The Clinical Value Of Exhaled Nitric Oxide Test For Asthma In Children

Objective:TO explore the diagnostic and therapy values of the exhaled nitric o xide test for asthma in children.Methods:1. A total number of155children who were diagnosed as asthma were enrolled from March to December in2012(subject group). There were33cases in the155cases who not received corticosteroid treatment in the past six months belonged to non-hormone therapy group and there were122cases who have received inhaled corticosteroid treatment for more than one months were assigned to hormone therapy group. Also all of155children was divided into there groups:uncontrolled group(30cases), partly controlled group(67cases) and controlled group(58cases). Each group was divided into two groups: people who has asthmatic family history was selected as one group and the rest cases as the other group. There were21cases in the non-hormone therapy group received standard therapy and we have collected the information on their frist time, the15th day, the30th day and the90th day’s referral information. In the same time, we screened out50healthy7-13-year children as the contr-olled group. Every people in subject group ENO concentration, pulmonary func tion and eosinophilic granulocyte were detected too.2. We make the branch of the group of paediatric respiratory of the Chinese Medical Association revis ed the asthma diagnostic criteria in2008as the golden standard for asthma di-agnosis and we drew receiver operating characteristic curves.With the curve we drew we to evaluate the diagnostic and differential diagnostic value of exhaled nitric oxide test. Results:1.Compared the level of ENO in non-hormone therapy group and control group. there were statistical significant differences in the level of ENO in each group (P<0.001). In those three groups. non-hormone therapy group has the highest average level of HNO and hormone therapy group has higher average level of ENO than controlled group2. There were significant differences between each two groups of controlled g-roup, uncontrolled group, partly controlled group and controlled group of the level of ENO (P<0.05). In those groups, uncontrolled group has the highest average level of ENO and partly controlled group has higher average level of ENO than controlled group.3. The level of ENO in uncontrolled group who has asthmatic family history was higher than that who has no asthmatic family group significantly(P=0.035) while there was no significant difference between uncontrolled group and contr-olled group (P>0.05)4. The level of ENO has positive relationship with EOS%and EOS#(P<0.05) in the same time has negative correlation with FVC%,PEF%,FEV1%,FEF25%, FEF50%and FEF75%(P>0.05).5. Cases who reexamination on the90th day has lower ENO level than those who reexamination on the frist day, the15th day and the30th day (P<0.05) Cases who reexamination on the15th day has lower ENO level than that who reexamination on the frist day; there is no significant difference between Csaes who reexamination on the15th day and on the30th day.6. With the receiver operating characteristic curves we found area under ROC curve was0.929and the standard error was0.018. The optimal diagnostic cut-off point was15.45ppb which was capable of differentiating asthma and non-as thma with sensitivity of81.9%. specificity of96.0%.Conclusions:1. The detection of ENO is a good indicator of airway inflammation reaction, which can be used as a tool to screen asthma, early diagnosis and differential diagnosis and also can used as the assessment of asthma control level:2. The level of ENO can reflect the eosinophilic granulocyte inflammation in airway and can be used as a tool to identify airway inflammation characteristic by eosinophilic granulocyte and steroid resistant asthma;3. Cases have allergy related diseases family history of asthma have higher le-vel ENO and better reflect of treatment than those have no family history;4. ENO test combining with pulmonary function may fully reflect the disease status and the level of asthma control;5. Specific treatment of asthma can reduce airway inflammation of asthmatic patients and the exist of persist of airway inflammation and ENO test can refl-ectthe treatment effect and it is a better target of monitoring the treatment of bronchial asthma.