哮喘联盟

   摘要
   背景：最近的美国胸科学会（ATS）指南支持在哮喘患者中使用呼出气一氧化氮(FENO)，并强调循证基础的空白情况。但FENO对于接受常规护理的高危、城市、少数民族人群中哮喘急性发作的预测作用知之甚少。
   方法：一项前瞻性、观察性、队列研究纳入138例持续哮喘的儿童，基线进行皮肤试验（风团直径≥3mm=+SPT）。于基线和之后每3个月检测一次  FENO水平、肺功能和哮喘相关卫生服务情况，为期1年。之后的三个月研究FENO与卫生服用利用的关系。采用最终模型进行重复结果测定，并调整了年龄、性别和肺功能因素。
   结果：入组患者平均年龄11岁（范围：5-17），其中大多数为男性（57%）、非裔美籍（91%）和遗传性过敏症患者（90%）。基线检测结果：FENO（中位值[IQR]）为31.5ppb [16-61]，FEV1/FVC（平均值 ± SD）为80.7±9.6%。随访期间共发生了237次急性哮喘相关的就医，其中105次为计划外就医（UD），125次为急诊室(ED)就医，以及7次住院。非校正/校正分析均显示FENO不能明显预测紧急就医、ED就医、UD就医或住院情况。使用推荐的截点不能提高FENO的预测价值(PPV 0.6-32.8%)，同样，应用基于指南的公式来评估随时间发生的改变也不能提高其预测价值。
   结论：对于城市少数民族哮喘患儿，因哮喘急性发作而导致的卫生服务使用，FENO可能不是一个有用的预测指标。
 

（苏楠 审校）
Chest. 2013 Jun 13. doi: 10.1378/chest.12-3098. [Epub ahead of print]

 

Guideline-Recommended Fractional Exhaled Nitric Oxide is a Poor Predictor of Health Care Use Among Inner-city Children and Adolescents Receiving Usual Asthma Care.
 

McCormack MC, Aloe C, Curtin-Brosnan J, Diette GB, Breysse PN, Matsui EC.
 

Abstract
ABSTRACT BACKGROUND: Recent American Thoracic Society (ATS) guidelines support use of FENO in patients with asthma and highlight gaps in the evidence base. Little is known about use of FENO to predict asthma exacerbations among high-risk, urban, minority populations receiving usual care.
METHODS: 138 children with persistent asthma were enrolled in a prospective observational cohort study and skin tested at baseline (wheal≥3mm=+SPT). Fractional exhaled nitric oxide (FENO) levels, lung function, and asthma-related health care use were assessed at baseline and every three months thereafter for one year. Relationships between FENO and health care utilization in the subsequent three months were examined. Final models accounted for repeated outcome measures and were adjusted for age, gender and lung function.
RESULTS: The mean age was 11 years (range 5-17), and most were male (57%), African American (91%), and atopic (90%). At baseline, FENO was (median [IQR]: 31.5ppb [16-61]) and FEV1/FVC was (mean ± SD: 80.7±9.6%). There were 237 acute asthma-related health care visits, 105 unscheduled doctor (UD) visits, 125 ED visits, and 7 hospitalizations during the follow-up period. FENO was not a significant predictor of acute visits, ED visits, UD visits, or hospitalization in either unadjusted or adjusted analyses. Use of recommended cutpoints did not improve the predictive value of FENO (PPV 0.6-32.8%), nor did application of the guideline-based algorithm to assess change over time.
CONCLUSIONS: FENO may not be a clinically useful predictor of health care use for asthma exacerbations in urban minority children with asthma.
 

Chest. 2013 Jun 13. doi: 10.1378/chest.12-3098. [Epub ahead of print]