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呼出气一氧化氮指导的治疗是否能改善哮喘儿童亚组的预后?

2020/06/11

   摘要
   简介:呼出气一氧化氮(FENO)是嗜酸性粒细胞性气道炎症的生物标志物,对哮喘的治疗有一定的指导意义。与标准治疗相比,在某些亚组中,FENO指导治疗对改善哮喘预后可能更有效。
   方法:采用7个随机临床试验(RCTs)的数据进行个体化数据分析,这些试验使用FENO指导哮喘治疗。在5个RCT参与者亚组之间描述哮喘加重和失控的发生率,以及首次加重和失控的时间。
   结果:1112名随机对照试验参与者有相关数据。在那些没有接受白三烯受体拮抗剂(LTRA)治疗,FENO指导治疗与降低哮喘加重风险(QR 0.68,95%CI 0.49-0.94)、延长出现首次加重时间(危险比(HR)0.76,95%CI 0.57-0.99)和临界降低失控风险(OR 0.70,95%置信区间0.49-1.00)。与肥胖儿童相比,非肥胖儿童在FENO指导下不易失去哮喘控制(OR 0.69,95%CI 0.48-0.99),且延长出现失控时间(HR 0.77,95%CI 0.61-0.99)。
   结论:与标准治疗方法相比,FENO指导对未经LTRA治疗和无肥胖患者的哮喘患者疗效可能更为有效。


 
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(Eur Respir J. 2020 May 21;55(5):1901879. doi: 10.1183/13993003.01879-2019.)

 
 
 
Does Treatment Guided by Exhaled Nitric Oxide Fraction Improve Outcomes in Subgroups of Children With Asthma?
 
Shona S Fielding, Marielle Pijnenburg, Johan de Jongste, Katherine Pike, Graham Roberts, Helen Petsky, Anne B Chang, Maria Fritsch, Thomas Frischer, Stanley J Szefler, Peter Gergen, Francoise Vermeulen, Robin Vael, Steve S Turner
 
Abstract
Introduction: Exhaled nitric oxide fraction (FENO), a biomarker of eosinophilic airway inflammation, may be useful to guide asthma treatment. F ENO-guided treatment may be more effective in certain subgroups for improving asthma outcomes compared to standard treatment.
Methods: An individual patient data analysis was performed using data from seven randomised clinical trials (RCTs) which used FENO to guide asthma treatment. The incidence of an asthma exacerbation and loss of control, and the time to first exacerbation and loss of control were described between five subgroups of RCT participants.
Results: Data were available in 1112 RCT participants. Among those not treated with leukotriene receptor antagonists (LTRA), but not among those who were treated with LTRA, FENO-guided treatment was associated with reduced exacerbation risk (OR 0.68, 95% CI 0.49-0.94), longer time to first exacerbation (hazard ratio (HR) 0.76, 95% CI 0.57-0.99) and borderline reduced risk for loss of control (OR 0.70, 95% CI 0.49-1.00). Nonobese children, compared to obese children, were less likely to lose asthma control when treatment was guided by FENO (OR 0.69, 95% CI 0.48-0.99) and time to loss of control was longer (HR 0.77, 95% CI 0.61-0.99).
Conclusions: Asthma treatment guided by F ENO may be more effective in achieving better asthma outcomes for patients who are not treated with LTRA and who are not obese, compared to standard practice.




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