zvigadzirwa

KLINICAL KUSHANDISA FENO MUASTMA

Dudziro ye exhaled NO mu asthma

nzira iri nyore yakatsanangurwa muAmerican Thoracic Society Clinical Practice Guideline yekududzira FeNO:

• A FeNO isingasviki 25 ppb muvakuru uye pasi pe20 ppb muvana vaduku kudarika makore gumi nemaviri zvinoreva kusavapo kweiyosinophilic airway kuzvimba.
• A FeNO yakakura kupfuura 50 ppb muvakuru kana kupfuura 35 ppb muvana inoratidza eosinophilic airway kuzvimba.
• Kukosha kweFeNO pakati pe25 ne50 ppb muvakuru (20 kusvika 35 ppb muvana) inofanira kududzirwa nekuchenjerera maererano nemamiriro echipatara.
• FeNO inokwira ine shanduko huru ye20 muzana uye inopfuura 25 ppb (20 ppb muvana) kubva padanho rakambogadzikana inoratidza kuwedzera eosinophilic airway kuzvimba, asi kune misiyano yakakura pakati pemunhu.
• Kuderera kweFeNO kunopfuura 20 muzana yehukoshero pamusoro pe50 ppb kana kupfuura 10 ppb yemitengo isingasviki 50 ppb inogona kuve yakakosha muchipatara.

Kuongororwa uye hunhu hweasthma

IGlobal Initiative yeAsthma inopa mazano pamusoro pekushandiswa kweFeNO yekuongorora asthma, sezvo inogona kunge isina kukwidziridzwa mu-noneosinophilic asthma uye inogona kukwidziridzwa mune zvirwere kunze kweasthma, zvakadai seosinophilic bronchitis kana allergic rhinitis.

Semutungamiri wekurapa

Nhungamiro dzepasi rose dzinokurudzira kushandisa mazinga eFeNO, kuwedzera kune kumwe kuongorora (semuenzaniso, kutarisirwa kwekiriniki, mibvunzo) kutungamira kutangwa uye kugadzirisa kweasthma controller therapy.

Shandisa mukutsvakurudza kwekliniki

Exhaled nitric oxide ine basa rakakosha mukutsvagisa kwekiriniki uye ingangobatsira mukuwedzera manzwisisiro edu easthma, senge izvo zvinokonzeresa kuwedzera asima uye masaiti uye nzira dzekuita kwemishonga yeasthma.

SHANDISA MUZVIMWE ZVIRWERE ZVOKUPEDZA

Bronchiectasis uye cystic fibrosis

Vana vane cystic fibrosis (CF) vane mazinga akaderera eFeNO pane akaenzana akaenzana kudzora.Kusiyana neizvi, imwe ongororo yakawana kuti varwere vane non-CF bronchiectasis vaive nemazinga akakwira eFeNO, uye mazinga aya aienderana nedhigirii rekusagadzikana kunoonekwa pachifuva CT.

Interstitial mapapu chirwere uye sarcoidosis

Muchidzidzo chevarwere vane scleroderma, yakakwira yakakwira NO yakacherechedzwa pakati pevarwere vane interstitial lung disease (ILD) vachienzaniswa nevaya vasina ILD, nepo zvakapesana zvakawanikwa mune imwe chidzidzo.Muchidzidzo chevarwere makumi mashanu nevaviri vane sarcoidosis, iyo inorehwa kukosha kweFeNO yaive 6.8 ppb, iyo yakanyanya kuderera pane yekucheka-nzvimbo ye25 ppb inoshandiswa kuratidza kuzvimba kweasthma.

Chronic obstructive pulmonary chirwere

FE_NOmazinga akakwidziridzwa zvishoma muCOPD yakagadzikana, asi anogona kuwedzera nechirwere chakanyanya uye panguva yekuwedzera.Iye zvino vanoputa vane anenge 70 muzana yakaderera mazinga eFeNO.Mune varwere vane COPD, FeNO mazinga angave anobatsira pakugadzirisa kuvapo kwekugadzirisa kuvharwa kwemhepo uye kugadzirisa kugadzirisa kweglucocorticoid, kunyange izvi zvisati zvaongororwa mumatambudziko makuru asina kurongeka.

Chikosoro musiyano weasthma

FENO ine mwero yekuongororwa kwechokwadi mukufanotaura kuongororwa kwechikosoro variant asthma (CVA) mune varwere vane chikosoro chisingaperi.Mukuwongorora kwakarongeka kwezvidzidzo gumi nenhatu (varwere ve2019), iyo yakakwana yekucheka-yekusiya mhando yeFENO yaive makumi matatu kusvika makumi mana ppb (kunyangwe tsika dzakaderera dzakacherechedzwa muzvidzidzo zviviri), uye nzvimbo yekupfupisa pasi pe curve yaive 0.87 (95% CI, 0.83-0.89).Kunyatsonaka kwaive kwakakwirira uye kunoenderana zvakanyanya kupfuura kunzwa.

Nonasthmatic eosinophilic bronchitis

Mune varwere vane nonasthmatic eosinophilic bronchitis (NAEB), sputum eosinophils uye FENO inowedzera mumhando yakafanana nevarwere vane asthma.Mukuongorora kwakarongeka kwezvidzidzo zvina (varwere ve390) kune varwere vane chirwere chisingaperi chisingaperi nekuda kweNAEB, mazinga akakwana eFENO akachekwa aiva 22.5 kusvika 31.7 ppb.Iyo inofungidzirwa senitivity yaive 0.72 (95% CI 0.62-0.80) uye inofungidzirwa chaiyo yaive 0.83 (95% CI 0.73-0.90).Saka, FENO inonyanya kubatsira kusimbisa NAEB, pane kuibvisa.

Zvirwere zvepamusoro zvekufema

Mune kumwe kuongorora kwevarwere vasina chirwere chemapapu, hutachiona hwepamusoro hwehutachiona hwakakonzera kuwedzera kweFENO.

Pulmonary hypertension

NO inonyatsozivikanwa semurevereri wepathophysiologic mu pulmonary arterial hypertension (PAH).Mukuwedzera kune vasodilation, NO inogadzirisa endothelial cell proliferation uye angiogenesis, uye inochengetedza hutano hwakakwana hwevascular.Sezvineiwo, varwere vane PAH vane yakaderera FENO kukosha.

FENO inoratidzika kunge inewo chirevo chekufungidzira, nehupenyu huri nani kune varwere vane kuwedzera kweFENO level nekurapa (calcium channel blockers, epoprostenol, treprostinil) kana ichienzaniswa nevaya vasina.Nokudaro, iyo yakaderera FENO mazinga muvarwere vane PAH uye kuvandudzwa nemishonga inoshanda inoratidza kuti inogona kuva inovimbisa biomarker yechirwere ichi.

Primary ciliary dysfunction

Nasal NO yakaderera kana kuti haipo kune varwere vane primary ciliary dysfunction (PCD).Kushandiswa kwemhino NO kuvharidzira PCD kune varwere vane kliniki yekufungira PCD inokurukurwa zvakasiyana.

Mamwe mamiriro

Mukuwedzera kune pulmonary hypertension, mamwe mamiriro akabatanidzwa nemazinga akaderera eFENO anosanganisira hypothermia, uye bronchopulmonary dysplasia, pamwe nekushandiswa kwedoro, fodya, caffeine, nezvimwe zvinodhaka.