Predictors for Identifying the Efficacy of Systemic Steroids on Sustained Exhaled Nitric Oxide Elevation in Severe Asthma
Predictors for Identifying the Efficacy of Systemic Steroids on Sustained Exhaled Nitric Oxide Elevation in Severe Asthma
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DOI：
10.2332/allergolint.12-oa-0530
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发表时间：
2013-09-01
影响因子：
6.8
通讯作者：
Minakata, Yoshiaki
中科院分区：
文献类型：
--
作者：
Matsunaga, Kazuto;Hirano, Tsunahiko;Minakata, Yoshiaki
背景：尽管吸入皮质类固醇（ICS）治疗，一些哮喘患者呼出气一氧化氮（FENO）水平仍较高。早期的研究表明，这可能是由于存在异质性气道炎症。我们的目的是评估预测因素，以确定系统性皮质类固醇对残余FENO升高严重asthene.Methods的疗效：20严重哮喘患者持续FENO升高（>= 40 ppb），尽管维持治疗，包括高日剂量ICS。结果：泼尼松龙治疗后，哮喘控制问卷（ACQ）、血嗜酸性粒细胞（EOS）、FENO、FVC、FEV 1、FEV 1/FVC比值和单氮洗脱曲线斜率（Δ N-2）均明显改善。70%的受试者显示FENO水平降低>= 20%。FENO水平的降低与ACQ（p < 0.0001）、FVC（p < 0.01）、FEV 1（p < 0.0001）和Delta N-2（p < 0.05）的改善显著相关。在基线测量中，FENO水平和血嗜酸性粒细胞数被确定为FENO水平降低>= 20%的显着预测因子通过全身类固醇therapy.Conclusions：全身皮质类固醇可以抑制残留FENO升高超过一半的严重哮喘患者和FENO水平的降低与哮喘控制和气流限制的改善相关。FENO水平和血嗜酸性粒细胞数量是重度哮喘患者全身激素治疗后气道残余炎症改善的预测因子。
Background: Some patients with asthma have high levels of exhaled nitric oxide fraction (FENO) despite inhaled corticosteroids (ICS) therapy. Early studies suggested that this might be explained by the presence of heterogeneous airway inflammation. We aimed to assess the predictors for identifying the efficacy of systemic corticosteroids on residual FENO elevations in severe asthma.Methods: Twenty severe asthmatics with persistent FENO elevation (>= 40 ppb) despite maintenance therapy including high-daily-dose ICS were enrolled. Asthma Control Questionnaire (ACQ), lung function, blood eosinophils, and FENO were assessed before and after 14 days treatment with 0.5 mg/kg oral prednisolone/day.Results: ACQ, blood eosinophils, FENO level, FVC, FEV1, FEV1/FVC ratio and the slope of the single nitrogen washout curve (Delta N-2) were significantly improved by treatment with prednisolone. 70% of the subjects showed >= 20% reductions in the FENO levels. The reduction in FENO levels was significantly correlated with the improvements in ACQ (p < 0.0001), FVC (p < 0.01), FEV1 (p < 0.0001), and Delta N-2 (p < 0.05). Among the measurements at baseline, the FENO levels and blood eosinophil numbers were identified as significant predictors of >= 20% reductions in the FENO levels by systemic steroid therapy.Conclusions: Systemic corticosteroids could suppress the residual FENO elevations in more than half of the patients with severe asthma and the reduction in FENO levels was associated with improvements in asthma control and airflow limitation. The FENO levels and blood eosinophil numbers were the predictors of improved residual airway inflammation by systemic steroid therapy in severe asthma.