哮喘患者的呼出气一氧化氮水平：个人最佳值和参考值
2009/12/15
背景：有多种因素可影响呼出气中一氧化氮分数[FE(NO)]。因此，采用呼出气一氧化氮浓度评价气道疾病还存在诸多问题。目前，临床上对呼出气浓度的最佳值尚未有统一的标准。
目的：本试验试图明确采用Olin、Travers及Dressel等人实验得出的方程算得的FE(NO)预测值与口服强的松后FE(NO)标准水平之间的关系。同时，比较服用强的松后的FE(NO)水平与氟替卡松吸入优化治疗后的FE(NO)水平。
方法：收集口服强的松（30 mg/d，连续14天）前后的试验数据及以前已发表研究中的相关数据，在这些研究中，患者有明确的吸入糖皮质激素剂量，这些剂量根据FE(NO) 或症状/肺功能调整以优化治疗。服用强的松后FE(NO)的几何平均值(17.7ppb; 95% CI, 15.5-20.2)显著低于氟替卡松优化治疗剂量下的FE(NO)（20.2 ppb; 95% CI, 17.1-23.8; P=.04）及哮喘失控状态下FE(NO)（27.6 ppb; 95% CI, 22.8-33.4; P < .001）。服用强的松后的FE(NO)水平与Olin 等人预测值无显著差异（16.8 ppb, 95% CI, 16.0-17.5; P=.44），但明显低于Travers 等人（21.5 ppb; 95% CI, 20.9-22.2; P=.005）和Dressel等人（27.8 ppb; 95% CI, 26.7-28.9; P < .001）研究的FE(NO)预测值。
结论：通过采用口服，而非吸入糖皮质激素获得FE(NO)水平最佳值，该值与Olin等人参考方程所得的预测值接近。但是，虽然FE(NO)水平高于预测值，在最佳剂量糖皮质激素吸入治疗后，仍能得到有效控制。针对FE(NO)参考值来治疗哮喘目前证据不足。
（林江涛 审校）
J Allergy Clin Immunol. 2009 Oct;124(4):714-8.e4.
Exhaled nitric oxide levels in asthma: Personal best versus reference values.
Smith AD, Cowan JO, Taylor DR.
BACKGROUND: Factors affecting the fraction of nitric oxide in exhaled air (FE(NO)) are multiple. Interpreting values when assessing airways disease may be problematic. Clinically optimum levels have not been defined.
OBJECTIVES: We aimed to establish the relationship between predicted values for FE(NO) obtained from equations by Olin et al, Travers et al, and Dressel et al, and normalized levels after oral prednisone. We also compared postprednisone FE(NO) levels with those obtained during optimized treatment with inhaled fluticasone.
METHODS: Data were obtained before and after a trial of oral prednisone (30mg/d for 14 days), and also from a previously published study in which patients had their dose of inhaled corticosteroid adjusted using either FE(NO) or symptoms/lung function to optimize treatment.
RESULTS: Seventy-three patients completed the study. The geometric mean FE(NO) after prednisone (17.7 parts per billion [ppb]; 95% CI, 15.5-20.2) was significantly lower than mean FE(NO) at the optimized fluticasone dose (20.2 ppb; 95% CI, 17.1-23.8; P=.04) and at loss of control (27.6 ppb; 95% CI, 22.8-33.4; P < .001). FE(NO) levels after prednisone did not differ significantly from the predicted values of Olin et al (16.8 ppb, 95% CI, 16.0-17.5; P=.44), but were significantly lower than values of Travers et al (predicted, 21.5 ppb; 95% CI, 20.9-22.2; P=.005) and Dressel et al (predicted, 27.8 ppb; 95% CI, 26.7-28.9; P < .001).
CONCLUSIONS: Optimum FE(NO) levels are best established by using oral rather than inhaled steroid treatment, and these approximate to predicted values from the reference equation by Olin et al. However, at optimized doses of inhaled corticosteroid, although FE(NO) levels were higher than predicted, asthma was well controlled. Targeting FE(NO) on reference values is not justified.
Smith AD, Cowan JO, Taylor DR. J Allergy Clin Immunol. 2009 Oct;124(4):714-8.e4.
目的：本试验试图明确采用Olin、Travers及Dressel等人实验得出的方程算得的FE(NO)预测值与口服强的松后FE(NO)标准水平之间的关系。同时，比较服用强的松后的FE(NO)水平与氟替卡松吸入优化治疗后的FE(NO)水平。
方法：收集口服强的松（30 mg/d，连续14天）前后的试验数据及以前已发表研究中的相关数据，在这些研究中，患者有明确的吸入糖皮质激素剂量，这些剂量根据FE(NO) 或症状/肺功能调整以优化治疗。服用强的松后FE(NO)的几何平均值(17.7ppb; 95% CI, 15.5-20.2)显著低于氟替卡松优化治疗剂量下的FE(NO)（20.2 ppb; 95% CI, 17.1-23.8; P=.04）及哮喘失控状态下FE(NO)（27.6 ppb; 95% CI, 22.8-33.4; P < .001）。服用强的松后的FE(NO)水平与Olin 等人预测值无显著差异（16.8 ppb, 95% CI, 16.0-17.5; P=.44），但明显低于Travers 等人（21.5 ppb; 95% CI, 20.9-22.2; P=.005）和Dressel等人（27.8 ppb; 95% CI, 26.7-28.9; P < .001）研究的FE(NO)预测值。
结论：通过采用口服，而非吸入糖皮质激素获得FE(NO)水平最佳值，该值与Olin等人参考方程所得的预测值接近。但是，虽然FE(NO)水平高于预测值，在最佳剂量糖皮质激素吸入治疗后，仍能得到有效控制。针对FE(NO)参考值来治疗哮喘目前证据不足。
（林江涛 审校）
J Allergy Clin Immunol. 2009 Oct;124(4):714-8.e4.
Exhaled nitric oxide levels in asthma: Personal best versus reference values.
Smith AD, Cowan JO, Taylor DR.
BACKGROUND: Factors affecting the fraction of nitric oxide in exhaled air (FE(NO)) are multiple. Interpreting values when assessing airways disease may be problematic. Clinically optimum levels have not been defined.
OBJECTIVES: We aimed to establish the relationship between predicted values for FE(NO) obtained from equations by Olin et al, Travers et al, and Dressel et al, and normalized levels after oral prednisone. We also compared postprednisone FE(NO) levels with those obtained during optimized treatment with inhaled fluticasone.
METHODS: Data were obtained before and after a trial of oral prednisone (30mg/d for 14 days), and also from a previously published study in which patients had their dose of inhaled corticosteroid adjusted using either FE(NO) or symptoms/lung function to optimize treatment.
RESULTS: Seventy-three patients completed the study. The geometric mean FE(NO) after prednisone (17.7 parts per billion [ppb]; 95% CI, 15.5-20.2) was significantly lower than mean FE(NO) at the optimized fluticasone dose (20.2 ppb; 95% CI, 17.1-23.8; P=.04) and at loss of control (27.6 ppb; 95% CI, 22.8-33.4; P < .001). FE(NO) levels after prednisone did not differ significantly from the predicted values of Olin et al (16.8 ppb, 95% CI, 16.0-17.5; P=.44), but were significantly lower than values of Travers et al (predicted, 21.5 ppb; 95% CI, 20.9-22.2; P=.005) and Dressel et al (predicted, 27.8 ppb; 95% CI, 26.7-28.9; P < .001).
CONCLUSIONS: Optimum FE(NO) levels are best established by using oral rather than inhaled steroid treatment, and these approximate to predicted values from the reference equation by Olin et al. However, at optimized doses of inhaled corticosteroid, although FE(NO) levels were higher than predicted, asthma was well controlled. Targeting FE(NO) on reference values is not justified.
Smith AD, Cowan JO, Taylor DR. J Allergy Clin Immunol. 2009 Oct;124(4):714-8.e4.
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哮喘控制测试的最小显著差异值
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咳嗽变异性哮喘和非哮喘慢性咳嗽同样存在气道壁增厚
