Clinical Signiifcance Of Exhaled Nitric Oxide Determination In Diagnosis And Treatment Of Bronchial Asthma

Objective: The subject focuses on evaluating patients with bronchialasthma before and after Salmeterol/fluticasone propionate inhalation (50/250),respectively before treatment and1month/3months,6months,on themeasurement of lung function、allergens and FeNO，in order to make clear therole FeNO measurement plays in diagnosis and treantment of bronchial asthma.Method：According to Standard of GINA2008，we choose60patientsdefinitely diagnosed with bronchial asthma outpatient and in hospital (both fornewly diagnosed patients not treated) of Bethune first hospital of Jilinuniversity between June and August in2012, the clinical diagnosis，at the sametime, selecting20healthy volunteers who do not smoke as the healthy controlgroup. The people above have no allergic history, no respiratory infectionhistory30days before the experiment. Do the measurement of lung function、allergens and FeNO，then let the patients with bronchial asthma inhalesalmeterol/fluticasone propionate (50/250)1suction/1time,2times/day. Aftertreatment, respectively, again do the measurement of allergens、lung functionand FeNO1month,3months,6months after the drug treatment，usingstatistical methods to understand the statistical significance of the detectionmethod above in the diagnosis of bronchial asthma.Results:During the process of Inhalation treatment,2case of patients got local oralcavity fungal infection, who relieved after using mycin tablet to rinse mouth;1case of patients felt nauseous and sick, whose symptom disappeared withoutspecial disposal;2cases of patients felt dizzy, whose symptom, also, withoutspecial disposal, disappeared. All60patients were required to finish the experiment.1. Allergens test resultsForty seven asthmatic patients before therapy can check out allergens,most of them have multiple allergens: in which artemisia/short ragweed ispositive:12cases Household dust mites/house dust is positive:32cases. Cathair/scurf is positive:4cases. Shellfish/shrimp/fish is positive：2cases. QingDabranch/fumagillin/aspergillus niger is positive:2cases. Fruits is positive:1case.Milk is positive:1case. Catkin is positive:3cases. Cockroach is positive:14cases. Humulus scandens/dandelion is positive:2cases. Egg white is positive:1cases. Pollen is positive:2cases. It shows that the most common allergens ofasthma patient is: household dust mites/house dust, followed by cockroach,artemisia/short ragweed, cat hair/scurf.②The total serum IgE of asthmaticpatients after treatment are significantly lower than before treatment, thedifferences are statically significant（P<0.01）,the difference between the totalserum IgE of one month，three months，six months after treatment arestatistically significant（P<0.01）。③The FeNO level of one month，threemonths，six months after treatment are significantly lower than before treatment,the differences are statically significant（P<0.01）the difference between FeNOlevel of one month，three months，six months after treatment are statisticallysignifican（tP<0.01）.The difference between before treatment, one month, threemonths after treatment and healthy control group are statistically significant（P<0.01）。The difference between6months after treatment and healthycontrol group are not statistically significant（P>0.05）。④The FEV1%level ofone month, three months,6months are significantly improved than beforetreatment, the differences are statically significant（P<0.01）.The differencebetween before treatment, one month, three months after treatment and healthycontrol group are statistically significant（P<0.01）。The difference between6 months after treatment and healthy control group are not statistically significant（P>0.05）。2. Correlation analysis of FeNO determination and FEV1,the total serumIgE.The total serum IgE and FeNO of asthma patients before and aftertreatment are all of positive linear correlation, FeNO and FEV1%beforetreatment are of negative correlation, there are no correlation between FeNOand FEV1%. after treatment. The total serum IgE and FEV1%before treatmentare of negative correlation, there are no correlation between the total serum IgEand FEV1%.Conclusion：1. Lung function, allergens, total IgE in sera, FeNO can be used as a indexfor patients testing the severity of chronic respiratory airway inflammation.2. In the diagnosis of the brochial asthma, FeNO can be used as animportant index of the severity of airway inflammation, whose sensitivity ishigher than lung function. In the process of using inhaling steroids to treatpatients with brochial asthma, the changes of FeNO indexes can be identifiedas an important index of deciding drug withdrawl and decrement.3. Total IgE in Serum and FeNO have positive correlation both before andafter treatment in patients with asthma, FeNO have negative correlations withFEV1%before treatment, not after treatment. Total IgE in serum have negativecorrelations with FEV1%before treatment, no correlation with the figure aftertreatment.