Importance of fractional exhaled nitric oxide in diagnosis of bronchiectasis accompanied with bronchial asthma
Importance of fractional exhaled nitric oxide in diagnosis of bronchiectasis accompanied with bronchial asthma
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DOI：
10.21037/jtd.2016.03.72
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发表时间：
2016-05-01
影响因子：
2.5
通讯作者：
Xie, Can-Mao
中科院分区：
文献类型：
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作者：
Chen, Feng-Jia;Liao, Huai;Xie, Can-Mao
背景：呼出一氧化氮 (FeNO) 分数测量是一种简单、快速、高重复性和无创的气道炎症评估方法。因此，FeNO 广泛用于哮喘的诊断和治疗。使用FeNO作为传统肺功能测试的替代方法来区分支气管扩张（BE）和支气管哮喘患者与单纯BE患者的可行性尚不清楚。方法：2013年2月至2015年2月，对99例通过高分辨率计算机断层扫描（HRCT）诊断为BE的患者进行了FeNO测量、支气管激发试验（BCT）或支气管扩张剂试验。支气管高反应性和/或可逆性气道阻塞用于定义哮喘。获得受试者工作特征（ROC）曲线，阐明FeNO在诊断BE哮喘患者中的临床作用，并确定最佳操作点。结果：99例BE患者中，20例出现哮喘，其中12例接受常规治疗，给予布地奈德（200 μg，bid）12周，观察浓度变化，评价FeNO在治疗中的作用。 FeNO 的 ROC 曲线下面积估计为 0.832。结果还显示，用于区分哮喘与非哮喘 BE 患者的临界值 > 22.5 ppb (ppb)（敏感性，90.0%；特异性，62.5%）。治疗后FeNO和1秒用力呼气量显着改善。结论：临床FeNO测量是一种简单、无创、快速的方法，可用于区分哮喘与非哮喘BE患者。该技术显示出治疗哮喘的潜力。
Background: Fractional exhaled nitric oxide (FeNO) measurement is a simple, rapid, highly reproducible, and noninvasive method of airway inflammation assessment. Therefore, FeNO is extensively used for the diagnosis and management of asthma. The feasibility of using FeNO as an alternative to conventional pulmonary function test to differentiate patients with bronchiectasis (BE) and bronchial asthma from those with BE only remains unclear.Methods: From February 2013 to February 2015, 99 patients diagnosed with BE through high-resolution computed tomography (HRCT) were subjected to FeNO measurement, bronchial challenge test (BCT), or bronchodilator test. Bronchial hyperreactivity and/or reversible airway obstruction was used to define asthma. The receiver operating characteristic (ROC) curves were obtained to elucidate the clinical functions of FeNO in the diagnosis of asthmatic patients with BE, and the optimal operating point was also determined.Results: Of 99 patients with BE, 20 patients presented asthma, and 12 of these patients received regular treatment, which were given with budesonide (200 mu g, bid) for 12 weeks to evaluate changes in the concentration and assess the role of FeNO in the treatment. The area under the ROC curve was estimated as 0.832 for FeNO. Results also revealed a cut off value of > 22.5 part per billion (ppb) FeNO for differentiating asthmatic from non-asthmatic (sensitivity, 90.0%; specificity, 62.5%) patients with BE. FeNO and forced expiratory volume for 1 second significantly improved after the treatment.Conclusions: Clinical FeNO measurement is a simple, noninvasive, and rapid method used to differentiate asthmatic from nonasthmatic patients with BE. This technique exhibits potential for asthma management.