| Objective:To explore the diagnostic and treatment value of fractional exhaled nitric oxide(FeNO) measurement in the bronchial asthma.Methods:1. A total of 118 patients with unknown-cause respiratory symptoms including gasping, dyspnea and cough were enrolled from July to December in 2009. 71 cases were diagnosed as asthma (A group), in which 52 cases not received treatment by glucocorticoids belonged to I group (12 cases were Cough Variant Asthma patients and 12 cases were Asthma merger allergie rhinitis patients). and another 19 cases received treatment by glucocorticoids belonged to II group.47 cases were diagnosed as non-asthma (B group). FeNO was measured by nitric oxide analyzer (NIOX; Aerocrine AB Solna, Sweden). GINA was defined as golden standard for asthma diagnosis. The value of FeNO was assessed and the optimal operating point of FeNO testing was determined by the means of the receiver operating characteristic (ROC) curves.2. Thirty asthmatic patients (first diagnosed. without treatment) were randomly divided into two groups treated with Montelukast plus Seretide and Seretide only for 4 weeks. According to Asthma Control Test (ACT) scores, these patients were divided into three groups:complete control group (25 points), partial control group (20-24 points), not controlling group (20 points below). The FeNO and pulmonary function before and after treatment were observed in these groups.Results:1. Compare the level of FeNO concentration.FEVl% of patients with bronchial asthma at I group.Ⅱgroup and B group, statistical significant differences were existing, P all<0.05.2. At I group, there is no significant correlation between FeNO and FEV1%, r=-0.062, P>0.05.3. Compare the level of FeNO concentration. FEV1% of patients at Cough Variant Asthma patients and typical asthma, there was no significant difference, P all>0.05.Compare the level of FeNO of patients at allergic rhinitis and asthma merger allergic rhinitis, statistical significant differences were existing P<0.05,but there was no significant difference of FEV1%, P>0.05.4. Area under ROC curve was 0.901. The optimal diagnostic cutoff point was 32.5ppb which was capable of differentiating asthma and non-asthma with sensitivity of 82.7%, specificity of 87.9%.5. The level of FeNO after treatment was lower than before treatment [(44.70±31.52) ppb vs (78.83±47.62) ppb,P< 0.05], the level of FEV1% after treatment was higher than before treatment [(90.03±14.99) vs (81.53±16.15) P< 0.05],after treatment, there is an obvious correlation between FeNO and ACT scores, r=-0.535, p<0.05, but there is no significant correlation between FeNO and FEV1%, r=-0.330. p>0.05, and there is no significant correlation between ACT scores and FEV1%. r=0.337, P>0.05.6. FeNO concentration of complete control group and partial control group had lower after treatment than before treatment, P all<0.05, but there was no obvious difference among the level of FeNO in not controlling group between before treatment and after treatment, p>0.05. After treatment, FeNO concentration of complete control group was lower than partial control group and not controlling group, P all<0.05.7. FeNO concentration of Montelukast plus Seretide group and Seretide only group had lower after treatment than before treatment, P all<0.05. The level of FeNO and ACT scores after treatment beween Montelukast plus Seretide group and Seretide only group exist significant differences. P<0.05.Conclusion:1. FeNO test may be helpful in the diagnosis of asthma with high sensitivity and specificity.2. FeNO test can reflect the treatment effect, it is a better target of monitoring the treatment of bronchial asthma. |
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