The Application Of Exhaled Nitric Oxide In Childhood Asthmatreatment And Its Clinical Significance

Objectives:To study the exhaled nitric oxide(FeNO) through 67 cases of morbidity at different times and different degree of children with asthma attack.At the same time,to detect the eosinophilic granulocyte(EOS),the eosinophile cationic protein(ECP) and the determination of pulmonary function forced expiratory volume in one second(FEV₁).To discuss the clinical significance of FeNO concentration as a target of asthma in non-invasive inflammatory indicators and the relations between it and ECP,EOS,FEV₁.Methods:To select 67 cases of children(5-14 years old) with asthma who are at out-patient or in hospital from September 2008 to February 2009,including acute exacerbation group(44 cases)and un-acute exacerbation group(23 cases).To use Electrochemiluminescence spectrophotometry to carry out separately the determination of FeNO concentration,at the same time,to determine EOS,ECP and FEV₁.then fill out questionnaire and record treatment-related clinical signs and symptoms.Follow-up acute exacerbation group after one week and one month respectively.Stimultaneously,to establish the control group.All the 21 cases of children(non-infected near two weeks,no previous history of asthma,no history of allergic diseases,and family history of allergic diseases) are selected from out-patient of Pediatric health care.Results:1,Compare the level of FeNO concentration,ECP,EOS,FEV₁ of children with bronchial asthma at acute exacerbation group and un-acute exacerbation group with the control group separately,to be found that FeNO,ECP,EOS were all increased,statistical significant differences were existing(P all<0.05).There was no obvious difference among the level of FeNO,ECP,EOS in Children with bronchial asthma between acute exacerbation group and un-acute exacerbation group(P > 0.05 ).2,By comparing the level of FeNO,ECP,EOS in different severity of disease from the children with Asthma in acute stage group,found that the levels of FeNO and ECP increase with the degree of asthma attacks,statistical significant differences were existing (P<0.05),there was no significant difference in EOS among the three groups(p>0.05 ).3,FeNO concentration,ECP,EOS,FEV₁ levels of acute exacerbation group were compared separately before treatment,treatment after a week and treatment after a month. The results show that the level of FeNO concentration,ECP,FEV₁ among the three groups exist significant differences:FeNO,ECP all decreased a week later than that is before treatment,FeNO increased at one month after treatment than treatment after a week,ECP declined at one month after treatment than treatment after a week.The level of FEV₁ had higher after treatment than before treatment,however,there was no statistical significance at the treatment after one week and one month,there was no significant difference of EOS levels before and after treatment.4,At acute exacerbation group and un-acute exacerbation group,there is an obvious correlation between concentration of FeNO and EOS,ECP(r= 0.51,p < 0.05 ),but there is no significant correlation between FeNO and FEV₁ of the two groups(r=0.144,P> 0.O5 )Conclusion:1,These findings strongly indicated a role for FeNO in the eosinophilic airway inflammation,it can reflect the control of asthma inflammation better than the clinical symptoms.FeNO increased at the stage of non-acute attack of asthma,it prompted the persistence of airway inflammation,and required long-term treatment.2,FeNO increased with the severity of asthma attacks,prompted that it can not only reflect the degree of acute attack of asthma,but also reflect the treatment effect,it is a better target of monitoring the treatment of bronchial asthma.3,There is a positive correlation between FeNO and ECP,EOS,it prompted that FeNO mainly reflect the level of Eosinophilic airway inflammation of patients with asthma.FeNO is a fast,convenient,accurate and non-invasive detection method to response to airway inflammation.