开始吸入激素治疗后FeNO可作为哮喘控制改善情况的预测指标
2014/10/16
摘要
简介：呼出气一氧化氮(FeNO)分数是一个哮喘炎症标记物。本研究为一项真实世界中一项研究，旨在评估依照目前指南对于FeNO临床使用的建议，开始吸入糖皮质激素(ICS)治疗后，是否只有高FeNO水平(⩾50 ppb)可预测哮喘控制的改善情况。
方法：一项回顾观察性研究，153例平均年龄为40岁无吸烟和激素使用史的哮喘受试者，在6周前后(平均随访时间)均接受500μg丙酸倍氯米松(中位值)治疗，评估其FeNO水平和哮喘控制情况。
结果：初始随访时，与正常FeNO水平 (<25 ppb)相比，中度FeNO水平(⩾25 且 <50 ppb)和高FeNO水平(⩾50 ppb)组达到哮喘控制调查问卷(ACQ)评分⩾1的受试者比例更高（78% 和 67% vs 43%, p<0.05），且在随访期间同时达到ACQ评分⩾1和哮喘控制的受试者比例也更高（31% 和37% vs 4%, p<0.05）。这些相关性与校正混杂因素后多因素logistic回归模型分析结果一致。
结论：在开始ICS治疗后，不仅高水平而且中度FeNO水平均与哮喘控制显著改善相关。这将挑战临床指南所述的只有高FeNO水平可预测对ICS治疗的反应。
（林江涛 审校）
Nitric Oxide. 2014 Jul8.pii: S1089-8603(14)00254-7.doi:10.1016/j.niox.2014.06.009. [Epub ahead of print]
FeNO as a predictor of asthma control improvement after starting inhaled steroid treatment.
Malinovschi A1, Muylem AV2, Michiels S2, Michils A2.
ABSTRACT
INTRODUCTION: The fraction of NO in exhaled air (FeNO) is a marker of inflammation in asthma. The aim of the present study was to assess, in a real-world setting, whether only high (⩾50 ppb) FeNO levels predict improvement in asthma control when being treated with inhaled corticosteroids (ICS), as suggested by current guidelines on the clinical use of FeNO.
METHODS: FeNO and asthma control were assessed in a retrospective observational study in 153 non-smoking, steroid-naïve, adult subjects with asthma with a mean age of 40 years both before and after 6 weeks (median follow-up time) of treatment with 500 μg beclomethasone (median).
RESULTS: Having at the initial visit intermediate FeNO (⩾25 and <50 ppb) and high FeNO (⩾50 ppb), compared to normal FeNO (<25 ppb), were associated with a larger proportion of subjects achieving an improvement of Asthma Control Questionnaire (ACQ) score with ⩾1 (78% and 67% vs 43%, p<0.05) or both ⩾1 improvement and asthma control at follow-up (31% and 37% vs 4%, p<0.05). These associations were consistent in multiple logistic regression models after adjustments for confounders.
CONCLUSIONS: It is not only high but also intermediate FeNO levels that are associated with a significant improvement in asthma control after starting ICS treatment. This challenges current clinical guidelines stating that only high FeNO levels predict response to ICS treatment.
Nitric Oxide. 2014 Jul8.pii: S1089-8603(14)00254-7.doi:10.1016/j.niox.2014.06.009. [Epub ahead of print]
