Division of Pediatric Pulmonology, Allergy, and Cystic Fibrosis Division of Respiratory Physiology, Charles Nicolle University Hospital, INSERM CIC 204, Rouen University, Rouen, France.
Pediatr Allergy Immunol. 2010 Nov;21(7):1015-20. doi: 10.1111/j.1399-3038.2010.01076.x.
Fractional exhaled nitric oxide (FeNO) is a non-invasive marker of bronchial inflammation in asthma. However, the interest of FeNO measurement remained limited in infantile wheeze. The aim of this prospective study was to evaluate the feasibility and reproducibility of FeNO off-line measurement in very young children with recurrent wheeze and to assess whether clinical control of infantile wheeze correlates with FeNO levels. Two exhalation samples were collected in mylar balloon during quite tidal breathing. FeNO measurements were performed off-line by a NO analyzer. The participating patients were aged ≤36 months, wheezes had started before the age of 24 months, and they were receiving maintenance treatment with inhaled corticosteroids for at least 3 months duration. The studied population comprised of 40 uncontrolled infants with persistent wheezy respiratory symptoms, median age 14.5 months, and 40 with optimal controlled infantile wheeze, median age 14 months. The reproducibility was excellent (r = 0.95; p < 0.0001). There was a significant difference in FeNO levels between the groups of persistent wheeze and well-controlled infants: 19.8 (2.5-99.3) ppb vs. 7.7 (0.6-29.5) ppb, p < 0.0001. At a FeNO level >15 ppb, the predictive values for uncontrolled disease were as follows: positive predictive value = 65%, negative predictive value = 90%. FeN0 levels were not increased by atopy or passive tobacco. Off-line assessment of FeNO is feasible, reproducible, and well accepted in wheezy very young children. Optimal clinical control of infantile wheeze appeared to be associated with the control of bronchial inflammation when evaluated by FeNO measurements.
呼出气一氧化氮（FeNO）是哮喘患者支气管炎症的一种非侵入性标志物。然而，FeNO 测量在婴儿喘息中的应用仍然有限。本前瞻性研究旨在评估在线下测量反复喘息的非常年幼儿童 FeNO 的可行性和可重复性，并评估婴儿喘息的临床控制是否与 FeNO 水平相关。在平静呼吸时，通过聚对二甲苯球囊收集 2 次呼气样本。通过 NO 分析仪进行离线 FeNO 测量。参与研究的患者年龄≤36 个月，喘息在 24 个月之前开始，并且他们正在接受吸入皮质类固醇的维持治疗，至少持续 3 个月。研究人群包括 40 名持续性喘息呼吸症状未控制的婴儿，中位年龄为 14.5 个月，和 40 名婴幼儿喘息得到良好控制的婴儿，中位年龄为 14 个月。重复性非常好（r = 0.95；p <0.0001）。持续性喘息组和良好控制组的 FeNO 水平有显著差异：19.8（2.5-99.3）ppb 与 7.7（0.6-29.5）ppb，p <0.0001。当 FeNO 水平>15 ppb 时，未控制疾病的预测值如下：阳性预测值=65%，阴性预测值=90%。特应性或被动吸烟不会增加 FeN0 水平。线下评估 FeNO 在喘息的非常年幼儿童中是可行的、可重复的，并且易于接受。当通过 FeNO 测量评估时，婴幼儿喘息的最佳临床控制似乎与支气管炎症的控制相关。
