Xie Zhichao, Chai Mingrong, Gu Weiqiang, Yuan Huizhen
Department of Pediatrics, Affiliated Dongguan People's Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan, China.
Transl Pediatr. 2020 Dec;9(6):784-794. doi: 10.21037/tp-20-351.
The current study aimed to explore the value of fractional exhaled nitric oxide (FeNO), exhaled carbon monoxide (eCO), and pulmonary function in the management of asthmatic children.
One hundred children diagnosed with asthma were selected as research subjects. Patients were divided into a 3-5-year-old group and a group with children 6 years and older. They were also grouped depending on whether they had asthma alone (A0 group) or whether their asthma was complicated with allergic rhinitis (A+AR group). The FeNO, eCO levels, and pulmonary function in the acute attack period were analyzed 1 month after treatment and clinical remission period.
Asthmatic children demonstrated greater pulmonary dysfunction and significantly higher FeNO and eCO during the acute attack phase compared to both one month after treatment and clinical remission. The remission phase was characterized by decreased levels of FeNO and eCO and improvement of pulmonary function. The eCO levels in children aged 3-5 years old, and both FeNO and eCO levels in children 6 years and older were statistically lower during remission regardless of whether the patients had asthma alone or asthma complicated with rhinitis. However, 10% of the 100 children in the clinical remission period still demonstrated mid to high levels of FeNO. The critical value of FeNO levels during the acute period in children 6 years and older with asthma and rhinitis was 34.5 ppb (AUROC 0.814, 95% CI: 0.684-0.944) with a sensitivity of 69.2% and specificity of 93.7%.
Dynamic monitoring of FeNO and eCO is an effective indicator of airway inflammation and thus represents an important clinical tool in assessing the severity of asthma in children.
本研究旨在探讨呼出一氧化氮分数（FeNO）、呼出一氧化碳（eCO）和肺功能在哮喘儿童管理中的价值。
选取100例诊断为哮喘的儿童作为研究对象。患者分为3至5岁组和6岁及以上儿童组。他们还根据是否仅患有哮喘（A0组）或哮喘是否合并过敏性鼻炎（A+AR组）进行分组。在治疗1个月后和临床缓解期分析急性发作期的FeNO、eCO水平和肺功能。
与治疗1个月后和临床缓解期相比，哮喘儿童在急性发作期表现出更严重的肺功能障碍，FeNO和eCO水平显著更高。缓解期的特征是FeNO和eCO水平降低以及肺功能改善。无论患者是仅患有哮喘还是哮喘合并鼻炎，3至5岁儿童的eCO水平以及6岁及以上儿童的FeNO和eCO水平在缓解期均有统计学意义的降低。然而，100例处于临床缓解期的儿童中有10%仍表现出中高水平的FeNO。6岁及以上患有哮喘和鼻炎的儿童在急性期FeNO水平的临界值为34.5 ppb（AUROC 0.814，95% CI：0.684 - 0.944），敏感性为69.2%，特异性为93.7%。
动态监测FeNO和eCO是气道炎症的有效指标，因此是评估儿童哮喘严重程度的重要临床工具。
