激素吸入治疗的哮喘儿童中，呼出气一氧化氮和低水平环境烟草烟雾暴露的相关性
2012/10/11
摘要
目的：呼出气一氧化氮（FeNO）与哮喘严重程度或哮喘控制的关系存在分歧。主动吸烟能降低FeNO，但被动吸烟与FeNO的关系尚不清楚。即使父母在儿童面前避免吸烟，儿童也可能暴露于低水平的环境烟草烟雾（ETS）或三手烟。我们认为，与无低水平ETS暴露的哮喘儿童相比，低水平ETS暴露的哮喘儿童FeNO较低。
方法：年龄8～18岁的稳定期哮喘患儿入选，这些患者采用低或中等剂量激素吸入治疗（ICS）。检测肺活量、哮喘控制问卷调查（ACQ）、检测FeNO、呼出气冷凝液pH（EBC pH）和EBC氨含量。基于尿可替宁检测结果，区分ETS暴露和无ETS暴露患儿，比较两者上述指标的差异。
结果：33名患儿入选，10名（30%）患儿尿可替宁≥1 ng/ml。两组在年龄、性别、BMI、过敏状态、FEV1、EBC pH和EBC氨含量上无显著差异。可替宁<1 ng/ml 的患儿其ACQ中位数为0.29（IQR: 0.22-0.57），可替宁≥1 ng/ml的患儿其ACQ中位数为0.64（IQR: 0.57-1.1）（P=0.02）。无ETS暴露儿童的FeNO（ppb）中位数为23.9（IQR: 15.2-34.5），而ETS暴露患儿的FeNO中位数为9.6（IQR: 5.1-15.8）。
结论：低至中等剂量激素吸入治疗的哮喘患儿，近期低水平ETS暴露能降低FeNO。在将FeNO作为气道炎症一个生物标志物进行阐述时，需要考虑低水平ETS暴露或三手烟暴露。
（苏楠 审校）
J Asthma. 2012 Sep;49(7):673-8. Epub 2012 Jul 17.
Relationship between Exhaled Nitric Oxide and Exposure to Low-Level Environmental Tobacco Smoke in Children with Asthma on Inhaled Corticosteroids.
de la Riva-Velasco E, Krishnan S, Dozor AJ.
Source
Division of Pediatric Pulmonology, Department of Pediatrics, Maria Fareri Children’s Hospital at Westchester Medical Center and New York Medical College , Valhalla, NY , USA.
Abstract
OBJECTIVES：The relationship between exhaled nitric oxide (FeNO) and asthma severity or control is inconsistent. Active smoking lowers FeNO, but the relationship between passive smoking and FeNO is less clear. Children may be exposed to low-level environmental tobacco smoke (ETS) or thirdhand smoke, even if parents avoid smoking in the presence of their children. Our hypothesis was that FeNO is lower in children with asthma exposed to low-level ETS when compared with those who are not exposed.
METHODS：Children with stable asthma, 8-18 years of age, on low- or medium-dose inhaled corticosteroids (ICS) were enrolled. Spirometry, Asthma Control Questionnaire (ACQ), FeNO, exhaled breath condensate pH (EBC pH), and EBC ammonia were compared between children with and without ETS exposure as determined by urinary cotinine.
RESULTS：Thirty-three subjects were enrolled, of which 10 (30%) had urinary cotinine levels ≥1 ng/ml. There were no significant differences between the two groups in age, sex, BMI percentile, atopy status, FEV(1), EBC pH, or EBC ammonia. Median ACQ was 0.29 (IQR: 0.22-0.57) for those with cotinine levels <1 ng/ml and 0.64 (IQR: 0.57-1.1) for those with cotinine levels of ≥1 ng/ml, p = .02. Median FeNO (ppb) was 23.9 (IQR: 15.2-34.5) for unexposed subjects and 9.6 (IQR: 5.1-15.8) for exposed subjects, p = .008.
CONCLUSIONS: Children with asthma on low to medium doses of ICS and recent low-level ETS exposure have lower FeNO levels when compared with non-ETS-exposed subjects. Exposure to low-level ETS or thirdhand smoke may be an important variable to consider when interpreting FeNO as a biomarker for airway inflammation.
J Asthma. 2012 Sep;49(7):673-8. Epub 2012 Jul 17.
目的：呼出气一氧化氮（FeNO）与哮喘严重程度或哮喘控制的关系存在分歧。主动吸烟能降低FeNO，但被动吸烟与FeNO的关系尚不清楚。即使父母在儿童面前避免吸烟，儿童也可能暴露于低水平的环境烟草烟雾（ETS）或三手烟。我们认为，与无低水平ETS暴露的哮喘儿童相比，低水平ETS暴露的哮喘儿童FeNO较低。
方法：年龄8～18岁的稳定期哮喘患儿入选，这些患者采用低或中等剂量激素吸入治疗（ICS）。检测肺活量、哮喘控制问卷调查（ACQ）、检测FeNO、呼出气冷凝液pH（EBC pH）和EBC氨含量。基于尿可替宁检测结果，区分ETS暴露和无ETS暴露患儿，比较两者上述指标的差异。
结果：33名患儿入选，10名（30%）患儿尿可替宁≥1 ng/ml。两组在年龄、性别、BMI、过敏状态、FEV1、EBC pH和EBC氨含量上无显著差异。可替宁<1 ng/ml 的患儿其ACQ中位数为0.29（IQR: 0.22-0.57），可替宁≥1 ng/ml的患儿其ACQ中位数为0.64（IQR: 0.57-1.1）（P=0.02）。无ETS暴露儿童的FeNO（ppb）中位数为23.9（IQR: 15.2-34.5），而ETS暴露患儿的FeNO中位数为9.6（IQR: 5.1-15.8）。
结论：低至中等剂量激素吸入治疗的哮喘患儿，近期低水平ETS暴露能降低FeNO。在将FeNO作为气道炎症一个生物标志物进行阐述时，需要考虑低水平ETS暴露或三手烟暴露。
（苏楠 审校）
J Asthma. 2012 Sep;49(7):673-8. Epub 2012 Jul 17.
Relationship between Exhaled Nitric Oxide and Exposure to Low-Level Environmental Tobacco Smoke in Children with Asthma on Inhaled Corticosteroids.
de la Riva-Velasco E, Krishnan S, Dozor AJ.
Source
Division of Pediatric Pulmonology, Department of Pediatrics, Maria Fareri Children’s Hospital at Westchester Medical Center and New York Medical College , Valhalla, NY , USA.
Abstract
OBJECTIVES：The relationship between exhaled nitric oxide (FeNO) and asthma severity or control is inconsistent. Active smoking lowers FeNO, but the relationship between passive smoking and FeNO is less clear. Children may be exposed to low-level environmental tobacco smoke (ETS) or thirdhand smoke, even if parents avoid smoking in the presence of their children. Our hypothesis was that FeNO is lower in children with asthma exposed to low-level ETS when compared with those who are not exposed.
METHODS：Children with stable asthma, 8-18 years of age, on low- or medium-dose inhaled corticosteroids (ICS) were enrolled. Spirometry, Asthma Control Questionnaire (ACQ), FeNO, exhaled breath condensate pH (EBC pH), and EBC ammonia were compared between children with and without ETS exposure as determined by urinary cotinine.
RESULTS：Thirty-three subjects were enrolled, of which 10 (30%) had urinary cotinine levels ≥1 ng/ml. There were no significant differences between the two groups in age, sex, BMI percentile, atopy status, FEV(1), EBC pH, or EBC ammonia. Median ACQ was 0.29 (IQR: 0.22-0.57) for those with cotinine levels <1 ng/ml and 0.64 (IQR: 0.57-1.1) for those with cotinine levels of ≥1 ng/ml, p = .02. Median FeNO (ppb) was 23.9 (IQR: 15.2-34.5) for unexposed subjects and 9.6 (IQR: 5.1-15.8) for exposed subjects, p = .008.
CONCLUSIONS: Children with asthma on low to medium doses of ICS and recent low-level ETS exposure have lower FeNO levels when compared with non-ETS-exposed subjects. Exposure to low-level ETS or thirdhand smoke may be an important variable to consider when interpreting FeNO as a biomarker for airway inflammation.
J Asthma. 2012 Sep;49(7):673-8. Epub 2012 Jul 17.
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