哮喘联盟

   摘要
   背景：呼出气一氧化氮是嗜酸粒细胞性气道炎症的替代指标，也是预测对皮质类固醇治疗应答很好的指标。
   目的：评价呼出气一氧化氮如何被用于指导英国哮喘管理的初级护理，以便在激素敏感型疾病的诊断中制定切实可行的FeNO使用程序，为哮喘管理提供指导。
   方法：纳入最佳病人护理研究数据库(OPCRD)中年龄在4～80岁，并且在索引日期通过NIOX MINO(R) 或Flex(R)进行了第一次FeNO评估的符合标准的678例患者，。在研究期间至少10例患者使用FeNO测量作为合格的实践。在索引日期前是一个超过一年的基线期，用来描绘病人的特点。紧跟着索引日期的那一年评估两组患者的结果：(i)使用FeNO测量确定激素敏感型疾病的患者，(ii)使用FeNO监测指导正在进行的哮喘管理的患者。(i)组的结果包括经过一个月或不到一个月的随访期内新发的初始使用吸入糖皮质激素（ICS）治疗的发生率，患者的首次FeNO测量值，以及在评估结果年的ICS剂量。(ii)组的结果包括依从性、依从性的变化(自基线)和ICS剂量。
   结果：在(i)组(n=304)， FeNO含量越高，随后一个月或一个月内开始使用ICS治疗的患者比例越高，人群的首次FeNO测量值为：分别有82%、46%和26%的患者伴有高水平、中等水平FeNO或低水平FeNO。在(ii)组 (n = 374)高水平FeNO与较差的基线依从性相关(p = 0.005)，但在结果评估年的依从性改善更大(p = 0.017)。在两个组别，伴有高水平FeNO的患者均与ICS剂量更高显著相关(p < 0.001)。
   结论：在英国，FeNO已被用于初级卫生保健实践，指导ICS初始治疗和确定剂量，以及确定差的ICS依从性。指导临床医生实践使用FeNO的简单程序可以改善诊断的准确性，并可量身打造更好的哮喘治疗方案。
 

（林江涛 审校）
Clin Transl Allergy. 2013 Nov 7;3(1):37. [Epub ahead of print]


 

Using fractional exhaled nitric oxide (FeNO) to diagnose steroid-responsive
disease and guide asthma management in routine care.
 

Price D, Ryan D, Burden A, Von Ziegenweidt J, Gould S, Freeman D, Gruffydd-Jones
K, Copland A, Godley C, Chisholm A, Thomas M.
 

Abstract
BACKGROUND: Fractional exhaled nitric oxide (FeNO) is a surrogate marker of eosinophilic airway inflammation and good predictor of corticosteroid response.
Aim: To evaluate how FeNO is being used to guide primary care asthma management in the United Kingdom (UK) with a view to devising practical algorithms for the use of FeNO in the diagnosis of steroid-responsive disease and to guide on-going asthma management.
METHODS: Eligible patients (n = 678) were those in the Optimum Patient Care Research Database (OPCRD) aged 4--80 years who, at an index date, had their first FeNO assessment via NIOX MINO(R) or Flex(R). Eligible practices were those using  FeNO measurement in at least ten patients during the study period. Patients were  characterized over a one-year baseline period immediately before the index date. Outcomes were evaluated in the year immediately following index date for two patient outcomes: (i) those in whom FeNO measurement was being used to identify steroid-responsive disease and (ii) those in whom FeNO monitoring was being used  to guide on-going asthma management. Outcomes for cohort (i) were incidence of new ICS initiation at, or within the one-month following, their first FeNO measurement, and ICS dose during the outcome year. Outcomes for cohort (ii) were  adherence, change in adherence (from baseline) and ICS dose.
OUTCOMES: In cohort (i) (n = 304) the higher the FeNO category, the higher the percentage of patients that initiated ICS at, or in the one month immediately following, their first FeNO measurement: 82%, 46% and 26% of patients with high, intermediate and low FeNO, respectively. In cohort (ii) (n = 374) high FeNO levels were associated with poorer baseline adherence (p = 0.005) but greater improvement in adherence in the outcome year (p = 0.017). Across both cohorts, patients with high FeNO levels were associated with significantly higher ICS dosing (p < 0.001).
CONCLUSIONS:In the UK, FeNO is being used in primary practice to guide ICS initiation and dosing decisions and to identify poor ICS adherence. Simple algorithms to guide clinicians in the practical use of FeNO could improved diagnostic accuracy and better tailored asthma regimens.
 

Clin Transl Allergy. 2013 Nov 7;3(1):37. [Epub ahead of print]