Tsuburai Takahiro, Tanaka Satoshi, Komase Yuko, Oyama Baku, Muraoka Hiromi, Shinozaki Yusuke, Nishiyama Kazuhiro, Shibuya Junko Ueno, Nishi Yoshihiro, Numata Yu, Hida Naoya, Mineshita Masamichi, Inoue Takeo
Department of Respiratory Medicine, St. Marianna University Yokohama Seibu Hospital, Yasashi-chou 1197-1, Asahi, Yokohama, Kanagawa, 241-0811, Japan.
Department of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
BMC Pulm Med. 2024 May 2;24(1):214. doi: 10.1186/s12890-024-03040-7.
In western Yokohama, our hospital and primary care clinics manage adults with asthma via a coordinated care system. We investigated the changes in the fractional expired nitric oxide (FeNO), forced expiratory volume in 1 second (FEV), and forced oscillation technique (FOT) parameters over 3 years in a cohort of patients in our collaborative system.
From 288 adults with well controlled asthma managed under the Yokohama Seibu Hospital coordinated care system between January 2009 and May 2018, we selected 99 subjects to undergo spirometry, FeNO and FOT testing over 3 years and analyzed the changes in these parameters.
Of the 99 patients enrolled, 17 (17.2%) experienced at least one exacerbation (insufficiently controlled (IC)), whereas, 82 (82.8%) remained in well controlled during the 3-year study period. Of well-controlled patients, 54 patients (54.5%) met the criteria for clinical remission under treatment (CR); the remaining 28 patients did not meet the CR criteria (WC). There were no differences in FeNO, FEV, or FOT parameters at baseline among the IC, WC, and CR groups. The levels of FEV decreased gradually, whereas the levels of FeNO decreased significantly over 3 years. The levels of percent predicted FEV (%FEV) significantly increased. We also observed significant improvement in FOT parameters; reactance at 5 Hz (R), resonant frequency (Fres), and integral of reactance up to the resonant frequency (AX). The CR group demonstrated significant relationships between the change in FeNO and the change in FEV and between the change in FEV and the change in FOT parameters. No significant correlations emerged in the IC or WC group.
The decrease in FeNO and increase in %FEV, we observed in all study participants suggest that the coordinated care system model benefits patients with asthma. Although it is difficult to predict at baseline which patients will experience an exacerbation, monitoring changes in FeNO and FEV is useful in managing patients with asthma. Furthermore, monitoring changes in R Fres, and AX via forced oscillation technique testing is useful for detecting airflow limitation.
在横滨西部，我院及基层医疗诊所通过协同照护系统管理成年哮喘患者。我们调查了协作系统中一组患者3年内呼出一氧化氮分数（FeNO）、一秒用力呼气容积（FEV）和强迫振荡技术（FOT）参数的变化。
从2009年1月至2018年5月在横滨西部医院协同照护系统管理下病情得到良好控制的288例成年哮喘患者中，选取99例受试者在3年内进行肺功能测定、FeNO和FOT检测，并分析这些参数的变化。
在纳入研究的99例患者中，17例（17.2%）经历了至少一次病情加重（控制不佳（IC）），而82例（82.8%）在3年研究期间病情仍得到良好控制。在病情得到良好控制的患者中，54例（54.5%）符合治疗下临床缓解（CR）标准；其余28例患者不符合CR标准（WC）。IC、WC和CR组在基线时的FeNO、FEV或FOT参数无差异。FEV水平逐渐下降，而FeNO水平在3年内显著下降。预计FEV百分比（%FEV）水平显著升高。我们还观察到FOT参数有显著改善；5 Hz时的电抗（R）、共振频率（Fres）以及直至共振频率的电抗积分（AX）。CR组显示FeNO变化与FEV变化之间以及FEV变化与FOT参数变化之间存在显著关系。IC组或WC组未出现显著相关性。
我们在所有研究参与者中观察到的FeNO降低和%FEV升高表明，协同照护系统模式对哮喘患者有益。虽然在基线时难以预测哪些患者会病情加重，但监测FeNO和FEV的变化对管理哮喘患者有用。此外，通过强迫振荡技术检测监测R、Fres和AX的变化有助于检测气流受限。
