Belfast City Hospital.
Queens University Belfast, Belfast, UK.
Curr Opin Allergy Clin Immunol. 2021 Feb 1;21(1):59-64. doi: 10.1097/ACI.0000000000000704.
Despite increased clinician awareness, nonadherence to inhaled corticosteroid treatment presents a major challenge to successful asthma management and risks inappropriate treatment escalation, particularly in severe disease. In patients with Type-2 mediated biology, fractional exhaled nitric oxide (FeNO) has a role in assessment and monitoring of adherence to inhaled corticosteroids.
Asthmatic patients with elevated FeNO are at an increased risk of exacerbation. High FeNO is often secondary to suboptimal adherence to inhaled corticosteroid treatment, whether intentional or nonintentional. FENO-suppression can 'unmask' underlying adherence issues and is a useful test in the presence of Type-2 biology in the 'difficult-to-control' asthma population. Identification of nonadherence can improve asthma control and prevent inappropriate commencement of costly biologic therapies.
Assessment of adherence and FeNO response to monitored inhaled corticosteroid in Type-2 biomarker high asthmatic individuals may prevent unnecessary escalation to biologic therapy. Establishing an 'optimised' FeNO may alert clinicians to the possibility of underlying nonadherence at future clinical assessments.
尽管临床医生的认识有所提高，但吸入皮质类固醇治疗的不依从仍是成功管理哮喘的主要挑战，并存在不适当治疗升级的风险，尤其是在严重疾病中。在 2 型生物学介导的患者中，呼出气一氧化氮分数（FeNO）在评估和监测吸入皮质类固醇治疗的依从性方面具有作用。
FeNO 升高的哮喘患者发生加重的风险增加。高 FeNO 通常继发于吸入皮质类固醇治疗的依从性不理想，无论是有意还是无意的。FENO 抑制可以“揭示”潜在的依从性问题，并且在“难以控制”的哮喘人群中存在 2 型生物学时是一种有用的测试。识别不依从性可以改善哮喘控制并防止不必要地开始昂贵的生物疗法。
在 2 型生物标志物高的哮喘患者中评估依从性和 FeNO 对监测的吸入皮质类固醇的反应，可能可以预防不必要地升级为生物疗法。确定“优化”的 FeNO 可能会提醒临床医生在未来的临床评估中存在潜在的不依从性的可能性。
