Zeiger Robert Stephen, Schatz Michael, Yang Su-Jau, Chen Wansu
Department of Allergy, Clairemont Mesa Medical Center, San Diego, CA.
Kaiser Permanente Southern California Research and Evaluation, Pasadena.
Perm J. 2019;23. doi: 10.7812/TPP/18-109.
The utility of fractional exhaled nitric oxide (FeNO) measurement in real-world asthma management requires investigation.
To determine whether FeNO-assisted care added to standard asthma management improves asthma control in a managed care organization.
Prospective observational study in patients aged 12 years and older with uncontrolled persistent asthma identified during a scheduled visit to an Allergy Department that routinely used FeNO (FeNO-assisted care, n = 426) vs visits to 4 Allergy Departments that did not, but followed routine guideline-based care (standard care, n = 925). The FeNO-assisted care was based on FeNO level, asthma control status, and step-care level.
Composite primary outcome was 1 or more asthma exacerbations or 7 or more dispensed canisters containing short-acting β-agonists in the follow-up year. Inverse probability of treatment weighting propensity scoring balanced covariates, and multivariable regression analyses compared outcomes between groups.
Compared with standard care, FeNO-assisted care was not associated with reducing the primary composite outcome (adjusted risk ratio = 0.94, 95% confidence interval = 0.69-1.29, p = 0.71), nor with a reduction in asthma exacerbations or dispensing of 7 or more short-acting β-agonist canisters as separate outcomes. In an atopic subgroup with aeroallergen sensitization, the composite outcome was similar between groups, but the rate of asthma exacerbations was lower with FeNO-assisted treatment (adjusted rate ratio = 0.67, 95% confidence interval = 0.49-0.91, p = 0.01).
These findings suggest future studies of FeNO-assisted care should be directed at the atopic phenotype.
呼出一氧化氮分数（FeNO）测量在实际哮喘管理中的效用有待研究。
确定在标准哮喘管理基础上增加FeNO辅助治疗是否能改善管理式医疗组织中的哮喘控制情况。
对12岁及以上未控制的持续性哮喘患者进行前瞻性观察研究，这些患者在预定就诊于常规使用FeNO的过敏科时被识别出来（FeNO辅助治疗组，n = 426），与就诊于4个未使用FeNO但遵循基于常规指南治疗的过敏科的患者（标准治疗组，n = 925）进行对比。FeNO辅助治疗基于FeNO水平、哮喘控制状态和分级治疗水平。
复合主要结局为在随访年度内发生1次或更多次哮喘加重或使用7个或更多含有短效β受体激动剂的吸入罐。采用治疗加权逆概率倾向评分平衡协变量，并通过多变量回归分析比较两组结局。
与标准治疗相比，FeNO辅助治疗与降低主要复合结局无关（调整风险比 = 0.94，95%置信区间 = 0.69 - 1.29，p = 0.71），也与减少哮喘加重或单独作为结局的使用7个或更多短效β受体激动剂吸入罐无关。在有变应原致敏的特应性亚组中，两组的复合结局相似，但FeNO辅助治疗组的哮喘加重率较低（调整率比 = 0.67，95%置信区间 = 0.49 - 0.91，p = 0.01）。
这些发现表明，未来关于FeNO辅助治疗的研究应针对特应性表型。
