呼出NO——吸烟者哮喘控制情况的标志
2010/01/07
关键词：哮喘控制；呼出NO；吸烟
作为嗜酸性粒细胞气道炎症的可靠标志，呼出NO (FeNO)常用于哮喘控制的监测。但吸烟可能抑制FeNO水平，因而FeNO能否作为吸烟患者哮喘管理的监测指标尚需评价。为了检测FeNO在吸烟者中对哮喘控制的预测能力，Michils等进行了411例非吸烟哮喘患者和59例吸烟哮喘患者一项临床观察研究。
所有研究对象均接受至少1次哮喘控制问卷 (Asthma Control Questionnaire, ACQ)调查并进行FeNO检测，其中245例非吸烟哮喘患者和51例吸烟哮喘患者至少访视2次。
研究结果显示，吸烟者和非吸烟者平均ACQ评分相近（1.5比1.7），但吸烟组FeNO明显低于非吸烟组(18.1 ppb比 33.7 ppb)。FeNO下降低于20%可排除哮喘控制改善（非吸烟组NPV 78%，吸烟组NPV 72%），而FeNO升高低于30%也不支持哮喘恶化（非吸烟组NPV 86%，吸烟组NPV 84%）。
综合研究结果，无论吸烟者还是非吸烟者，FeNO的连续变化与哮喘控制有关。因此作者认为，吸烟并不影响FeNO测定在吸烟哮喘患者中的临床价值。
（韩伟 青岛市市立医院东院呼吸科 266071 摘译）
Eur Respir J 2009; 33:1295-1301
Exhaled nitric oxide as a marker of asthma control in smoking patients
A. Michils1, R. Louis2, R. Peché3, S. Baldassarre1 and A. Van Muylem1
Keywords: Asthma control, exhaled nitric oxide, tobacco smoking
Exhaled nitric oxide fraction (FeNO), which is a reliable marker of eosinophilic airway inflammation, is partially suppressed by tobacco smoking. Consequently, its potential as a biomarker in asthma management has never been evaluated in smoking patients. In the present study, the authors tested the validity of FeNO to predict asthma control in this population.
FeNO and the Asthma Control Questionnaire (ACQ) were recorded at least once in 411 nonsmoking (345 with at least two visits) and 59 smoking (51 with at least two visits) asthma patients.
Despite similar mean ACQ scores (1.5 versus 1.7), FeNO was reduced in smoking asthmatics (18.1 ppb versus 33.7 ppb). A decrease in FeNO of <20% precludes asthma control improvement in nonsmoking (negative predictive value (NPV) 78%) and in smoking patients (NPV 72%). An increase in FeNO <30% is unlikely to be associated with deterioration in asthma control in both groups of patients (NPV = 86% and 84% in nonsmoking and smoking patients, respectively).
It is concluded that, even in smokers, sequential changes in FeNO have a relationship with asthma control. The present study is the first to indicate that cigarette smoking does not obviate the clinical value of measuring FeNO in asthma among smokers.
Eur Respir J 2009; 33:1295-1301
作为嗜酸性粒细胞气道炎症的可靠标志，呼出NO (FeNO)常用于哮喘控制的监测。但吸烟可能抑制FeNO水平，因而FeNO能否作为吸烟患者哮喘管理的监测指标尚需评价。为了检测FeNO在吸烟者中对哮喘控制的预测能力，Michils等进行了411例非吸烟哮喘患者和59例吸烟哮喘患者一项临床观察研究。
所有研究对象均接受至少1次哮喘控制问卷 (Asthma Control Questionnaire, ACQ)调查并进行FeNO检测，其中245例非吸烟哮喘患者和51例吸烟哮喘患者至少访视2次。
研究结果显示，吸烟者和非吸烟者平均ACQ评分相近（1.5比1.7），但吸烟组FeNO明显低于非吸烟组(18.1 ppb比 33.7 ppb)。FeNO下降低于20%可排除哮喘控制改善（非吸烟组NPV 78%，吸烟组NPV 72%），而FeNO升高低于30%也不支持哮喘恶化（非吸烟组NPV 86%，吸烟组NPV 84%）。
综合研究结果，无论吸烟者还是非吸烟者，FeNO的连续变化与哮喘控制有关。因此作者认为，吸烟并不影响FeNO测定在吸烟哮喘患者中的临床价值。
（韩伟 青岛市市立医院东院呼吸科 266071 摘译）
Eur Respir J 2009; 33:1295-1301
Exhaled nitric oxide as a marker of asthma control in smoking patients
A. Michils1, R. Louis2, R. Peché3, S. Baldassarre1 and A. Van Muylem1
Keywords: Asthma control, exhaled nitric oxide, tobacco smoking
Exhaled nitric oxide fraction (FeNO), which is a reliable marker of eosinophilic airway inflammation, is partially suppressed by tobacco smoking. Consequently, its potential as a biomarker in asthma management has never been evaluated in smoking patients. In the present study, the authors tested the validity of FeNO to predict asthma control in this population.
FeNO and the Asthma Control Questionnaire (ACQ) were recorded at least once in 411 nonsmoking (345 with at least two visits) and 59 smoking (51 with at least two visits) asthma patients.
Despite similar mean ACQ scores (1.5 versus 1.7), FeNO was reduced in smoking asthmatics (18.1 ppb versus 33.7 ppb). A decrease in FeNO of <20% precludes asthma control improvement in nonsmoking (negative predictive value (NPV) 78%) and in smoking patients (NPV 72%). An increase in FeNO <30% is unlikely to be associated with deterioration in asthma control in both groups of patients (NPV = 86% and 84% in nonsmoking and smoking patients, respectively).
It is concluded that, even in smokers, sequential changes in FeNO have a relationship with asthma control. The present study is the first to indicate that cigarette smoking does not obviate the clinical value of measuring FeNO in asthma among smokers.
Eur Respir J 2009; 33:1295-1301
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