San Remo Rehabilitation Hospital, Sasebo, Japan; Clinical Research Center, Fukuoka National Hospital, Fukuoka, Japan.
Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Allergol Int. 2018 Apr;67(2):253-258. doi: 10.1016/j.alit.2017.09.004. Epub 2017 Oct 21.
We report the utility of combining lung sound analysis and fractional exhaled nitric oxide (FeNO) for phenotype classification of airway inflammation in patients with bronchial asthma. We investigated the usefulness of the combination of the expiration-to-inspiration sound power ratio in the mid-frequency range (E/I MF) of 200-400 Hz and FeNO for comprehensively classifying disease type and evaluating asthma treatment.
A total of 233 patients with bronchial asthma were included. The cutoff values of FeNO and E/I MF were set to 38 ppb and 0.36, respectively, according to a previous study. The patients were divided into 4 subgroups based on the FeNO and E/I MF cutoff values. Respiratory function, the percentages of sputum eosinophils and neutrophils, and patient background characteristics were compared among groups.
Respiratory function was well controlled in the FeNO low/E/I MF low group (good control). Sputum neutrophil was higher and FEV,%pred was lower in the FeNO low/E/I MF high group (poor control). History of childhood asthma and atopic asthma were associated with the FeNO high/E/I MF low group (insufficient control). The FeNO high/E/I MF high group corresponded to a longer disease duration, increased blood or sputum eosinophils, and lower FEV/FVC (poor control).
The combination of FeNO and E/I MF assessed by lung sound analysis allows the condition of airway narrowing and the degree of airway inflammation to be assessed in patients with asthma and is useful for evaluating bronchial asthma treatments.
我们报告了联合肺部声音分析和呼出气一氧化氮（FeNO）分数用于支气管哮喘患者气道炎症表型分类的效用。我们研究了呼气至吸气中频段（200-400 Hz）声能比（E/I MF）与 FeNO 联合使用对综合分类疾病类型和评估哮喘治疗的有用性。
共纳入 233 例支气管哮喘患者。根据先前的研究，将 FeNO 和 E/I MF 的截止值分别设定为 38 ppb 和 0.36。根据 FeNO 和 E/I MF 的截止值，将患者分为 4 组。比较各组间呼吸功能、痰中嗜酸性粒细胞和中性粒细胞百分比以及患者背景特征。
FeNO 低/E/I MF 低组（控制良好）的呼吸功能得到很好的控制。FeNO 低/E/I MF 高组（控制不佳）的痰中性粒细胞较高，FEV%pred 较低。儿童期哮喘和特应性哮喘史与 FeNO 高/E/I MF 低组（控制不足）相关。FeNO 高/E/I MF 高组与疾病持续时间较长、血或痰嗜酸粒细胞增加以及 FEV/FVC 降低（控制不佳）相对应。
通过肺部声音分析评估的 FeNO 和 E/I MF 的联合使用可评估哮喘患者气道狭窄程度和气道炎症程度，有助于评估支气管哮喘治疗。
