Fractional exhaled nitric oxide levels as a predictor of long-term prognoses in patients with mild asthma

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• 作者：Masahiro Yamashita^a ; ^{yamam@iwate-med.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Mitsue Shibanai^a ; ^{mitsues@iwate-med.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Kenshi Sekimura^a ; ^{ksekimur@iwate-med.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Hiroo Nitanai^a ; ^{hnitanai-imc@sound.ocn.ne.jp" class="auth_mail" title="E-mail the corresponding author} ; Masahito Ogasawara^b ; ^{ogasawam@m.ehime-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Hitoshi Kobayashi^a ; ^{hkobayas@iwate-med.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Kohei Yamauchi^a ; ^{kyamauch@iwate-med.ac.jp" class="auth_mail" title="E-mail the corresponding author}
• 关键词：FeNO ; Individualization ; Inhaled corticosteroid therapy ; Mild asthma ; Prognosis
• 刊名：Respiratory Investigation
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：54
• 期：3
• 页码：139-147
• 全文大小：654 K

文摘

There is a growing belief that patients with bronchial asthma (BA) should be provided an individualized and optimized treatment plan. We aimed to clarify the predictors of long-term prognoses in patients with mild BA.

Methods

We conducted a retrospective study of consecutive patients who were newly diagnosed with mild BA at Iwate Medical University from 2011 to 2013, focusing on achievement of full asthma control based on the Asthma Control Test as an indicator of prognosis. Predictors were identified on the basis of a chart review.

Results

Among 71 patients with mild BA, 37 patients completed regular clinic visits for 1 year. Nineteen (51.4%) of these patients achieved full asthma control. Current smoking and the fractional exhaled nitric oxide (FeNO) level at the first patient visit were identified by multivariate logistic regression as possible predictors of the discontinuation of clinic visits and achievement of full asthma control, respectively. Low FeNO levels at the first clinic visit yielded a receiver operating characteristic-area under the curve of 0.860 (95% confidence interval [CI]=0.774–0.975) for the achievement of full asthma control. Using an FeNO cut-off level of 34 parts per billion yielded a sensitivity of 76.5% (95% CI=59.5–88.2%) and specificity of 73.7% (95% CI=58.5–84.2%).

Conclusion

Our preliminary results suggested that patients with newly diagnosed mild BA who display higher FeNO levels at their first clinic visits should be appropriately educated during early visits to receive optimal treatment and complete regular clinic visits.