Study On The Significance Of Fractional Exhaled Nitric Oxide Monitoring In The Conctroller Treatment Of Asthmatic Children

Objective: To evaluate the clinical significance of fractional exhaled nitric oxide(FeNO)in guiding the adjustment of asthma control treatment,and to investigate the relationship among childhood asthma control test(C-ACT),pulmonary ventilation function and FeNO in asthmatic children.Methods: From November 2014 to March 2016,sixty asthmatic children(6-12 years old)from pediatric outpatient of the People’s Hospital of Guangxi Zhuang Autonomous Region,were enrolled as an experimental group.Asthmatic children were allocated randomly to the Conventional standard group(30 subjects)and the Combine standard group(30 subjects).Thirty healthy children were enrolled as a control group.The initial regiments for all the asthmatic children included inhaled corticosteroids(ICS)plus long-actingβ2agonists(LABA).The regiments for the Conventional standard group included step-down or withdrawal according to the childhood asthma control level(completely controlled),while those in the Combine standard group received tailored dosage or withdrawal of therapy according to FeNO level besides the children clinical control level.All the asthmatic children were followed up for12 months,the frequency of exacerbation and drug adjustment,the C-ACT score,lung function,and the level of FeNO were assessed at the 1,3,6,9 and 12 months after treatment.The frequency of exacerbation,drug adjustment,C-ACT score and lung function were compared between the Conventional standard group and Combine standard group at the end point.The relationship among the C-ACT score,lung function parameters and FeNO level was analyzed.Results:1.The FeNO level of children in the Conventional standard group and the Combine standard group were both significantly higher than those in healthy control group(P<0.05).There is no significant difference of FeNO level between patients in the Conventional standard group and the Combine standard group(P>0.05).2.The frequency of exacerbation and step-down in the Conventional standard group were both higher than children in the Combine standard group(P<0.05).3.From the first month to the end point after treatment,the C-ACT score and Forced expiratory volume in one second(FEV1),Maximal mid-expiratory flow(MMEF)of both groups improved significantly,and the Combine standard group improved better than the Conventional standard group(P<0.05.).There is no significant difference of the C-ACT score and FEV1,MMEF at the first,the third and the sixth month after treatment between children in the Conventional standard group and the Combine standard group(P>0.05).Children in the Combine standard group,the C-ACT score and FEV1,MMEFat the ninth and the twelfth month after treatment were higher than Children in the Conventional standard group(P<0.05).4.Of all children in the Combine standard group,from before treatment to the third month after treatment,Pearson,s correlation revealed positive correlation between the FeNO level and the C-ACT score(r=-0.514,P<0.05),and FEV1(r=-0.483,P 均<0.05),and MMEF(r=-0.458,P<0.05).From the third month to the twelfth monthafter treatment,there was no relationship between the FeNO level and the C-ACT score(P>0.05),and FEV1(P>0.05),and MMEF(P>0.05).Conclusion : 1.Adjustment of therapy based on the childhood asthma control level and FeNO,early step-down or withdrawal can be avoided,therefore asthma exacerbation can be decreased,Pulmonary ventilation function can be improved.2.FeNO level and asthma clinical symptoms,lung function is not completely parallel,cannot be replaced by each other.