基于FeNO检测的儿童支气管哮喘ICS剂量调整研究

Dose Adjustment Study of ICS for Bronchial Asthma in Children Based on FeNO Detection

目的:探讨呼出气一氧化氮(fractional exhaled nitric oxide,FeNO)对支气管哮喘患儿吸入性糖皮质激素(inhaled corticosteroid,ICS)剂量调整的作用。方法:选取2020年1月—2021年12月丹阳市妇幼保健院收治的92例支气管哮喘患儿作为研究对象,并随机分为观察组和对照组,各46例。对照组根据哮喘控制状况和肺功能水平调整ICS剂量,观察组在此基础上联合FeNO调整ICS剂量。两组患儿均随访12个月,每3个月随访1次。比较两组患儿随访前和随访第12个月第1秒用力呼气容积占预计值百分比(FEV_(1)%pred)、最大呼气流量占预计值百分比(PEF%pred)、儿童哮喘控制测试(childhood asthma control test,C-ACT)评分,随访前及随访第3、6、9和12个月气道FeNO水平,随访第3、6、9和12个月ICS平均每日给药剂量,以及随访期内支气管哮喘复发率、ICS停药率和不良反应发生率。结果:两组患儿随访前和随访第12个月FEV_(1)%pred、PEF%pred和C-ACT评分差异均无统计学意义(P>0.05);随访前及随访第3、6、9和12个月气道FeNO水平差异均无统计学意义(P>0.05);观察组患儿随访第9、12个月ICS平均每日给药剂量均明显低于对照组(P<0.05);随访期内,两组复发率差异无统计学意义(P=0.765),观察组患儿ICS停药率高于对照组(P=0.029),而不良反应发生率明显低于对照组(P=0.044)。结论:基于FeNO的哮喘管理可在不影响ICS治疗效果的前提下,降低ICS给药剂量,缩短ICS疗程,并降低用药安全性风险,可为支气管哮喘患儿ICS剂量调整提供参考依据。

Objective:To explore the effect of fractional exhaled nitric oxide(FeNO)on the dose adjustment of inhaled corticosteroid(ICS)in children with bronchial asthma.Method:A total of 92 children with bronchial asthma admitted to Danyang Maternal and Child Health Hospital from January 2020 to December 2021 were selected as study subjects,and were randomly divided into the observation group and the control group,with 46 cases each.The control group adjusted the ICS dose according to the asthma control status and lung function level,and the observation group combined with FeNO to adjust the ICS dose on this basis.The children in both groups were followed up for 12 months,once every 3 months.Two groups were compared in terms of forced expiratory volume in one second as a percentage of predicted value(FEV_(1)%pred),peak expiratory flow as a percentage of predicted value(PEF%pred),and childhood asthma control test(C-ACT)scores before follow-up and at 12 months of followup.The levels of airway FeNO before and at the 3rd,6th,9th and 12th month of follow-up,the average daily dose of ICS at the 3rd,6th,9th and 12th month of follow-up,the recurrence rate of bronchial asthma,the withdrawal rate of ICS and the incidence of adverse reactions during the follow-up period were also analyzed.Result:There were no significant differences in FEV_(1)%pred,PEF%pred and C-ACT scores between the two groups before and at the 12th month of follow-up(P>0.05).There were no significant differences in the levels of FeNO in the airway before and at the 3rd,6th,9th and 12th month of follow-up(P>0.05).The average daily dose of ICS in the observation group were significantly lower than those in the control group at the 9th and 12th month of follow-up(P<0.05).During the follow-up period,the recurrence rate of bronchial asthma was no significant difference in two groups(P=0.765),the withdrawal rate of ICS in the observation group was higher than that in the control group(P=0.029),while the incidence of adverse reactions was significantly lower than that in the control group(P=0.044).Conclusion:The asthma management based on FeNO can reduce the dosage of ICS,shorten the course of ICS and reduce the risk of medication safety without affecting the effect of ICS treatment,which can provide a reference basis for the adjustment of ICS dosage in children with bronchial asthma.