Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy; Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy.
Ann Allergy Asthma Immunol. 2020 Oct;125(4):440-446.e1. doi: 10.1016/j.anai.2020.06.036. Epub 2020 Jul 1.
Fractional exhaled nitric oxide (FeNO) is a noninvasive biomarker of type 2 asthma that can predict response to inhaled corticosteroid therapy. Little is known regarding the magnitude of FeNO reduction after an oral corticosteroid (OCS) course, and less is known whether there are differential responses based on race in children with mild-to-moderate asthma.
To assess the effect of a short course of OCS on FeNO in children with asthma and to determine whether the effect is influenced by race.
Children presenting with an acute asthma exacerbation, who had a FeNO measurement within the past 6 months when clinically stable, were enrolled. Spirometry and FeNO were obtained at the time of exacerbation and after a short course of prednisone.
A total of 92 children were identified (aged 11 ± 3.3 years; white, n = 46 [50%], Hispanics, n = 30 [33%], African Americans [AAs], n = 16 [7%]). At baseline, AAs were more atopic and had higher mean FeNO values than both white (48.9 vs 25.6 ppb; P < .05) and Hispanic children (22.5 ppb; P < .05), despite being prescribed similar inhaled corticosteroid doses. During the exacerbation, AAs had the highest FeNO values, whereas there was no difference in lung function between AAs and non-AAs. After prednisone therapy, there was a 56.6% reduction in FeNO, and although AAs maintained the highest FeNO levels, the relative reduction was similar between AAs and non-AAs (53.9% vs 57.8%, respectively).
FeNO levels reduced by more than 50% after an OCS course. African American children had a greater degree of type 2-driven airway inflammation at baseline, during an exacerbation and after a short course of OCS, compared with non-AAs, although the relative reduction in FeNO was similar between the groups.
呼出气一氧化氮分数（FeNO）是 2 型哮喘的一种非侵入性生物标志物，可预测吸入皮质类固醇治疗的反应。对于口服皮质类固醇（OCS）疗程后 FeNO 的降低幅度知之甚少，对于轻中度哮喘儿童，基于种族的反应是否存在差异知之甚少。
评估短期 OCS 治疗对哮喘儿童 FeNO 的影响，并确定种族是否影响其效果。
纳入了因哮喘急性加重而就诊，且在临床稳定时最近 6 个月内进行过 FeNO 测量的儿童。在哮喘加重时和短期泼尼松治疗后，均进行了肺量测定和 FeNO 测量。
共确定了 92 名儿童（年龄 11 ± 3.3 岁；白人，n=46 [50%]，西班牙裔，n=30 [33%]，非裔美国人 [AA]，n=16 [7%]）。在基线时，AA 组更具特应性，且 FeNO 值高于白人（48.9 比 25.6 ppb；P <.05）和西班牙裔儿童（22.5 ppb；P <.05），尽管他们吸入皮质类固醇的剂量相似。在哮喘加重期间，AA 组的 FeNO 值最高，而 AA 组和非 AA 组的肺功能没有差异。在泼尼松治疗后，FeNO 降低了 56.6%，尽管 AA 组的 FeNO 水平仍然最高，但 AA 组和非 AA 组的相对降低幅度相似（分别为 53.9%和 57.8%）。
OCS 疗程后，FeNO 水平降低了 50%以上。与非 AA 组相比，AA 组在基线时、哮喘加重时和短期 OCS 治疗后具有更高程度的 2 型驱动气道炎症，尽管两组的 FeNO 相对降低幅度相似。
