Watanabe Keisuke, Shinkai Masaharu, Shinoda Masahiro, Hara Yu, Yamaguchi Nobuhiro, Rubin Bruce K, Ishigatsubo Yoshiaki, Kaneko Takeshi
Respiratory Disease Center, Yokohama City University Medical Center, Yokohama, Japan.
Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA.
Clin Respir J. 2016 May;10(3):380-8. doi: 10.1111/crj.12228. Epub 2014 Nov 26.
There are some controversial reports that investigated the usefulness of exhaled nitric oxide (eNO) to predict the efficacy of inhaled corticosteroids (ICS) in chronic cough patients. Therefore, we retrospectively analysed the usefulness of eNO measurement with portable analyser to predict the requirement of ICS therapy in persistent cough (defined as lasting for 3 weeks or more) patients in Japan and investigated whether it might improve the management of persistent cough at primary care practice.
We retrospectively reviewed the clinical records of adult patients who had been referred to our hospital for persistent cough from 1 June 2009 to 30 April 2011.
Forty-two patients had the requirement of ICS (group S) and 35 patients had no requirement of ICS (group N). Forty-three per cent of the patients who required ICS had not received ICS, and 29% of the patients who did not required ICS had received ICS. In the steroid-naive patients without current smoking, mean eNO level was significantly higher in group S [60.6 ± 14.1 parts per billion (ppb) vs 22.2 ± 2.3 ppb, P = 0.001] and the sensitivity and the specificity of eNO for predicting the requirement of ICS were 78.6% and 80.0%, respectively. The rate of the patients who received inappropriate treatment about ICS tended to be reduced from 41% to 21% if the eNO was used to predict the requirement of ICS with cut-off value of eNO 26.5 ppb (P = 0.118).
Measurement of eNO could be one of the management tools for persistent cough at primary care practice.
关于呼出一氧化氮（eNO）预测吸入性糖皮质激素（ICS）对慢性咳嗽患者疗效的研究，存在一些有争议的报道。因此，我们回顾性分析了使用便携式分析仪测量eNO对预测日本持续性咳嗽（定义为持续3周或更长时间）患者ICS治疗需求的有效性，并研究其是否能改善基层医疗中持续性咳嗽的管理。
我们回顾性分析了2009年6月1日至2011年4月30日因持续性咳嗽转诊至我院的成年患者的临床记录。
42例患者需要ICS治疗（S组），35例患者不需要ICS治疗（N组）。需要ICS治疗的患者中有43%未接受ICS治疗，而不需要ICS治疗的患者中有29%接受了ICS治疗。在无当前吸烟史的未使用过类固醇的患者中，S组的平均eNO水平显著更高[60.6±14.1十亿分之一（ppb）对22.2±2.3 ppb，P = 0.001]，eNO预测ICS治疗需求的敏感性和特异性分别为78.6%和80.0%。如果使用eNO以26.5 ppb的临界值预测ICS治疗需求，接受不适当ICS治疗的患者比例倾向于从41%降至21%（P = 0.118）。
测量eNO可能是基层医疗中持续性咳嗽管理的工具之一。
