Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
J Allergy Clin Immunol Pract. 2013 Nov-Dec;1(6):639-48.e1-8. doi: 10.1016/j.jaip.2013.07.013. Epub 2013 Oct 9.
Atopic asthma is characterized by Th2 cytokine-driven inflammation of the airway mucosa, which is signaled by the fraction of exhaled nitric oxide (FENO).
We tested whether an FENO-guided anti-inflammatory treatment algorithm could improve asthma-related quality of life and asthma symptom control, and reduce exacerbations in atopic asthmatics within primary care.
Altogether, 187 patients with asthma and who were nonsmokers (age range, 18-64 years) with perennial allergy and who were on regular inhaled corticosteroid treatment were recruited at 17 primary health care centers, randomly assigned to 2 groups and followed up for 1 year. For the controls (n = 88), FENO measurement was blinded to both operator and patient, and anti-inflammatory treatment was adjusted according to usual care. In the active group (n = 93), treatment was adjusted according to FENO. Questionnaires on asthma-related quality of life (Mini Asthma Quality of Life Questionnaire) and asthma control (Asthma Control Questionnaire) were completed, and asthma events were noted.
The Asthma Control Questionnaire score change over 1 year improved significantly more in the FENO-guided group (-0.17 [interquartile range {IQR}, -0.67 to 0.17] vs 0 [-0.33 to 0.50]; P = .045), whereas the Mini Asthma Quality of Life Questionnaire score did not (0.23 [IQR, 0.07-0.73] vs 0.07 [IQR, -0.20 to 0.80]; P = .197). The change in Asthma Control Questionnaire was clinically important in subpopulations with poor control at baseline (P = .03). Furthermore, the exacerbation rate (exacerbations/patient/y) was reduced by almost 50% in the FENO-guided group (0.22 [CI, 0.14-0.34] vs 0.41 [CI, 0.29-0.58]; P = .024). Mean overall inhaled corticosteroid use was similar in both groups (P = .95).
Use of FENO to guide anti-inflammatory treatment within primary care significantly reduced the exacerbation rate and improved asthma symptom control without increasing overall inhaled corticosteroid use.
特应性哮喘的特征是气道黏膜的 Th2 细胞因子驱动的炎症，这由呼出气一氧化氮（FENO）的分数来表示。
我们测试了一种 FENO 指导的抗炎治疗算法是否可以改善特应性哮喘患者的相关生活质量和哮喘症状控制，并减少初级保健中的哮喘加重。
总共招募了 187 名哮喘患者，他们是非吸烟者（年龄范围 18-64 岁），患有常年过敏，并且正在接受常规吸入皮质类固醇治疗，他们被分配到 17 个初级保健中心，随机分为两组，并随访 1 年。对于对照组（n=88），FENO 测量对操作员和患者均为盲法，并且根据常规护理调整抗炎治疗。在主动组（n=93）中，根据 FENO 调整治疗。完成了与哮喘相关的生活质量（Mini Asthma Quality of Life Questionnaire）和哮喘控制（Asthma Control Questionnaire）的问卷，并记录了哮喘事件。
在 FENO 指导组中，1 年内哮喘控制问卷评分的变化明显更大（-0.17[四分位距 {IQR}，-0.67 至 0.17]比 0[-0.33 至 0.50]；P=0.045），而 Mini Asthma Quality of Life Questionnaire 评分没有（0.23[IQR，0.07-0.73]比 0.07[IQR，-0.20 至 0.80]；P=0.197）。在基线控制不佳的亚组中，哮喘控制问卷的变化具有临床意义（P=0.03）。此外，在 FENO 指导组中，哮喘加重率（患者/年的加重次数）降低了近 50%（0.22[CI，0.14-0.34]比 0.41[CI，0.29-0.58]；P=0.024）。两组的总体吸入皮质类固醇使用率相似（P=0.95）。
在初级保健中使用 FENO 指导抗炎治疗显著降低了哮喘加重率，并改善了哮喘症状控制，而不增加总体吸入皮质类固醇的使用。
