Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
Department of Psychology, Faculty of Humanities and Social Sciences, University of Bath, Bath, UK.
NPJ Prim Care Respir Med. 2022 Mar 21;32(1):13. doi: 10.1038/s41533-022-00272-0.
Current methods to assess asthma and guide inhaled corticosteroid (ICS) dose titration mainly centre on patient-reported symptoms and lung function assessments. However, these methods correlate only weakly with airway inflammation making them unreliable predictors of future exacerbations and ICS requirement. Fractional Exhaled Nitric Oxide (FeNO) is a simple non-invasive objective measure of airways inflammation used predominantly in specialist clinics. Previous qualitative studies have mainly focused on the acceptability of FeNO in secondary care and there is limited insight to support clinicians and patients using FeNO in primary care asthma reviews. This study aimed to explore adult patient with asthma and primary care health care professional (HCP) views on introducing FeNO as part of routine asthma reviews. Twenty-three health care professionals and 22 patients were interviewed over the phone or online. Both groups reported that current asthma reviews are often seen as tick-box exercises and that introducing the FeNO test would make reviews more tailored to the individual patient, rather than relying on subjective patient reports of asthma control. Adults with asthma also highlighted support more open communication and their understanding of asthma, as they desired to feel more engaged in decisions and conversations about their asthma. HCPs reported valuing patient education and empowerment over a paternalistic approach, when time and resources allow. They also recognised FeNO to provide an objective measure of inflammation that could support them in the education and empowerment of patients. FeNO was seen by both groups as a potentially valuable addition to current asthma reviews mainly led by nurses, both for increasing their understanding of current risk of exacerbation and also to provide more tailored and personalised asthma management to patients. Our findings highlighted the need for open and clear communication about how to interpret FeNO results.
目前评估哮喘和指导吸入皮质类固醇（ICS）剂量滴定的方法主要集中在患者报告的症状和肺功能评估上。然而，这些方法与气道炎症的相关性较弱，因此无法可靠预测未来的加重和 ICS 的需求。呼出气一氧化氮分数（FeNO）是一种简单的非侵入性气道炎症客观测量方法，主要用于专科诊所。之前的定性研究主要集中在二级护理中 FeNO 的可接受性上，而在初级保健哮喘评估中使用 FeNO 支持临床医生和患者的见解有限。本研究旨在探讨哮喘成人患者和初级保健医疗保健专业人员（HCP）对将 FeNO 作为常规哮喘评估一部分的看法。通过电话或在线对 23 名医疗保健专业人员和 22 名患者进行了访谈。两组均报告称，目前的哮喘评估通常被视为勾选框练习，引入 FeNO 测试将使评估更针对个体患者，而不是依赖于患者对哮喘控制的主观报告。哮喘成人患者还强调支持更开放的沟通和他们对哮喘的理解，因为他们希望在有关哮喘的决策和对话中感到更投入。HCP 报告说，在时间和资源允许的情况下，他们重视患者教育和赋权，而不是家长式的方法。他们还认识到 FeNO 可提供炎症的客观衡量标准，这可以支持他们对患者的教育和赋权。两组均认为 FeNO 是当前哮喘评估的潜在有价值的补充，主要由护士主导，这既可以增加他们对当前加重风险的了解，也可以为患者提供更具针对性和个性化的哮喘管理。我们的研究结果强调了需要就如何解释 FeNO 结果进行开放和明确的沟通。
