| BackgroundBronchial asthma(asthma)is a chronic inflammatory disease of the airwaysassociated with bronchial hyper-responsiveness andreversible airflow obstruction.At present,pulmonary function and clinical symptoms are used to diagnose,monitorand guide medicationof asthma,but there are some limitations(not reflecting the airway inflammation and showing reversible respiratory airflow obstruction of every pulmonary function testing,especially being treated of asthma).Its can not meet the clinical needs.Fractional exhaled nitric oxide(FeNO)is thought to reflect the presence ofeosinophilic airway inflammation,and is a non-invasivetest,easy to measure and good repeatability that has being used to clinical.FeNO is currently probed to explain asthma molecular phenotype,assess severity of inflammation and predict inhaled corticosteroid(ICS)responsiveness.In recent years,some scholars believe that FeNO levels can be used to diagnose asthma and guide the use of asthma medication,but its current diagnostic value of eosinophilic phenotype asthma and the ICS treatment efficacy has not yet reach a consencus.ObjectiveTo determine the clinic diagnostic value of FeNO measurement in the diagnosis of bronchial asthma of eosinophils and its therapeutic reactions of ICS.MethodsPatients,from April 2015 to February 2016 hospitalized patients in the First Affiliated Hospital of Xinxiang Medical University with bronchial asthma,were selected as asthma group with acute aggravating period.The asthma group were divided into eosinophilic group(31)and noneosinophilic group(31)according to the kind of induced sputum classification;the eosinophilic group were divided into mild(7 cases),moderate(13 cases)and sever asthma(11 cases).Each group was given 0.2g doxofylline of venous transfusion,1 time/day,oral 10 mg cetirizine,1 time/per night,oral 10 mg montelukast,1 time/per night,2mg budesonide and 2.5ml compound ipratropium bromide solution for inhalation,2 times/day.Before giving patients treatment,we must give people FeNO detection,pulmonary function testing,asthma control test(ACT),bronchial relaxation test and induced sputum test;FeNO,ACT and lung function testing were tested again after treatment with budesonide(200ug q12h)inhalation for 4 weeks.At the same time,sisty-two healthy people were recruited as control group and their FeNO levels were tested.ResultsBefore treatment,theFeNOlevels of asthmatic patients were markedly higher than those of controllers,and were statistically significant difference(t=7.414,P=0.000);the FeNO levels of eosinophilic group were markedly higher than noneosinophilic group and were statistically significant difference(t=6.568,P=0.000).In the asthmatic group,the levels of Fe NO showed a positive linear correlation with sputum eosinophils(?=0.823,P=0.000);but the correlative of the eosinophilic group was similar(?=0.770,P=0.000),the noneosinophilic group was not similar(?=0.300,P=0.101).The FeNO levels of eosinophilic group compared before and after treatment were statistically significant difference(t=7.440,P=0.000)and the noneosinophilic group were no statistically difference(t=2.013,P=0.083).Before and after treatment,the levels of FeNO among the groups of eosinophilic group were significant difference(t=3.535,P=0.012;t=8.171,P=0.000;t=7.161,P=0.000).After treatment according to the ACT score we judged whether control,the control rate of the eosinophilic group was 67.7% vs the noneosinophilic group,s 22.6% was significant difference(?2=12.765,P=0.000),the control rate of mild group was 28.6% vs moderate group 76.9% was significantly different(?2=6.418,P=0.011),mild group vs sever group 81.8% was significantly different(?2=7.103,P=0.008),moderate group vs sever group was no difference(?2=0.087,P=0.769).ConclusionFeNO is a good parameter for the management of eosinophlic airway inflammation.It can be used to diagnose eosinophilic phenotype asthma and has a clinical value to evaluate the therapeutic reactions of ICS in eosinophilic phenotype asthma. |
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