Abstract
ObjectiveTo examine the feasibility of fractional exhaled nitrous oxide (FeNO) guided stepped care in patients with chronic persistent asthma.Methods160 patients with asthma were enrolled and randomly divided into study and control groups, and were given standardized treatment according to GINA 2014. All patients were evaluated every 3 months and their medication was adjusted according to the results of evaluation. The control group was adjusted according to the recommended protocol from GINA, while the study group was adjusted on the basis of the control group and combined with the results of FeNO. The complete control rate, failure rate of stepwise treatment, ACQ score, lung function, and peripheral blood eosinophil count were compared between the two groups.ResultsIn both study and control groups, the patient condition was effectively controlled. Strikingly, the failure rate of step therapy in study group was lower than that of control group (P<0.05), although there were no significant differences between the two groups on total control rate, ACQ score, lung function, and peripheral blood eosinophil count (P>0.05). Furthermore, the levels of FeNO positively correlated with ACQ scores and eosinophil counts or negatively with lung function.ConclusionsThe dynamic monitoring of FeNO could effectively guide the medication and reduce the rate of treatment failure, which could be used to inform standardized management of asthma.
Highlights
The establishment of airway inflammation theory is the most important progress in the field of asthma research in the past 40 years [1]
The first two are structural isozymes, while the third has high inducible NOS (iNOS) activity and is not affected by the concentration of calcium ions. iNOS was expressed in the epithelial cells of the respiratory tract, and the expression of iNOS was significantly higher in the asthma patients [12]
The stimulation of inflammatory cytokines in asthmatic patients might increase the expression of iNOS through a variety of mechanisms, resulting in a significant increase in the level of fractional exhaled nitric oxide (FeNO) [13]
Summary
The establishment of airway inflammation theory is the most important progress in the field of asthma research in the past 40 years [1]. The long-term management of asthma patients is based on the standards set by the Global Initiative for Asthma (GINA, 2014) [2], but its control level is based on the improvement of clinical symptoms and lung function in patients without the severity of the chronic airway inflammation [3]. The related researches on the feasibility of adjusting asthma medication according to fractional exhaled nitric oxide (FeNO) are limited. Fractional exhaled nitrous oxide (FeNO) is a direct and noninvasive method for monitoring airway inflammation. The purpose of the current study is to explore the clinical significance of stepped care for patients with chronic persistent asthma according to the dynamic monitoring of FeNO. We examine the clinical significance of stepped care for chronic persistent asthma in primary hospitals, and provide clinical evidence for standardized management and further improvement of the total control rate of asthma
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