Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
J Allergy Clin Immunol Pract. 2015 Jul-Aug;3(4):553-9. doi: 10.1016/j.jaip.2015.02.005. Epub 2015 Mar 29.
International guidelines recommend up-titration of anti-inflammatory treatment in asthmatic patients with poor symptom control, but patients without eosinophilic airway inflammation are less likely to benefit from this. The mannitol bronchoprovocation test and fractional exhaled nitric oxide (FeNO) are increasingly used in the diagnostic assessment of asthma, but the utility of combining these tests has not been evaluated.
The aim of this study was to determine the value of combining FeNO and the mannitol test to assess patients with asthma referred for specialist assessment because of poor symptom control.
All patients referred consecutively over a 12-month period for the assessment of asthma at the Respiratory Outpatient Clinic at Bispebjerg Hospital in Copenhagen were examined with bronchial provocation to mannitol, FeNO, and induced sputum.
Among asthmatic patients with partly controlled or uncontrolled symptoms according to Global Initiative for Asthma criteria, only 23% had sputum eosinophilia (eosinophils >2.99%). A positive mannitol test did not increase the likelihood of airway eosinophilia significantly (positive test: 32% vs negative test: 18%, P = .12). However, a positive mannitol test combined with a FeNO > 25 ppb indicated a high likelihood of airway eosinophilia (73%), compared with FeNO > 25 ppb and a negative mannitol test (29%) (P < .05). In contrast, in patients with FeNO < 25 ppb, a positive mannitol test was not associated with airway eosinophilia (sputum eosinophils > 2.99%: positive mannitol test: 0%, negative test: 11%, ns).
Combining the mannitol test and FeNO may aid in the differentiation between eosinophilic and noneosinophilic asthma in patients referred for specialist management because of poorly controlled asthma symptoms.
国际指南建议在症状控制不佳的哮喘患者中上调抗炎治疗，但没有气道嗜酸性粒细胞炎症的患者不太可能从中受益。甘露醇支气管激发试验和呼出气一氧化氮（FeNO）越来越多地用于哮喘的诊断评估，但尚未评估这些检测联合使用的效果。
本研究旨在确定联合使用 FeNO 和甘露醇试验评估因症状控制不佳而转诊至专科评估的哮喘患者的价值。
在哥本哈根比斯加普医院呼吸门诊连续 12 个月，所有因哮喘评估而转诊的患者均接受了支气管激发甘露醇试验、FeNO 和诱导痰检查。
在根据全球哮喘倡议标准被诊断为部分控制或未控制症状的哮喘患者中，仅 23%的患者痰液中有嗜酸性粒细胞（嗜酸性粒细胞 >2.99%）。阳性甘露醇试验并未显著增加气道嗜酸性粒细胞的可能性（阳性试验：32%，阴性试验：18%，P =.12）。然而，阳性甘露醇试验与 FeNO > 25 ppb 联合提示气道嗜酸性粒细胞高度可能（73%），与 FeNO > 25 ppb 和阴性甘露醇试验（29%）相比（P <.05）。相比之下，在 FeNO < 25 ppb 的患者中，阳性甘露醇试验与气道嗜酸性粒细胞无关（痰液嗜酸性粒细胞 > 2.99%：阳性甘露醇试验：0%，阴性试验：11%，无统计学差异）。
联合使用甘露醇试验和 FeNO 可能有助于区分因哮喘症状控制不佳而转诊至专科管理的患者中的嗜酸性粒细胞性和非嗜酸性粒细胞性哮喘。
