探索远程监测的呼出气一氧化氮抑制试验在重度哮喘中的长期效用。
Exploring the Long-Term Utility of Remotely Monitored FeNO Suppression Testing in Severe Asthma.
作者信息
Busby John, Holmes Joshua, Almutairi Mohammed, Berrar-Torre Irene, Butler Claire, Chen Christabelle, Dennison Paddy, Gilbey Sharron, Jackson David J, Kerley Sumita, Makhecha Sukeshi, Mansur Adel, Nichols Anna-Louise, Patel Pujan H, Pfeffer Paul E, Rupani Hitasha, Sweeney Joan, Heaney Liam G
机构信息
School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraydah, Saudi Arabia.
出版信息
J Allergy Clin Immunol Pract. 2025 Jul;13(7):1816-1823. doi: 10.1016/j.jaip.2025.04.036. Epub 2025 Apr 30.
BACKGROUND
Confirmation of optimal inhaled corticosteroid use is essential before initiating biologic therapy. Fractional exhaled nitric oxide (FeNO) suppression testing (FeNOSuppT) is a proven phenotyping technique; however, its long-term effect on clinical outcomes remains unclear.
OBJECTIVES
To assess the real-world feasibility of delivering FeNOSuppT alongside digital inhaler monitoring and to examine its effect on biologic initiation and clinical outcomes.
METHODS
Prospective cohort study within 7 U.K. severe asthma centers. Patients received a sensor-enabled inhaled corticosteroid/long-acting β-agonist (ICS/LABA) inhaler during an initial appointment between July 2020 and June 2022. A positive FeNOSuppT was defined as greater than 42% FeNO reduction at short-term follow-up (typically 1-3 mo postbaseline). Biologic initiation and clinical outcomes were compared at short-term and long-term (typically 12 mo postbaseline) follow-up.
RESULTS
Of 353 included patients, 257 (72.8%) completed the FeNOSuppT and 140 (54.5%) were positive. A positive FeNOSuppT was associated with greater improvements in the % predicted short-term forced expiratory volume in 1 second (FEV%; 8.6% vs -0.3; P < .001) and the 6-Item Asthma Control Questionnaire (ACQ6; 0.7 vs 0.3; P = .001) compared with a negative test. Of 168 patients eligible for biologics who completed the FeNOSuppT, those with a positive result initiated biologics less often (48.2% vs 65.2%; P = .035). Despite this, there was a greater improvement in FEV (11.0% vs 2.3%; P = .016), and a similar reduction in both asthma symptoms (ACQ6 0.7 vs 0.8; P = .623) and exacerbations (66.7% vs 66.7%; P = .349) at long-term follow-up when compared with those with a negative FeNOSuppT.
CONCLUSIONS
Delivering FeNOSuppT aligned with digital monitoring is feasible within routine care. A positive FeNOSuppT was associated with lower rates of biologic initiation, with similar clinical outcomes.
背景
在开始生物治疗之前，确认吸入性糖皮质激素的最佳使用情况至关重要。呼出一氧化氮分数（FeNO）抑制试验（FeNOSuppT）是一种经过验证的表型分析技术；然而，其对临床结局的长期影响仍不清楚。
目的
评估在数字吸入器监测的同时进行FeNOSuppT的现实可行性，并研究其对生物制剂起始治疗和临床结局的影响。
方法
在英国7个重症哮喘中心进行前瞻性队列研究。2020年7月至2022年6月期间，患者在初次就诊时接受了带有传感器的吸入性糖皮质激素/长效β受体激动剂（ICS/LABA）吸入器。FeNOSuppT阳性定义为短期随访（通常在基线后1 - 3个月）时FeNO降低超过42%。在短期和长期（通常在基线后12个月）随访时比较生物制剂起始治疗情况和临床结局。
结果
在纳入的353例患者中，257例（72.8%）完成了FeNOSuppT，140例（54.5%）为阳性。与阴性试验相比，FeNOSuppT阳性与预测的1秒用力呼气容积百分比（FEV%；8.6%对 - 0.3；P <.001）和6项哮喘控制问卷（ACQ6；0.7对0.3；P =.001）的更大改善相关。在完成FeNOSuppT的168例符合生物制剂治疗条件的患者中，结果为阳性的患者开始使用生物制剂的频率较低（48.2%对65.2%；P =.035）。尽管如此，与FeNOSuppT阴性的患者相比，长期随访时FEV有更大改善（11.0%对2.3%；P =.016），哮喘症状（ACQ6 0.7对0.8；P =.623）和急性加重次数（66.7%对66.7%；P =.349）有类似程度的降低。
结论
在常规护理中，结合数字监测进行FeNOSuppT是可行的。FeNOSuppT阳性与生物制剂起始治疗率较低相关，但临床结局相似。
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