有关。
Delclaux C, et al. J Asthma. 2008 Dec;45(10):867-873.
Department of Physiology, Assistance Publique, Hopitaux de Paris; Universite Paris Descartes, Hopital Europeen Georges Pompidou.
Objectives: To evaluate exhaled NO fraction (FE(NO)) and peak expiratory flow (PEF) time-courses during acute asthma treatment (beta 2-agonist plus systemic steroid) and to assess whether FE(NO) time-course predicts subsequent asthma control.
Methods: Sixty-five asthmatic patients (mean +/- SD, 34 +/- 10 years) were prospectively enrolled in three Emergency Departments.
Results: Sixteen patients were excluded (failure of offline FE(NO) measurement at 100 mL/s [FE(NO 0.1)], n = 4, and early discharge). The 49 remaining patients performed FE(NO 0.1) and PEF on admission, at the 2nd (H2) and 6th hour (H6). Follow-up using an Asthma Control Diary was obtained in 27 of 49 patients, whether they were hospitalized (n = 9) or discharged (n = 18). All but 2 patients had elevated FE(NO) on admission (median [interquartile], 49 [26-78] ppb). Unlike PEF, mean FE(NO 0.1) of our sample was not significantly modified by treatment. No significant relationship was evidenced between exhaled NO and PEF variations. The variation of FE(NO 0.1) [H0 minus H6] was different in patients who were hospitalized (decrease of 8 +/- 20 ppb) versus discharged (increase of 5 +/- 20 ppb, p = 0.04). This variation of FE(NO 0.1) was correlated with the Diary score (control of subsequent week), an initial increase in FE(NO 0.1) being associated with better asthma control. Nevertheless, neither exhaled NO nor PEFR were good predictors of asthma control.
Conclusions: An increase in FE(NO) is observed in almost all patients with acute asthma, and its subsequent increase within 6 hours is associated with a better degree of asthma control in the subsequent week.
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一套评价哮喘患者认知和行为问卷调查的有效性验证
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成人哮喘患者疾病控制、症状困扰、功能与生命质量的关系
