천식 의심 환자에서 기관지 확장제 반응 및 만니톨 기도과민성과 호기산화질소의 연관성
Relationship between Bronchodilator Response, Airway Hyperresponsiveness, and Exhaled Nitric Oxide Levels in Patients with Suspected Bronchial Asthma
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
목적: 호기산화질소(FeNO)는 천식에서 기도 염증의 비침습적 지표로서 활용되어 왔다. 또한, 호기산화질소(FeNO) 측정은 천식 평가에 유용한 도구로 인식되고 되고 있다. 이 연구의 목적은 천식 의심 환자에서 기관지확장제 반응(BDR) 및 만니톨 기도 과민성(AHR) 여부에 따른 FeNO의 차이를알아보고자 하였다. 방법: FeNO를 측정한 기관지 천식 의심 환자들(≥ 13세) 중 BDR 및 AHR 검사를 시행한 대상자들 두 군으로 구분하였고 각 군에서의 나이, 폐활량, 호산구, 혈청 총 IgE, 아토피 상태 등을 수집하였다. 또한, 각 FEV1 및 FEF25-75%을 기준으로하여 각 검사 결과에 따라 FeNO 값을 비교 및 상관분석을 시행하였고 검사 양성을 예측하기 위한 ROC 곡선을 구하였다. 결과: BDR 검사군 124명, 만니톨 AHR 검사군 145명으로총 259명의 환자들을 분석하였고 양 군의 평균 나이는 각각52.8세와 35.3세였다. 환자의 BDR 여부, AHR 여부, 아토피여부, 혈액 호산구 분율(4% 기준)과 총 IgE 값(300 IU/mL 기준)에 따른 FeNO 값은 유의한 차이가 있었다. 또한, BDR 및AHR 검사에서 FEV1의 기관지 확장제 사용 후 최종 증가 정도 및 PD15 값과 FeNO와의 상관관계가 FEF25-75%의 최종 증가 정도 및 PD15 값보다 더 높았다. BDR 및 AHR 양성을예측하기 위한 위한 최적의 FeNO 결정값은 각각 38.5와 29.5 ppb였다. 결론: 천식 의심 환자에 있어 FeNO는 BDR 및 AHR과 연관이 있었으며 양성 여부를 예측할 수 있는 보조적인 진단역할에 도움이 될 것으로 보인다.
Abstract
Background/Aims: Exhaled nitric oxide (NO) has been extensively investigated as a marker of airway inflammation in asthma, and fractional exhaled nitric oxide (FeNO) is recognized as a useful tool for its evaluation. The aim of this study was to investigate the relationships between FeNO levels and bronchodilator response (BDR), and between FeNO and mannitol-induced airway hyperresponsiveness (AHR), in patients with suspected asthma. Methods: Clinical variables were collected from patients aged ≥ 13 years with suspected bronchial asthma and measured levels of FeNO. These levels were compared with patient values for forced expiratory volume in the first second (FEV1) and forced expiratory flow at 25 and 75% of the pulmonary volume (FEF25-75%) in bronchodilator response tests under control conditions, and during bronchial provocation with mannitol. Correlations and receiver operating characteristic (ROC) curves between FeNO levels and each test were assessed. Results: A total of 259 patients were included in the analysis. The mean ages of the two test groups were 41.1 and 47.8 years, respectively. FeNO levels were strongly correlated with bronchodilator response (%) and with the mannitol dose producing a 15% fall in FEV1 (PD15). On the other hand, FeNO levels were only weakly correlated with FEF25-75%. The optimal cut-off values for FeNO to predict a positive BDR and AHR were 38.5 and 29.5 parts per billion, respectively. Conclusions: This study suggests that FEV1 and FEF25-75% airway responses correlate with FeNO levels in patients with suspected bronchial asthma. FeNO levels may help to predict positive responses to BDR and AHR.
참고문헌 (30)
- "2017 GINA report, global strategy for asthma management and prevention" (2017)[URL]
- Lougheed, Lemière C, "Canadian thoracic society asthma management continuum - 2010 consensus summary for children six years of age and over, and adults", Can Respir J, 17, pp.15~24 (2010)
- del Giudice MM, "Fractional exhaled nitric oxide (FENO), lung function and airway hyperresponsiveness in naïve atopic asthmatic children", J Asthma, 41, pp.759~765 (2004)
- Wang Y, "Diagnostic value and influencing factors of fractional exhaled nitric oxide in suspected asthma patients", Int J Clin Exp Pathol, 8, pp.5570~5576 (2015)
- Keen C, "Small airway function, exhaled NO and airway hyper-responsiveness in paediatric asthma", Respir Med, 105, pp.1476~1484 (2011)
- Muñoz-López F, "The interest of FEF(25-75) in evaluating bronchial hyperresponsiveness with the methacholine test", Allergol Immunopathol (Madr), 40, pp.352~356 (2012)
- Smith RW, "Association among fraction of exhaled nitrous oxide, bronchodilator response and inhaled corticosteroid type", Can Respir J, 22, pp.153~156 (2015)
- 고한석, "소아 천식에서 호기산화질소와 폐기능 검사의 관계", Korean Journal of Pediatrics, 51(2), pp.181~187 (2008), 대한소아과학회
- Kim SH, "Use of the exhaled nitric oxide for management of asthma and respiratory diseases", Korean J Med, 74, pp.579~586 (2008)
- Taylor DR, "Exhaled nitric oxide measurements: clinical application and interpretation", Thorax, 61, pp.817~827 (2006)
- Ramser M, "The value of exhaled nitric oxide in predicting bronchial hyperresponsiveness in children", J Asthma, 45, pp.191~195 (2008)
- Porsbjerg C, "Combining the mannitol test and FeNO in the assessment of poorly controlled asthma", J Allergy Clin Immunol Pract, 3, pp.553~559 (2015)
- Dweik RA, "An official ATS clinical practice guideline: Interpretation of exhaled nitric oxide levels (FENO) for clinical applications", Am J Respir Crit Care Med, 184, pp.602~615 (2011)
- Jatakanon A, "Correlation between exhaled nitric oxide, sputum eosinophils, and methacholine responsiveness in patients with mild asthma", Thorax, 53, pp.91~95 (1998)
- Mattes J, "NO in exhaled air is correlated with markers of eosinophilic airway inflammation in corticosteroid-dependent childhood asthma", Eur Respir J, 13, pp.1391~1395 (1999)
- Stirling RG, "Increase in exhaled nitric oxide levels in patients with difficult asthma and correlation with symptoms and disease severity despite treatment with oral and inhaled corticosteroids. Asthma and allergy group", Thorax, 53, pp.1030~1034 (1998)
- Martin MJ, "The utility of exhaled nitric oxide in patients with suspected asthma", Thorax, 71, pp.562~564 (2016)
- Smith AD, "Exhaled nitric oxide:a predictor of steroid response", Am J Respir Crit Care Med, 172, pp.453~459 (2005)
- Szefler SJ, "Significant variability in response to inhaled corticosteroids for persistent asthma", J Allergy Clin Immunol, 109, pp.410~418 (2002)
- 최봉석, "천식 환아에서 호기산화질소(exhaled nitric oxide)와 폐기능 및 기도과민성의 연관성", Allergy Asthma & Respiratory Diseases, 19(3), pp.291~299 (2009), 대한 소아알레르기 호흡기학회
- Piacentini GL, "Exhaled nitric oxide, serum ECP and airway responsiveness in mild asthmatic children", Eur Respir J, 15, pp.839~843 (2000)
- Backer V, "FENO and AHR mannitol in patients referred to an out-of-hospital asthma clinic:a real-life study", J Asthma, 51, pp.411~416 (2014)
- Sverrild A, "Airway hyperresponsiveness to mannitol and methacholine and exhaled nitric oxide: a random-sample population study", J Allergy Clin Immunol, 126, pp.952~958 (2010)
- Perzanowski MS, "Exhaled Nitric Oxide and Airway hyperresponsiveness to adenosine 5’-monophosphate and methacholine in children with asthma", Int Arch Allergy Immunol, 166, pp.107~113 (2015)
- 서보선, "소아천식 환자에서 충격진동법과 폐활량기로 측정한 소기도 장애와 호기산화질소와의 관계", Allergy Asthma & Respiratory Diseases, 3(4), pp.267~271 (2015), 대한 소아알레르기 호흡기학회[DOI]
- Martin MJ, "The utility of exhaled nitric oxide in patients with suspected asthma", Thorax, 71, pp.562~564 (2016)
- Zietkowski Z, "Comparison of exhaled nitric oxide measurement with conventional tests in steroid-naive asthma patients", J Investig Allergol Clin Immunol, 16, pp.239~246 (2006)
- Sato S, "Clinical usefulness of fractional exhaled nitric oxide for diagnosing prolonged cough", Respir Med, 102, pp.1452~1459 (2008)
- Smith AD, "Diagnosing asthma:comparisons between exhaled nitric oxide measurements and conventional tests", Am J Respir Crit Care Med, 169, pp.473~478 (2004)
- 서현석, "천식 소아에서 호기산화질소 농도와 기도 과민성, 혈액 호산구 수, 혈청 호산구 양이온 단백 농도와의 상관관계", Allergy Asthma & Respiratory Diseases, 22(3), pp.282~291 (2012), 대한 소아알레르기 호흡기학회