Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, Lakewood, CA, USA.
J Breath Res. 2012 Dec;6(4):047101. doi: 10.1088/1752-7155/6/4/047101. Epub 2012 Jun 7.
The up-regulation of nitric oxide (NO) by inflammatory cytokines and mediators in central and peripheral airway sites can be easily monitored in exhaled air (F(E)NO). It is now possible to estimate the predominant airway site of increased F(E)NO i.e. large versus peripheral airway/alveoli, and its potential pathologic and physiologic role in obstructive lung disease. In asthma, six double-blind, randomized, controlled algorithm trials have reported only equivocal benefits of add-on measurements of F(E)NO to usual clinical guideline management including spirometry. Significant design issues, as emphasized by Gibson, may exist. However, meta-analysis of these six studies (Petsky et al 2012 Thorax 67 199-208) concluded that routine serial measurements of F(E)NO for clinical asthma management does not appear warranted. In COPD including chronic bronchitis and emphysema, despite significant expiratory airflow limitation, when clinically stable as well as during exacerbation, F(E)NO, j'(awNO) and C(ANO) may all be normal or increased. Furthermore, the role of add-on monitoring of exhaled NO to GOLD management guidelines is less clear because of the absence of conclusive doubleblind, randomized, control trial studies concerning potential clinical benefits in the management of COPD.
气道内炎症细胞因子和介质可使一氧化氮（NO）水平上调，这一现象可在呼出气（F（E）NO）中轻易监测到。目前，人们已经可以对 F（E）NO 增高的主要气道部位（大气道与小气道/肺泡）进行评估，这有助于进一步明确其在阻塞性肺疾病中的潜在病理生理学作用。在哮喘中，六项双盲、随机、对照算法试验报告称，在常规临床指南管理（包括肺量测定）中添加 F（E）NO 测定对改善病情仅有一定作用，结果存在争议。正如 Gibson 所强调的，这些试验可能存在重大设计问题。但是，对这六项研究进行的荟萃分析（Petsky 等，2012 年《胸》67：199-208）认为，在哮喘管理中常规进行 F（E）NO 连续监测似乎没有必要。在 COPD 包括慢性支气管炎和肺气肿中，即使存在显著的呼气气流受限，在临床稳定期和加重期时，F（E）NO、j'（awNO）和 C（ANO）可能都正常或升高。此外，由于缺乏关于 COPD 管理中附加监测呼出气 NO 对 GOLD 管理指南潜在临床获益的明确双盲、随机、对照试验研究，因此，在 COPD 管理中添加监测 F（E）NO 的作用尚不明确。
