呼出气一氧化氮测定在老年哮喘诊治中的应用价值

目的探讨呼出气一氧化氮(FeNO)测定在老年哮喘诊治中的应用价值。方法 2013年1月至2014年1月通过测定收治的老年哮喘患者FeNO水平和肺功能的检测结果,比较其与健康对照组的FeNO水平、痰诱导嗜酸性粒细胞计数及肺功能差异,以及在吸入沙美特罗/丙酸氟替卡松(50/250)治疗前,治疗后1、3、6个月的FeNO水平、痰诱导嗜酸性粒细胞计数及肺功能差异。结果哮喘组的肺功能检查指标第1秒用力肺活量(FEV1)/用力肺活量(FVC)较健康对照组明显下降,而FeNO和痰诱导嗜酸性粒细胞计数则较健康对照组明显升高,且差异具有统计学意义(t=4.32、8.66、25.33,P0.05)。FeNO诊断阳性率明显高于FEV1/FVC肺功能监测及痰诱导嗜酸性粒细胞计数,且差异具有统计学意义(χ2=3.96、4.95,P0.05)。治疗前、治疗后1、3、6个月的FEV1/FVC、FeNO等评价指标差异显著(F=4.32、8.66、25.33,P0.05)。另外,随着患者规律吸入糖皮质激素治疗1、3、6个月,患者的FEV1/FVC、FeNO等评价指标呈现明显的改善趋势。结论 FeNO测定对支气管哮喘的敏感性较其他2项检查灵敏度高,FeNO测定可以有效反映老年人支气管哮喘的临床治疗效果,对老年人支气管哮喘的诊治有较强的临床意义。     

吸烟对支气管哮喘患者吸入糖皮质激素治疗的影响

目的 探讨吸烟对支气管哮喘(简称哮喘)患者临床症状、肺功能及气道炎症的影响,以及对激素治疗的敏感性.方法 选取2009年1 2月至2011年1月门诊就诊的40例慢性持续期哮喘患者,根据是否吸烟分为吸烟组(15例)和非吸烟组(23例).所有患者给予糖皮质激素(布地奈德)吸入治疗,必要时可吸入β2受体激动剂.发放哮喘日记卡及峰流速仪.记录治疗前及治疗28 d后哮喘症状评分、哮喘控制测试(ACT)评分、肺功能、晨间及夜间最高呼气流速(PEF),诱导痰中嗜酸粒细胞及中性粒细胞百分比,并测定痰液中白介素8(IL-8)及嗜酸粒细胞趋化因子(eotaxin)水平.结果 两组患者治疗前除性别构成外,年龄、病程、ACT评分、肺功能指标差异均无统计学意义.两组患者治疗后ACT评分(F=39.991,P<0.05)、FEV1%pred(F＝56.075,P<0.05)、PEV1%pred(F＝53.535,P<0.05),嗜酸粒细胞百分比(F＝15.271,P<0.05)及eotaxin(F=24.172,P<0.05)水平均较治疗前有明显改善,哮喘症状评分显著降低(P<0.05).其中非吸烟组以上指标的改善程度均优于吸烟组(P<0.05).结论 吸烟降低了哮喘患者对ICS治疗的反应性.对吸烟的哮喘患者,治疗可能需要特殊调整.     

支气管哮喘患者呼出气一氧化氮、肺功能、ACQ7评分之间的相关性研究

目的探讨呼出气一氧化氮(FeNO)、肺通气功能及支气管哮喘(简称哮喘)控制水平的相关关系,寻找适用于哮喘患者的气道炎症监测及管理的方法。方法按GINA2008标准入选我院门诊2010年3月至2011年6月就诊65例确诊为哮喘的患者,进行FeNO测定,同时测定肺功能,记录第1秒用力呼气容积(FEV1)、第1秒用力呼气容积占预计值百分比(FEV1%pred)、用力肺活量(FVC)、FEV1/FVC、呼气峰流速(PEF)、FEF25/75、FEF25/75%等指标,行诱导痰检测,记数嗜酸粒细胞的比率(EOS%)。进行哮喘控制问卷(ACQ7)及哮喘控制测试(ACT)调查表的填写。结果经多元逐步回归分析,FeNO的值主要受到年龄、FEF25/75、FEF25/75%、日间症状的影响,与体质量指数、过敏等因素无显著相关关系,与FEV1、FEV1%pred、ACQ7评分、ACT评分等亦无显著相关(P0.05),FeNO与诱导痰EOS%呈显著正相关(r=0.327,P=0.022)。ACQ7与FEV1、FEV1%pred呈显著负相关(分别是r=-0.491,P=0.000,r=-0.469,P=0.012)。结论 FeNO能够客观反映气道EOS炎症水平,年龄越小、日间症状越明显、小气道阻力越高,FeNO水平越高。结合肺功能指标和FeNO更能全面反映哮喘疾病现况及控制水平。     

哮喘气道中性粒细胞性炎症表型的临床意义

目的探讨哮喘中性粒细胞性气道炎症与临床控制的关系,为哮喘临床防治提供指导。方法选择2011年8月至2014年6月在第三军医大学新桥医院呼吸内科门诊就诊的中性粒细胞性哮喘患者40例,采集患者病史、ACT评分、诱导痰和肺功能等检查结果,统计分析诱导痰中性粒细胞百分比、绝对计数与ACT评分、FEV1%pred的相关性。结果在纳入的40例中性粒细胞哮喘患者中,女性26例(65.00%),男性14例,平均年龄(42.70±13.74)岁,发病年龄>12岁31例(77.50%),病程(11.32±12.25)年,ACT(17.15±4.80)分,诱导痰嗜酸粒细胞比例(0.49±0.80)%,诱导痰嗜酸粒细胞计数(0.03±0.06)×106/g,诱导痰中性粒细胞比例(73.79±5.83)%,诱导痰中性粒细胞计数(5.21±2.09)×106/g,FEV1%pred(75.50±21.83)%。在中性粒细胞哮喘组中,诱导痰中性粒细胞百分比、中性粒细胞绝对计数、细胞总数、ACT评分与FEV1%pred存在相关性(P<0.05,r分别为-0.373、-0.530、-0.519、0.552)。结论中性粒细胞性哮喘其临床特征多种多样;哮喘患者气道中性粒细胞性炎症与临床控制存在相关性,提示中性粒细胞炎症可能参与了气道阻塞的发生发展;ACT是一种简易评价哮喘控制水平的工具。     

哮喘患儿呼出气一氧化氮浓度、肺功能及哮喘控制测试评分的相关性及其评估价值研究

目的探讨哮喘患儿呼出气一氧化氮(Fe NO)浓度、肺功能、哮喘控制测试(ACT)评分的相关性及其评估价值。方法选取2013年12月—2014年12月在衡水市桃城区妇幼保健院小儿呼吸科门诊初治1个月后的哮喘患儿162例,检测患儿Fe NO浓度及肺功能,进行ACT评分,并分析FeNO浓度、肺功能及ACT评分间的相关性。结果 162例患儿中肺功能正常者105例(占64.81%),肺功能轻度减退者57例(占35.19%);FeNO正常者64例(占39.51%),偏高者62例(占38.27%),较高者36例(占22.22%)。Pearson相关性分析结果显示,ACT评分与FeNO浓度呈中度负相关(r=-0.668,P=0.000);ACT评分与第一秒用力呼气容积占预计值百分比(FEV1%)呈高度正相关(r=0.754,P=0.000);FEV1%与FeNO浓度呈中度负相关(r=-0.524,P=0.000)。结论哮喘患儿FeNO、肺功能及ACT评分间具有相关性,ACT评分可用以评估哮喘患儿疾病控制情况,肺功能和FeNO浓度可用以评估哮喘患儿气道炎症和疾病控制情况。     

肺功能及哮喘控制测试(ACT)在哮喘患者管理中的价值

目的探讨肺功能及哮喘控制测试在支气管哮喘患者管理中的价值。方法将肺功能及ACT应用于支气管哮喘患者136例。每月填写1次ACT,在哮喘患者应用ACT前药物治疗时、应用ACT 6个月结束时测定第1秒用力呼气量(FEV1)、FEV1占预计值百分比(FEV1%预计值)和用力肺活量(FVC)、FVC占预计值百分比(FVC%预计值),同时测定ACT评分观察哮喘患者在药物治疗、肺功能检查,应用ACT 6个月末时ACT使用率、治疗的依从性、哮喘控制情况。结果每月1次坚持应用ACT 132例,使用率97%;坚持使用规范的治疗128例,治疗依从性达94%;症状完全控制率达47%,良好控制率达74.2%。ACT评分治疗6个月后较入选时升高,肺功能指标亦有明显改善,FEV1与ACT评分呈正相关(r=0.82,P<0.01)。结论肺功能及ACT用于支气管哮喘患者的管理能提高患者对治疗的依从性和哮喘控制率。     

吸烟对支气管哮喘患者吸入糖皮质激素治疗的影响

目的 探讨吸烟对支气管哮喘(简称哮喘)患者临床症状、肺功能及气道炎症的影响,以及对激素治疗的敏感性.方法 选取2009年12月至2011年1月门诊就诊的40例慢性持续期哮喘患者,根据是否吸烟分为吸烟组(15例)和非吸烟组(23例).所有患者给予糖皮质激素(布地奈德)吸入治疗,必要时可吸入β2受体激动剂.发放哮喘日记卡及峰流速仪.记录治疗前及治疗28 d后哮喘症状评分、哮喘控制测试(ACT)评分、肺功能、晨间及夜间最高呼气流速(PEF),诱导痰中嗜酸粒细胞及中性粒细胞百分比,并测定痰液中白介素8(IL 8)及嗜酸粒细胞趋化因子(eotaxin)水平.结果 两组患者治疗前除性别构成外,年龄、病程、ACT评分、肺功能指标差异均无统计学意义.两组患者治疗后ACT评分(F=39.991,P＜0.05)、FEV1％ pred(F=56.075,P＜0.05)、PEF％ pred(F=53.535,P＜0.05),嗜酸粒细胞百分比(F=15.271,P＜0.05)及eotaxm(F=24.172,P＜0.05)水平均较治疗前有明显改善,哮喘症状评分显著降低(P ＜0.05).其中非吸烟组以上指标的改善程度均优于吸烟组(P＜0.05).结论 吸烟降低了哮喘患者对ICS治疗的反应性.对吸烟的哮喘患者,治疗可能需要特殊调整.     

吸烟对哮喘患者FeNO和肺功能的影响

目的探讨吸烟对哮喘患者FeNO和肺功能的影响。方法选取2017年1月至2018年5月于承德医学院附属医院确诊的哮喘患者217例,其中吸烟患者81例(吸烟组),不吸烟患者74例(不吸烟组),已戒烟患者62例(已戒烟组),比较3组间FeNO值、第1秒用力呼气容积占预计值百分比(FEV_1%)、第1秒用力呼气容积/用力肺活量(FEV_1/FVC)、最大呼气流量(MEF)25-75/预计值、和哮喘控制测试(ACT)评分,探讨FeNO与肺功能各指标、ACT评分、吸烟指数、嗜酸性粒细胞百分比(EO%)的相关性。结果吸烟患者FEV_1/FVC较不吸烟组低,差异有统计学意义(P0.05)。吸烟患者MEF25-75/预计值较不吸烟及已戒烟患者低,差异有统计学意义(P0.05)。吸烟组FeNO值较不吸烟组、已戒烟组低,差异有统计学意义(P0.05)。哮喘患者FeNO水平与血EO%呈正相关(r=0.482,P=0.041),与FEV_1/FVC、MEF25～75/预计值、吸烟指数呈负相关性(r=-0.237、-0.384、-0.526,P=0.022、0.003、0.038),差异有统计学意义(P0.05)。结论吸烟可以降低哮喘患者小气道功能指标与FeNO值,使用单一的FeNO方法评估吸烟患者的气道炎症,有可能会低估其气道炎症水平。FeNO水平更能反映哮喘患者嗜酸性气道炎症,能在一定程度上反映小气道功能障碍,尤其在不吸烟的哮喘患者评估价值更高,且FeNO值越高,小气道阻力越高。     

Significance of serum eosinophil cationic protein and interleukin-4 and their significance in bronchial asthma

目的 探讨支气管哮喘患者血清嗜酸性粒细胞阳离子蛋白(ECP)和白细胞介素(IL)-4的变化及其临床意义.方法 收集哮喘患者54例,并将其分为哮喘缓解组(26例)和哮喘发作组(28例),血清嗜酸性粒细胞阳离子蛋白和IL-4水平的检测应用酶联免疫吸附法(ELISA).结果 与对照组相比较,哮喘急性发作期嗜酸性粒细胞阳离子蛋白、IL-4含量明显升高,FEV1显著下降(P＜0.05);治疗后嗜酸性粒细胞阳离子蛋白、IL-4水平均明显降低,FEV1、FEV1/FVC均升高.哮喘缓解期患者嗜酸性粒细胞阳离子蛋白、IL-4水平明显高于对照组.直线相关分析显示,嗜酸性粒细胞阳离子蛋白与IL-4呈正相关,与FEV1和FEV1/FVC呈负相关.结论 嗜酸性粒细胞阳离子蛋白和IL-4可作为评价哮喘患者气道炎症程度和指导抗炎治疗的指标.     

门诊成人支气管哮喘患者临床控制水平及其影响因素分析

目的 分析门诊成人支气管哮喘患者的临床控制水平及其影响因素,为哮喘的规范化治疗提供参考。方法 选取2017年7月至2022年7月上海中医药大学附属龙华医院呼吸科门诊就诊的100例成人哮喘患者,根据哮喘控制测试(asthma control test, ACT)评分表评估患者哮喘控制水平,将患者分为控制良好组(n=36)与未控制组(n=64)。采用多因素Logistic回归分析门诊成人支气管哮喘患者控制水平的影响因素。结果 100例门诊成人支气管哮喘患者的控制率(ACT≥20分)为36%。单因素Logistic回归分析显示两组患者的性别、年龄、吸烟史、家族史、急性加重住院史、合并过敏性鼻窦炎、肺功能等差异无统计学意义(P>0.05)。两组患者的BMI、FeNO、嗜酸性粒细胞计数以及嗜酸性粒细胞百分比差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示,有吸烟史、发病年龄≤33岁、FeNO>54ppb、血嗜酸性粒细胞百分比>5.5%是影响门诊成人支气管哮喘患者控制水平的危险因素(P<0.05)。ROC曲线分析显示,以Logistic回归分析总...     

支气管哮喘患者呼出气一氧化氮、肺功能、ACQ7评分之间的相关性研究

目的 探讨呼出气一氧化氮(FeNO)、肺通气功能及支气管哮喘(简称哮喘)控制水平的相关关系,寻找适用于哮喘患者的气道炎症监测及管理的方法.方法 按GINA 2008标准入选我院门诊2010年3月至2011年6月就诊65例确诊为哮喘的患者 进行FeNO测定 同时测定肺功能 记录第1秒用力呼气容积(FEV1)、第1秒用力呼...     

Relación del test de control del asma (ACT) con la función pulmonar,niveles de óxido nítrico exhalado y grados de control según la Iniciativa Global para el Asma (GINA)

Introduction

The current goal of asthma treatment is to achieve and maintain control. This study aimed to explore the relationship between the ACT (Asthma Control Test) questionnaire and the levels of control according to GINA (Global Initiative for Asthma) to establish the cut-off points for the ACT and evaluate its relationship with lung function and fractionated exhaled nitric oxide level (FeNO).

Patients and methods

A multi-centre prospective study including 441 patients followed up in an outpatient Chest Clinic. A clinical protocol was followed, and FeNO, spirometry and ACT performed. Disease was classified according to levels of control using GINA. The study analysed sensitivity, specificity and area under the curve (ROC), and the ACT cut-off points. We studied the differences between the functional parameters and FeNO between levels of control.

Results

For controlled asthma the cut-off obtained was ACT≥21 (area under the curve 0.791) and for uncontrolled ≤18 (AUC 0.774). We found significant differences in FeNO levels and pulmonary function among ACT≥21 and ACT≤18, although only 26.3% of patients with ACT≤18 had a FEV1 <80% and 40% higher FeNO (≥35 ppb). We found a correlation between baseline FEV1 and ACT (r=0.19, P<0.01) and between ACT and FeNO (r=−0.16, P<0.01).

Conclusions

The cut-off points would be, for controlled asthma ACT≥21, partly controlled asthma ACT=19–20 and uncontrolled asthma ACT≤18. A more complete assessment would require including monitoring operating parameters and FeNO.     

呼出气一氧化氮对支气管哮喘的诊断价值及其与气道炎症的相关性分析

目的 通过探讨呼出气一氧化氮(FeNO)与肺泡灌洗液中气道炎症细胞、肺功能、血清总IgE及支气管激发试验的相关性,明确FeNO对哮喘的诊断价值,并寻求适用于哮喘患者气道炎症监测、评估与管理的方法.方法 选择符合标准的哮喘患者103例及健康对照组49例,对其分别进行FeNO及支气管激发试验.同时哮喘患者行BALF检查;同时进行肺功能,记录FEV1％pred、FEV1/FVC、最大呼气中期流速(MMFR)、呼气峰流速(PEF);行血常规、血清总IgE检查.结果 将FeNO的影响因素引入多重线性回归分析,发现FeNO主要受年龄、过敏性鼻炎、吸烟指数的影响,与肺泡灌洗液中嗜酸粒细胞百分比(EOS％)呈显著正相关(r =0.278,P=0.007).外周血EOS％增高,FeNO值增加,但外周血EOS％在不同FeNO水平间的差异无统计学意义(F=2.868,P=0.062);血清总IgE随FeNO增加显著,且其在不同FeNO水平间的差异有统计学意义(F=4.407,P=0.015).ROC曲线示PC20的曲线下面积AUC:0.853,95％ CI:0.778～0.928,FeNO曲线下面积AUC:0.712,95％ CI:0.628～0.796.PC20≤8 g/L为阳性判断标准时的灵敏度(0.837vs 0.674)以及特异度(0.776 vs 0.571)均高于以FeNO浓度≥26.5 ppb的阳性阈值.结论 FeNO与肺泡灌洗液EOS及血清总IgE关系密切,在评估哮喘患者嗜酸性气道炎症中具有重要作用;与支气管激发试验相比,FeNO在诊断哮喘上的灵敏度和特异度相对较低,因此在哮喘的诊断上FeNO检测不能完全替代支气管激发试验.     

Exhaled nitric oxide in the management of childhood asthma: a prospective 6-months study

Fractional exhaled nitric oxide (FeNO) is elevated in asthma and reflects eosinophilic airway inflammation. The aim of this prospective, randomized, single-blind study was to examine whether the inclusion of repeated FeNO measurements into asthma monitoring leads to an improvement in asthma outcome. Forty-seven children with mild to moderate asthma were allocated to a FeNO group (n = 22) and to a control group (n = 25). In the FeNO group therapy was based on symptoms, beta-agonist use, lung function, and FeNO whereas in the control group therapy was based on symptoms, beta-agonist use and lung function only. Patients performed five visits in 6 weeks intervals. Frequency of respiratory symptoms, beta-agonist use, FEV(1)% predicted and the frequency of exacerbations were similar between groups. Patients in the FeNO group received higher doses of inhaled corticosteroids (ICS) (control group: median (interquartile range): 241 microg (26-607 microg); FeNo group: 316 microg (200-500 microg) and had significantly higher MEF(50)% predicted (control group: median (interquartile range): 68.5% (55.8-83.1%); FeNO group: 83.2% (62.9%-98.3%). At a cut-off point of 22.9 ppb FeNO the best predictive value for exacerbations with a sensitivity of 80% and specificity of 60% was found. Significant relationships were observed between FeNO and dose of ICS (beta = -8.77; P < 0.002), beta-agonist use 2 weeks prior to a visit (beta = 0.11; P < 0.05), asthma symptoms (beta = 0.02; P < 0.0001), and bronchial hyperresponsiveness (beta = 0.04; P = 0.02). In conclusion, FeNO was related to important markers of asthma control. A therapy regimen aimed at lowering FeNO in children with asthma improved parameters of small airway function, but was not able to improve clinical markers of asthma control.     

Is Exhaled Nitric Oxide a Useful Adjunctive Test for Assessing Asthma?

Rationale. To determine the general utility of clinical (Asthma Control Test) and physiologic (forced expiratory volume in the first second of exhalation [FEV₁] and fractionated exhaled nitric oxide level [FeNO]) parameters for characterizing asthma patients. Methods. Two cross-sectional independent studies simultaneously enrolled 100 patients in the US and 109 patients in Spain ≥ 18 years of age with a physician-diagnosis of asthma and confirmed by a ≥ 12% improvement in FEV₁ after bronchodilators or the presence of airway hyperresponsiveness, a central feature of asthma, as measured by methacholine challenge (PC₂₀ < 10 mg/mL). There was no restriction on asthma severity or treatment. Patients were excluded if they had a diagnosis of chronic obstructive pulmonary disease and/or were current cigarette smokers. Statistical analyses were performed to compare ACT, FeNO, and spirometry within and between sites. Results. Population characteristics revealed significant differences in distributions of age, percent-predicted FEV₁ (%FEV₁), FeNO, inhaled corticosteroid usage, and atopy between the two populations. The Spain site enrolled younger patients with milder asthma, based on higher %FEV₁ values and less frequent treatment with inhaled corticosteroids. At each site, mean FeNO levels decreased as asthma control categories increased, and means were lower in the US. There was a negative correlation between ACT and FeNO that was statistically significant for Spain patients not treated with inhaled corticosteroids. Conclusions. The results of this study support the use of FeNO as an adjunctive tool for assessing asthma primarily in mild inhaled corticosteroid (ICS)-naïve asthma patients. The lack of correlation of ACT with FeNO in this and other studies across the entire population appears to reflect the heterogeneity of asthma patients who have an admixture of asthma severity and treatment regimens making it very difficult to appreciate the nuances of sensitive tests like FeNO.     

哮喘控制测试评分的探索

目的哮喘控制测试（asthma control test,ACT）被认为是监测和评估支气管哮喘（简称哮喘）病情简单有效的工具,本文观察哮喘患者的ACT评分与第1秒用力呼气容积（FEV1）的相关性。方法收集我院门诊确诊为哮喘的患者52例,年龄为18～56岁。患者填写ACT问卷,要求患者回忆近四周的情况并回答5个问题,得分20-24分为良好控制,得分低于20分则未得到控制。上午进行肺功能测定,分析FEV1占预计值的百分比（FEV1pred%）与ACT分数相关性。结果ACT评分〈20组（n=37）FEV1pred%为（62.22±15.91）%,ACT评分≥20（n=15）组FEV1pred%为（89.85±12.28）%,两组间FEV1pred%差异有统计学意义（P〈0.01）。FEV1pred%〈60%组（n=13）的ACT得分为9.62±3.52,60%≤FEV1pred%〈80%组（n=23）ACT得分为15.91±3.12,FEV1%pred≥80%组（n=16）ACT得分为20.59±2.31,方差分析和3组间均数两两比较,差异均有统计学意义（F=95.657,P〈0.01）,三组间均数两两比较（P值均〈0.05）。以FEV1pred%为自变量,ACT评分为因变量进行相关分析,两者具有良好的相关性（r=0.820,P〈0.01）。结论ACT评分与患者的FEV1有良好的相关性,对不同肺功能水平具有一定的鉴别能力,可作为肺功能测试的补充,筛查哮喘未控制患者,以指导治疗。     

未控制支气管哮喘患者痰嗜酸粒细胞水平与肺功能相关性分析

目的:分析未控制支气管哮喘(哮喘)患者不同水平痰嗜酸粒细胞的临床特点,探讨未控制哮喘患者痰嗜酸粒细胞与肺功能的相关性。方法:纳入2017年8月至2019年9月就诊于内蒙古自治区人民医院呼吸与危重症医学科的未控制哮喘患者167例病例资料进行回顾性研究,根据诱导痰嗜酸粒细胞百分比结果将患者分为2组,以痰嗜酸粒细胞百分比≥2...     

儿童胸闷变异性哮喘肺功能改变的特征

目的探讨胸闷变异性哮喘患儿肺功能改变的特点,为临床诊断和管理提供依据。方法选取2018年8月至2019年5月确诊为胸闷变异性哮喘的44例患儿为研究对象,选取同期初诊的非急性发作期的典型哮喘患儿62例及健康体检儿童46例为对照组。所有入组儿童在初诊或体检时进行呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)和肺通气功能的检测,胸闷变异性哮喘组和典型哮喘组行支气管激发试验。分析对比不同组患儿的FeNO水平、肺通气功能改变及气道高反应性严重程度。结果胸闷变异性哮喘组FeNO中位数值为14.0(8.0,24.0)ppb,其水平明显低于典型哮喘组[31.0(12.0,51.0)ppb,P<0.05],高于健康儿童组[9.0(7.0,18.5)ppb,P<0.05];胸闷变异型哮喘儿童肺通气功能参数中FEV1/FVC[0.998(0.967~1.079)]、PEF[(94.41±12.91)]、FEF50[79.15(64.78~93.75)]、FEF75[66.50(53.10~95.90)]均显著低于健康儿童组[1.080(1.039~1.103),P<0.01]、[(106.38±14.14),P<0.01]、[86.17(79.05~97.67),P<0.05]、[72.29(66.14~81.90),P<0.05],但与典型哮喘组无明显差异(P>0.05);胸闷变异性哮喘组第1秒用力呼气容积(FEV1)下降20%时吸入的乙酰甲胆碱累积剂量(PD20-FEV1)均值为(0.855±0.691)mg,显著高于典型哮喘组[(0.321±0.213)mg,P<0.01]。结论胸闷变异性哮喘患儿FeNO水平高于健康儿童,通气功能FEV1/FVC、PEF及小气道功能指标均低于健康儿童;胸闷变异性哮喘患儿肺通气功能与非急性发作期的典型哮喘患儿接近,但其FeNO水平及气道高反应性的程度均显著低于后者。     

Asthma Control Test and Peak Expiratory Flow Rate: Independent Pediatric Asthma Management Tools

Background: Management of asthma reflects the complexity of the pathogenesis. According to current National Heart Lung Blood Institute (NHLBI) guidelines, asthma control can be assessed using the validated asthma control test, measures of airway function, and overall assessment of risk and quality of life. We hypothesized that the asthma control test and measures of airway function are independent tools in asthma management. We also studied whether the presence of nasal symptoms is correlated to these measures. Methods: Serial visits (n = 45) to a pediatric respiratory clinic in an underserved area of San Diego County with a predominantly Hispanic population were reviewed. Patients were included if they were able to perform airway function tests and had more than one provider visit. Patients with other major diseases were excluded. We determined whether uncontrolled asthmatics, defined as an Asthma Control test (ACT) score of 19 or less, had lower % predicted peak expiratory flow Measurements as a group compared to those with higher scores. In addition, the individual ACT and airway function results were analyzed. Patients with and without nasal symptoms at the time of presentation were sub-analyzed to determine differences in ACT and peak flow measurements. Results: Based on n = 45 physician visits, the mean ACT score was 21 +/? 3.3 (range 12–25) and the mean peak expiratory flow rate (PEFR) was 87.4% +/? 11 (range 65–109%). Patients with ACT scores < / = to 19 or lower (< / = 90%) PEFRs were determined not to have more nasal symptoms. The measures of ACT and peak expiratory flow were independent and not correlated. Conclusions. Our study indicates that ACT and PEFR are distinct parameters used to manage patients in a pediatric outreach asthma clinic.