Xu Xiaohui, Hu Hui, Kearney Gregory D, Kan Haidong, Carrillo Genny, Chen Xinguang
a Department of Epidemiology and Biostatistics , School of Public Health, Texas A&M University , College Station , TX , USA.
b Department of Epidemiology , College of Public Health and Health Professions and College of Medicine, University of Florida , Gainesville , FL , USA.
Inhal Toxicol. 2016 Dec;28(14):724-730. doi: 10.1080/08958378.2016.1264502.
Fractional concentration of exhaled nitric oxide (FeNO) is recommended by the American Thoracic Society (ATS) as a noninvasive biomarker of airway inflammation. In addition to inflammation, many factors may be associated with FeNO, particularly tobacco exposure; however, only age has been included as an influential factor for children below 12 years. Numerous studies have demonstrated negative associations between tobacco exposure and FeNO levels with self-reported data, but few with an objective assessment of smoking.
Data from the National Health and Nutrition Examination Survey (NHANES) 2007-2012 were analyzed to examine the association between FeNO and active/passive tobacco. Exposure was assessed by both self-report and serum cotinine levels among 11,160 subjects aged 6-79 years old with asthma, or without any respiratory disease.
Study results indicated 28.8% lower FeNO, 95% CI [25.2%, 32.3%] and 38.1% lower FeNO, 95% CI: [28.1, 46.2] was observed among healthy and asthmatic participants with serum cotinine in the highest quartile compared to those in the lowest quartile, respectively. Self-reported smoking status and recent tobacco use were also associated with decreased FeNO. Self-reported passive smoking was significantly associated with a 1.0% decrease in FeNO 95% CI [0.0, 2.0] among asthmatic subjects but not among healthy subjects.
Active smoking, whether measured by self-report or serum cotinine, was associated with decreased FeNO levels. In addition to age, increased attention should be given to tobacco exposure when using FeNO as a biomarker in clinical practice. Additional research is needed to establish reference value of FeNO considering the impact of tobacco exposure.
美国胸科学会（ATS）推荐呼出一氧化氮分数（FeNO）作为气道炎症的无创生物标志物。除炎症外，许多因素可能与FeNO相关，尤其是烟草暴露；然而，对于12岁以下儿童，仅年龄被列为影响因素。众多研究已通过自我报告数据证实烟草暴露与FeNO水平之间存在负相关，但很少有研究对吸烟情况进行客观评估。
分析2007 - 2012年美国国家健康与营养检查调查（NHANES）的数据，以研究FeNO与主动/被动吸烟之间的关联。在11160名年龄在6 - 79岁、患有哮喘或无任何呼吸系统疾病的受试者中，通过自我报告和血清可替宁水平评估暴露情况。
研究结果表明，与最低四分位数组相比，血清可替宁处于最高四分位数组的健康参与者和哮喘参与者的FeNO分别降低了28.8%，95%置信区间[25.2%，32.3%]和38.1%，95%置信区间：[28.1，46.2]。自我报告的吸烟状况和近期烟草使用也与FeNO降低有关。在哮喘受试者中，自我报告的被动吸烟与FeNO降低1.0%显著相关，95%置信区间[0.0，2.0]，但在健康受试者中无此关联。
无论是通过自我报告还是血清可替宁测量，主动吸烟均与FeNO水平降低有关。在临床实践中将FeNO用作生物标志物时，除年龄外，还应更多关注烟草暴露情况。考虑到烟草暴露的影响，需要进一步研究以确定FeNO的参考值。
