Ludviksdottir Dora, Diamant Zuzana, Alving Kjell, Bjermer Leif, Malinovschi Andrei
University of Iceland, Reykjavik, Iceland.
Clin Respir J. 2012 Oct;6(4):193-207. doi: 10.1111/crj.12001.
Current guidelines recommend tailoring of asthma management according to disease control, which is largely defined by increased symptoms and deterioration in lung function. These features do not reflect the severity nor the type of the asthmatic airway inflammation. Fractional exhaled nitric oxide (FE(NO)) is a simple, non-invasive and cost-effective online test applicable in both adults and children. In addition to symptoms and lung function measurements, FE(NO) reflects airway eosinophilia and hence allows online assessment of the corticosteroid-sensitive T helper 2 type airway inflammation in asthmatic patients. FE(NO) can thus be applied to aid asthma diagnosis and treatment monitoring both in clinical practice and for research purposes.
The scope of this review is to provide an overview of the most important clinical studies using FE(NO) in asthma management and to summarise the implications of FE(NO) measurements in clinical practice.
In several studies, FE(NO) measurements provided additional information on aspects of asthma including phenotyping, corticosteroid-responsiveness and disease control. Thus, if correctly applied and interpreted, FE(NO) can aid asthma diagnosis, identify patients at risk of exacerbation and support customized treatment decisions. A simple and reliable tool to quantify peripheral nitric oxide will further aid to identify patients with small airways inflammation.
当前指南建议根据疾病控制情况调整哮喘管理方案，而疾病控制在很大程度上由症状加重和肺功能恶化来界定。这些特征并不能反映哮喘气道炎症的严重程度或类型。呼出一氧化氮分数（FE(NO)）是一种简单、无创且经济高效的在线检测方法，适用于成人和儿童。除了症状和肺功能测量外，FE(NO)还能反映气道嗜酸性粒细胞增多情况，从而可以在线评估哮喘患者中对皮质类固醇敏感的2型辅助性T细胞气道炎症。因此，FE(NO)可应用于临床实践和研究目的，以辅助哮喘诊断和治疗监测。
本综述的范围是概述在哮喘管理中使用FE(NO)的最重要临床研究，并总结FE(NO)测量在临床实践中的意义。
在多项研究中，FE(NO)测量提供了有关哮喘各个方面的额外信息，包括表型分析、皮质类固醇反应性和疾病控制。因此，如果正确应用和解读，FE(NO)可以辅助哮喘诊断，识别有加重风险的患者，并支持个性化的治疗决策。一种简单可靠的量化外周一氧化氮的工具将进一步有助于识别患有小气道炎症的患者。
