哮喘联盟

   摘要
   背景：呼出气一氧化氮（FENO）被越来越多的应用于哮喘诊断和治疗。然而，这项指标很少在检测职业性哮喘中使用。
   目的：检测无创性方法在评估气道炎症中的作用。
   方法：本研究是在面包店、糕点店和美容行业的年轻工人回顾性队列中进行的一项巢式病例对照试验。受试者在一次医疗随访期间进行临床检查。采集血标本，并检测FENO水平。病例组来自“确诊”或“可能”存在职业哮喘的受试者。
   结果：共178位工人被纳入研究，19例为哮喘病例。在单变量分析中，FENO与病例/对照者身体情况、身高和吸烟情况有关。在多元线性回归模型中，病例/对照者身体情况、身高和吸烟状态是FENO变化的独立危险因素。使用低FENO阈值（分别为8.5和10.5 ppb）时，敏感性较好或一般的比例分别为80%和70%。FENO>8.5 ppb和临床检测阳性可增加特异性但不减低敏感性（分别达到80.5%和79.0%）。
   结论：本研究表明FENO检测不能单独作为筛查职业性哮喘的有效指标。能否联合使用FENO和调查问卷或重复测量，仍然需要进一步的探讨。
 

（刘国梁 审校）
Int J Tuberc Lung Dis. 2014 Jun;18(6):744-50. doi: 10.5588/ijtld.13.0641.

 

Exhaled nitric oxide and screening for occupational asthma in two at-risk sectors: bakery and hairdressing.

 
Florentin A, Acouetey DS, Remen T, Penven E, Thaon I, Zmirou-Navier D, Paris C.
 

ABSTRACT
BACKGROUND: Fractional exhaled nitric oxide (FENO) levels are increasingly being used in the diagnosis and management of asthma. However, this indicator has rarely been used to detect occupational asthma.
OBJECTIVE: To examine non-invasive methods to estimate airway inflammation.
METHODS: A nested case-control study was conducted among a retrospective cohort of young workers in the bakery, pastry-making and hairdressing industries. Subjects underwent a clinical examination during a medical visit. Blood samples were collected and FENO levels measured. Cases were subjects diagnosed as suffering from 'confirmed' or 'probable' occupational asthma.
RESULTS: Of the 178 workers included in the study, 19 were cases. In univariate analysis, FENO was associated with case/control status, and height and smoking status. In a multiple linear regression model, case/control status (P < 0.001), height (P = 0.006) and smoking status (P < 0.001) remained independent risk factors for variations in FENO levels. Good or fair sensitivity of respectively around 80% and 70% can be achieved using low FENO thresholds (8.5 and 10.5 ppb, respectively). FENO >8.5 ppb and a positive clinical examination increases specificity without loss of sensitivity (to 80.5% and 79.0%, respectively).
CONCLUSION: This study suggests that FENO measurements alone cannot be considered a useful screening test for occupational asthma. Further investigations are needed to investigate the use of combined FENO and questionnaire or repeated measures.
 

Int J Tuberc Lung Dis. 2014 Jun;18(6):744-50. doi: 10.5588/ijtld.13.0641.