Avital A, Uwyyed K, Berkman N, Godfrey S, Bar-Yishay E, Springer C
Institute of Pulmonology, Hadassah University Hospital and Hebrew University-Hadassah Medical School, Jerusalem, Israel.
Pediatr Pulmonol. 2001 Oct;32(4):308-13. doi: 10.1002/ppul.1124.
Exhaled nitric oxide (eNO) has been used to diagnose asthma in adults and children using either the slow vital capacity method (SVCm) or, in younger children, the tidal breathing method (TBm). Adenosine 5'-monophosphate (AMP) challenge also has been found to be a sensitive and specific test for the diagnosis of asthma. In the present study, we used the AMP provocation concentration that caused wheezing (PCW) to confirm the diagnosis of asthma (PCW < or = 200 mg/mL). We studied 36 children (2-7 years) with mild intermittent asthma, 13 children (3-7 years) with moderate persistent asthma treated with inhaled steroids, 20 nonasthmatic children (2-7 years) with chronic cough and recurrent pneumonia, and 15 healthy children (4-6 years). Expired gas was collected in collection bags by the TBm, and eNO was measured. We evaluated the efficacy of eNO values in diagnosing asthma. The mean eNO level of the mild intermittent asthmatic children (5.6 +/- 0.4 ppb) not receiving inhaled corticosteroids was significantly higher (ANOVA P < 0.0001) than that of the moderate persistent asthmatics who were treated with inhaled steroids, the nonasthmatic children with chronic cough, and the group of healthy children (3.7 +/- 0.6 ppb, P < 0.05; 3.2 +/- 0.3 ppb, P < 0.001; 2.2 +/- 0.2 ppb, P < 0.001, respectively). The points of intersection for sensitivity and specificity curves of eNO to differentiate mild intermittent asthmatics from nonasthmatic children with chronic cough and from healthy children were 77% and 88% for eNO values of 3.8 ppb and 2.9 ppb, respectively. We conclude that eNO collected by the TBm can differentiate steroid-naive young children with intermittent asthma from healthy children, from nonasthmatic children with chronic cough, and from asthmatic children treated with inhaled steroids.
呼出一氧化氮（eNO）已被用于诊断成人和儿童哮喘，采用慢肺活量法（SVCm），对于年幼儿童则采用潮气呼吸法（TBm）。5'-单磷酸腺苷（AMP）激发试验也被发现是诊断哮喘的一种敏感且特异的检测方法。在本研究中，我们使用引起喘息的AMP激发浓度（PCW）来确诊哮喘（PCW≤200mg/mL）。我们研究了36名2至7岁患有轻度间歇性哮喘的儿童、13名3至7岁接受吸入性糖皮质激素治疗的中度持续性哮喘儿童、20名2至7岁患有慢性咳嗽和反复肺炎的非哮喘儿童以及15名4至6岁的健康儿童。通过TBm将呼出气体收集在收集袋中，并测量eNO。我们评估了eNO值在诊断哮喘方面的有效性。未接受吸入性糖皮质激素治疗的轻度间歇性哮喘儿童的平均eNO水平（5.6±0.4ppb）显著高于接受吸入性糖皮质激素治疗的中度持续性哮喘儿童、患有慢性咳嗽的非哮喘儿童以及健康儿童组（分别为3.7±0.6ppb，P<0.05；3.2±0.3ppb，P<0.001；2.2±0.2ppb，P<0.001）。eNO区分轻度间歇性哮喘儿童与患有慢性咳嗽的非哮喘儿童以及健康儿童的敏感性和特异性曲线的交点，对于eNO值3.8ppb和2.9ppb分别为77%和88%。我们得出结论，通过TBm收集的eNO可以区分未使用糖皮质激素的患有间歇性哮喘的年幼儿童与健康儿童、患有慢性咳嗽的非哮喘儿童以及接受吸入性糖皮质激素治疗的哮喘儿童。
