High fractional exhaled nitric oxide and sputum eosinophils are associated with an increased risk of future virus-induced exacerbations: A prospective cohort study
High fractional exhaled nitric oxide and sputum eosinophils are associated with an increased risk of future virus-induced exacerbations: A prospective cohort study
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DOI：
10.1111/cea.12935
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发表时间：
2017-08-01
影响因子：
6.1
通讯作者：
Porsbjerg, C.
中科院分区：
文献类型：
--
作者：
Bjerregaard, A.;Laing, I. A.;Porsbjerg, C.
背景：哮喘加重的主要诱因是呼吸道病毒感染，最常见的是鼻病毒。一般来说，2型炎症与病情恶化的风险增加有关。基线时的2型炎症是否会增加未来病毒引起的恶化的风险尚不清楚。目的：评估2型炎症是否与病毒诱发哮喘加重的风险增加相关。方法：对稳定型哮喘患者进行肺活量测定、皮肤点刺试验、FeNO测定和痰诱导细胞计数测定。患者随访18个月，在此期间，当他们出现恶化症状时，他们在研究单位接受评估。在这些评估中收集的鼻拭子用PCR检测病毒。结果：共纳入81例哮喘患者，其中22例（27%）在随访期间病情加重。其中15例（68%）在病情加重时检测到呼吸道病毒。基线时痰嗜酸性粒细胞>.1 %增加了随后病毒引起的恶化的风险（HR 7.6 95% CI: 1.635.2， P= 0.010）， FeNO >25 ppb （HR 3.4 95% CI: 1.1-10.4， P= 0.033）也是如此。结论和临床意义：在现实生活中，稳定疾病期间建立的2型炎症是病毒诱导恶化的危险因素。2型炎症的测量，如痰嗜酸性粒细胞和FeNO，可以在未来的研究中纳入哮喘患者的风险评估。
Background: The major trigger of asthma exacerbations is infection with a respiratory virus, most commonly rhinovirus. Type 2 inflammation is known to be associated with an increased risk of exacerbations in general. Whether type 2 inflammation at baseline increases the risk of future virus-induced exacerbations is unknown.Objective: To assess whether type 2 inflammation is associated with an increased risk of virus-induced exacerbations of asthma.Methods: Stable asthmatics had spirometry, skin prick test, measurement of FeNO and sputum induced for differential cell counts. Patients were followed up for 18 months, during which they were assessed at the research unit when they had symptoms of an exacerbation. Nasal swabs collected at these assessments underwent viral detection by PCR.Results: A total of 81 asthma patients were recruited, of which 22 (27%) experienced an exacerbation during the follow-up period. Of these, 15 (68%) had a respiratory virus detected at exacerbation. Sputum eosinophils >1% at baseline increased the risk of having a subsequent virus-induced exacerbation (HR 7.6 95% CI: 1.635.2, P=.010) as did having FeNO >25 ppb (HR 3.4 95% CI: 1.1-10.4, P=.033).Conclusion and Clinical Relevance: Established type 2 inflammation during stable disease is a risk factor for virus-induced exacerbations in a real-life setting. Measures of type 2 inflammation, such as sputum eosinophils and FeNO, could be included in the risk assessment of patients with asthma in future studies.