哮喘中的呼出气一氧化氮

FeNO in Asthma.

作者信息

Loewenthal Lola, Menzies-Gow Andrew

机构信息

Department of Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, United Kingdom.

National Heart and Lung Institute, Imperial College London, United Kingdom.

出版信息

Semin Respir Crit Care Med. 2022 Oct;43(5):635-645. doi: 10.1055/s-0042-1743290. Epub 2022 Mar 4.

Abstract

Asthma is a common disease affecting 350 million people worldwide, which is characterized by airways inflammation and hyperreactivity. Historically diagnosis and treatment have been mainly based on symptoms, which have the potential to result in misdiagnosis and inappropriate treatment. Nitric oxide (NO) is exhaled in human breath and is a marker of airways inflammation. Levels of NO are increased in the exhaled breath of patients with type 2 asthma and fractional exhaled nitric oxide (FeNO) provides an objective biomarker of airway inflammation. FeNO testing is an accessible, noninvasive, and easy-to-use test. Cut-off values have been established by the American Thoracic Society (ATS), the Global Initiative for Asthma (GINA), and the National Institute for Health and Care Excellence (NICE) but vary between guidance. FeNO levels have been shown to be predictive of blood and sputum eosinophil levels but should not be used in isolation and current guidance emphasizes the importance of incorporating clinical symptoms and testing when utilizing FeNO results. The inclusion of FeNO testing can increase diagnostic accuracy of asthma, while high levels in asthmatic patients can help predict response to inhaled corticosteroids (ICS) and suppression of levels with ICS to monitor adherence. FeNO levels are also a predictor of asthma risk with increased exacerbation rates and accelerated decline in lung function associated with high levels as well as having an emerging role in predicting response to some biologic therapies in severe asthma. FeNO testing is cost-effective and has been shown, when combined with clinical assessment, to improve asthma management.

摘要

哮喘是一种常见疾病,全球有3.5亿人受其影响,其特征为气道炎症和高反应性。从历史上看,诊断和治疗主要基于症状,这有可能导致误诊和不恰当的治疗。一氧化氮(NO)通过人体呼出,是气道炎症的一个标志物。2型哮喘患者呼出的气体中NO水平会升高,呼出一氧化氮分数(FeNO)可提供气道炎症的客观生物标志物。FeNO检测是一种可及、无创且易于使用的检测方法。美国胸科学会(ATS)、全球哮喘防治创议(GINA)和英国国家卫生与临床优化研究所(NICE)已确定了临界值,但不同指南中的临界值有所差异。已表明FeNO水平可预测血液和痰液嗜酸性粒细胞水平,但不应单独使用,当前指南强调在利用FeNO结果时纳入临床症状和检测的重要性。纳入FeNO检测可提高哮喘的诊断准确性,而哮喘患者的高FeNO水平有助于预测对吸入性糖皮质激素(ICS)的反应以及通过ICS抑制水平以监测依从性。FeNO水平也是哮喘风险的一个预测指标,高水平与更高的加重率和肺功能加速下降相关,并且在预测重度哮喘对某些生物疗法的反应方面正发挥着新的作用。FeNO检测具有成本效益,并且已表明,与临床评估相结合时,可改善哮喘管理。

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