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Associated demographics of persistent exhaled nitric oxide elevation in treated asthmatics

机译：哮喘患者持续呼出气一氧化氮升高的相关人口统计学资料

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Background: The fraction of exhaled nitric oxide (FENO) is reduced by anti-inflammatory treatment in asthma. However, the FENO level is also regulated by individual demographics and there is considerable variation among clinically stable patients. Objective: We hypothesized that some demographics may be responsible for persistent FENO elevation despite inhaled corticosteroids (ICS) therapy in asthma. Methods: This was a prospective observational study. We initially screened 250 stable asthmatics and determined the FENO cut-off point for identifying poorly controlled asthma defined by one of the following criteria: Asthma control test <20, or forced expiratory volume in one-second % of predicted <80%, or peak expiratory flow variability <80% (Study 1). After 12-weeks, 229 patients who maintained high or low FENO were selected and the independent factors which might contribute to a high FENO were examined (Study 2). Results: A FENO level >39.5 p.p.b. yielded 67% sensitivity and 76% specificity for identifying the patients with poorly controlled asthma. The persistent high FENO group (≥40 p.p.b.) was more likely to be ex-smokers, to show evidence of atopy (positive specific IgE, higher serum IgE and blood eosinophils), and to have allergic comorbidities. Especially, past smoking history, blood eosinophils, and chronic rhinosinusitis were identified to be independent predictors of high FENO. Neither the dose of ICS nor other medication use showed any difference between the groups. Conclusions and Clinical Relevance: These results suggested that past smoking history, blood eosinophilia, and chronic rhinosinusitis are involved in the persistent airway inflammation detected by FENO. Although their relative contributions on FENO values should be further quantified, clarification of the features of the subjects with high FENO might provide clues for adjustment of the treatment approach in asthma. Original Articles
机译：背景：哮喘中的抗炎治疗降低了呼出气一氧化氮（FENO）的比例。但是，FENO水平也受各个人口统计学的影响，并且临床上稳定的患者之间存在相当大的差异。目的：我们假设尽管哮喘患者吸入皮质类固醇（ICS）治疗，但某些人口统计学特征仍可能导致FENO持续升高。方法：这是一项前瞻性观察研究。我们最初筛选了250例稳定的哮喘患者，并确定了FENO临界点，以识别由以下标准之一定义的哮喘控制不佳：哮喘对照试验<20，或强迫呼气量占预期的<80％的一秒，或峰值呼气流量变异性<80％（研究1）。 12周后，选择229例FENO高或低的患者，并检查可能导致FENO高的独立因素（研究2）。结果：FENO等级> 39.5 p.p.b.鉴定哮喘控制不佳的患者可获得67％的敏感性和76％的特异性。持续的高FENO组（≥40 p.p.b.）更可能是前吸烟者，表现出特应性的证据（阳性特异性IgE，较高的血清IgE和血液嗜酸性粒细胞），并具有过敏性合并症。特别是，过去的吸烟史，血液嗜酸性粒细胞和慢性鼻-鼻窦炎被确定为高FENO的独立预测因子。两组间ICS剂量或其他药物使用均无差异。结论和临床意义：这些结果表明，过去的吸烟史，血液嗜酸性粒细胞增多和慢性鼻-鼻窦炎与FENO检测到的持续气道炎症有关。尽管应该进一步量化他们对FENO值的相对贡献，但明确FENO较高的受试者的特征可能为调整哮喘的治疗方法提供线索。原创文章

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