哮喘联盟

    背景：过敏性哮喘与FE(NO)水平上升有关，但是呼出气体中一氧化氮（NO）水平是否可以在非过敏性哮喘患者和吸烟哮喘患者中作为炎症标志物还存在分歧。本研究分析了过敏性或非过敏性哮喘对呼出气体中一氧化氮水平的影响，同时特别关注了吸烟史对其影响情况。
    方法：695名研究对象来自于意大利都灵及瑞典哥特堡和乌普萨拉，检测其呼出气体中的一氧化氮水平。现发哮喘定义为患者自述医生对其已经诊断为哮喘，同时至少存在一个哮喘临床症状或过去一年中有过哮喘发作记录。过敏状态通过检测特异性的免疫球蛋白E（IgE）来确定。吸烟史通过问卷调查进行评估。
    结果：单变量分析显示，与非特异性健康对照者相比，过敏性哮喘与FE(NO)的增加有关，FE(NO)平均增加91％（60-128％）[平均95％可信区间]，而非过敏性哮喘与FE（NO）无显著相关性[6% (-17-35％)]。对无吸烟史患者进行的多变量分析显示，过敏性哮喘患者的FE(NO)水平比非特异性健康对照者平均高77％（27-145％），而非过敏性哮喘患者较非特异性健康对照者平均高97％（46-166％）。多变量分析显示，有吸烟史的哮喘患者与FE（NO）增加不存在相关性。
    结论：无吸烟史的哮喘患者中，过敏性和非过敏性哮喘与FE（NO）水平增加有关。对有吸烟史的哮喘患者的FE（NO）限值检测显示，这些哮喘患者主要为非嗜酸性粒细胞性炎症表现型。 

                   
Both allergic and nonallergic asthma are associated with increased FE(10)？FE(NO) levels, but only in never-smokers.

Malinovschi A, Janson C, Högman M, Rolla G, Torén K, Norbäck D, Olin AC.
Department of Medical Cell Biology: Integrative Physiology, Uppsala University, Uppsala, Sweden.

Background: Allergic asthma is consistently associated with increased FE(NO) levels whereas divergence exists regarding the use of exhaled nitric oxide (NO) as marker of inflammation in nonallergic asthma and in asthmatic smokers. The aim of this study is to analyze the effect of having allergic or nonallergic asthma on exhaled nitric oxide levels, with special regard to smoking history.
Methods: Exhaled NO measurements were performed in 695 subjects from Turin (Italy), Gothenburg and Uppsala (both Sweden). Current asthma was defined as self-reported physician-diagnosed asthma with at least one asthma symptom or attack recorded during the last year. Allergic status was defined by using measurements of specific immunoglobulin E (IgE). Smoking history was questionnaire-assessed.
Results: Allergic asthma was associated with 91 (60, 128) % [mean (95% CI)] increase of FE(NO) while no significant association was found for nonallergic asthma [6 (-17, 35) %] in univariate analysis, when compared to nonatopic healthy subjects. In a multivariate analysis for never-smokers, subjects with allergic asthma had 77 (27, 145) % higher FE(NO) levels than atopic healthy subjects while subjects with nonallergic asthma had 97 (46, 166) % higher FE(NO) levels than nonatopic healthy subjects. No significant asthma-related FE(NO) increases were noted for ex- and current smokers in multivariate analysis.
Conclusions: Both allergic and nonallergic asthma are related to increased FE(NO) levels, but only in never-smoking subjects. The limited value of FE(NO) to detect subjects with asthma among ex- and current smokers suggests the predominance of a noneosinophilic inflammatory phenotype of asthma among ever-smokers.