Kim Chang-Keun, Koh Young Yull, Callaway Zak
Department of Pediatrics, Asthma & Allergy Center, Inje University Sanggye Paik Hospital, Seoul, South Korea.
J Asthma. 2009 Mar;46(2):105-12. doi: 10.1080/02770900802604111.
There are a number of useful direct airway sampling procedures to help diagnose and monitor asthma in patients. However, non-invasive techniques are the ideal, especially in children, given the necessity of safe and repeatable measurements to monitor treatment efficacy and disease progression. Bronchoalveolar lavage (BAL) may be too invasive for clinical use in children, while questions still surround the utility of induced sputum (IS). More novel techniques, such as fractional exhaled nitric oxide (FE(NO)) and exhaled breath condensate (EBC), are still unproven. Eosinophilic airway inflammation is a major feature of childhood asthma, and it has been revealed as a major treatment target with inhaled corticosteroids. Moreover, treatment protocols governed by sputum eosinophil counts may be more efficacious - by reducing the frequency and severity of exacerbations - than treatment based on clinical symptoms and other traditional objective measures of lung function. The selection of an appropriate airway inflammation monitoring technique must take everything into consideration, including safety, reproducibility, repeatability, sensitivity to treatment, and the overall clinical/research goals.
有许多有用的直接气道采样程序可帮助诊断和监测患者的哮喘。然而，非侵入性技术是理想之选，尤其是对于儿童，因为需要进行安全且可重复的测量来监测治疗效果和疾病进展。支气管肺泡灌洗（BAL）对于儿童临床应用而言可能侵入性过大，而诱导痰（IS）的效用仍存在疑问。更多新颖的技术，如呼出一氧化氮分数（FE(NO)）和呼出气冷凝物（EBC），仍未得到证实。嗜酸性气道炎症是儿童哮喘的主要特征，并且已被揭示为吸入性糖皮质激素的主要治疗靶点。此外，与基于临床症状和其他传统肺功能客观指标的治疗相比，依据痰液嗜酸性粒细胞计数制定的治疗方案可能更有效——通过减少发作的频率和严重程度。选择合适的气道炎症监测技术必须考虑到所有因素，包括安全性、可重复性、重复性、对治疗的敏感性以及总体临床/研究目标。
