Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, United Kingdom; Manchester University NHS Foundation Trust, Manchester, United Kingdom.
National Heart and Lung Institute, Imperial College London & Royal Brompton Hospital, London, United Kingdom.
J Allergy Clin Immunol Pract. 2023 Jun;11(6):1787-1795.e5. doi: 10.1016/j.jaip.2023.02.009. Epub 2023 Feb 18.
Domiciliary measurements of airflow obstruction and inflammation may assist healthcare teams and patients in determining asthma control and facilitate self-management.
To evaluate parameters derived from domiciliary spirometry and fractional exhaled nitric oxide (Feno) in monitoring asthma exacerbations and control.
Patients with asthma were provided with hand-held spirometry and Feno devices in addition to their usual asthma care. Patients were instructed to perform twice-daily measurements for 1 month. Daily symptoms and medication change were reported through a mobile health system. The Asthma Control Questionnaire was completed at the end of the monitoring period.
One hundred patients had spirometry, of which 60 were given additional Feno devices. Compliance rates for twice-daily measurements were poor (median [interquartile range], 43% [25%-62%] for spirometry; 30% [3%-48%] for Feno); at least 15% of patients took little or no spirometry measurements and 40% rarely measured Feno. The coefficient of variation (CV) values in FEV and Feno were higher, and the mean % personal best FEV lower in those who had major exacerbations compared with those without (P < .05). Feno CV and FEV CV were associated with asthma exacerbation during the monitoring period (area under the receiver-operating characteristic curve, 0.79 and 0.74, respectively). Higher Feno CV also predicted poorer asthma control (area under the receiver-operating characteristic curve, 0.71) at the end of the monitoring period.
Compliance with domiciliary spirometry and Feno varied widely among patients even in the setting of a research study. However, despite significant missing data, Feno and FEV were associated with asthma exacerbations and control, making these measurements potentially clinically valuable if used.
家庭环境中气流阻塞和炎症的测量可能有助于医疗团队和患者确定哮喘控制情况，并促进自我管理。
评估家庭肺功能测定和呼出气一氧化氮（Feno）分数衍生参数在监测哮喘加重和控制中的作用。
除常规哮喘治疗外，为哮喘患者提供手持式肺功能测定仪和 Feno 设备。患者被指导进行为期 1 个月的每日 2 次测量。通过移动健康系统报告每日症状和药物变化。在监测期末完成哮喘控制问卷。
100 例患者进行了肺功能测定，其中 60 例患者额外配备了 Feno 设备。每日 2 次测量的依从率较低（肺功能测定的中位数[四分位距]为 43%[25%-62%]；Feno 为 30%[3%-48%]）；至少有 15%的患者很少或根本不进行肺功能测定，40%的患者很少测量 Feno。与无重大加重的患者相比，有重大加重的患者的 FEV 和 Feno 的变异系数（CV）值较高，个人最佳 FEV 的平均值较低（P<.05）。Feno CV 和 FEV CV 与监测期间的哮喘加重相关（曲线下面积分别为 0.79 和 0.74）。Feno CV 较高也预示着监测期末哮喘控制较差（曲线下面积为 0.71）。
即使在研究环境中，患者对家庭肺功能测定和 Feno 的依从性也存在很大差异。然而，尽管存在大量缺失数据，Feno 和 FEV 与哮喘加重和控制相关，如果使用，这些测量可能具有潜在的临床价值。
