KUSHANDISWA KWEFENO MUCHIKORO CHEASTMA

Dudziro yeNO inoburitswa mumhepo muasthma

Nzira iri nyore yakataurwa muAmerican Thoracic Society Clinical Practice Guideline yekududzira FeNO:

• Kuwanda kweFeNO pasi pe25 ppb muvanhu vakuru uye pasi pe20 ppb muvana vari pasi pemakore gumi nemaviri zvinoreva kusavapo kwekuzvimba kwemhepo kunouraya mweya.
• FeNO inopfuura 50 ppb muvanhu vakuru kana inopfuura 35 ppb muvana inoratidza kuzvimba kwemhepo inofambisa mweya.
• Nhamba yeFeNO iri pakati pe25 ne50 ppb muvanhu vakuru (20 kusvika 35 ppb muvana) inofanira kutsanangurwa nokungwarira maererano nemamiriro ezvinhu ekiriniki.
• Kukwira kweFeNO ine shanduko inopfuura 20 muzana uye inopfuura 25 ppb (20 ppb muvana) kubva padanho raive rakagadzikana kare kunoratidza kuwedzera kwekuzvimba kwemhepo inofambisa mweya, asi kune misiyano yakakura pakati pevanhu.
• Kuderera kweFeNO inopfuura 20 muzana yehuwandu huri pamusoro pe50 ppb kana kupfuura 10 ppb yehuwandu huri pasi pe50 ppb kunogona kuva kwakakosha mukurapa.

Kuongororwa uye kutsanangurwa kweasthma

Sangano reGlobal Initiative for Asthma harisi kukurudzira kushandiswa kweFeNO pakuongorora asthma, sezvo ingave isina kukwira muasthma isina osinophilic uye inogona kukwira muzvirwere zvisiri zveasthma, zvakaita se eosinophilic bronchitis kana allergic rhinitis.

Segwara rekurapa

Mitemo yepasi rose inokurudzira kushandisa mazinga eFeNO, pamwe nekumwe kuongorora (semuenzaniso, kurapwa kwekiriniki, mibvunzo) kutungamira kutanga nekugadzirisa kurapwa kweasthma controller therapy.

Shandisa mukutsvaga kwekiriniki

Nitric oxide inoburitswa nemhepo ine basa rakakosha mukutsvagisa kwekiriniki uye ingangobatsira mukuwedzera kunzwisisa kwedu nezveasthma, zvakaita sezvikonzero zvinokonzera kuwedzera kweasthma uye nzvimbo nemaitiro ekushanda kwemishonga yeasthma.

KUSHANDISA MUZVIMWE ZVIRWERE ZVEKUFUMARA

Bronchiectasis uye cystic fibrosis

Vana vane cystic fibrosis (CF) vane mazinga eFeNO akaderera pane akakodzera. Kusiyana neizvi, imwe ongororo yakawana kuti varwere vane bronchiectasis isiri CF vaiva nemazinga akakwira eFeNO, uye mazinga aya aienderana nehuwandu hwekusarongeka hunoonekwa pachipfuva cheCT.

Chirwere chemapapu chemukati memapapu uye sarcoidosis

Mukudzidza kwakaitwa pavarwere vane scleroderma, huwandu hweNO hwakakwira hwakaburitswa mumhepo hwakaonekwa pakati pevarwere vane interstitial lung disease (ILD) zvichienzaniswa neavo vasina ILD, nepo zvakapesana zvakawanikwa mune imwe ongororo. Mukudzidza kwakaitwa pavarwere 52 vane sarcoidosis, avhareji yeFeNO value yaive 6.8 ppb, iyo iri pasi zvakanyanya pane cut-point ye25 ppb inoshandiswa kuratidza kuzvimba kweasthma.

Chirwere chemapapu chisingaperi

FE_NOmazinga eCOPD akaderera zvishoma muCOPD yakagadzikana, asi anogona kuwedzera kana chirwere chakanyanya uye panguva yekuwedzerwa kwehuwandu. Vanoputa fodya parizvino vane mazinga eFeNO akaderera angangoita 70 muzana. Muvarwere vane COPD, mazinga eFeNO anogona kubatsira mukuona kuvapo kwekuvharika kwemhepo inodzoreka uye kuona kuti glucocorticoid inoshanda sei, kunyangwe izvi zvisati zvaongororwa mumiedzo mikuru yakasarudzika.

Kukosora kwakasiyana kweasthma

FENO ine kunyatsoongorora zviri pakati nepakati mukufanotaura kuongororwa kwechirwere cheasthma (CVA) muvarwere vane chikosoro chisingaperi. Muongororo yakarongeka yezvidzidzo gumi nezvitatu (varwere ve2019), huwandu hwakanakisa hweFENO hwaive 30 kusvika 40 ppb (kunyange zvazvo kukosha kwakaderera kwakaonekwa muzvidzidzo zviviri), uye nzvimbo pfupi iri pasi pekongiri yaive 0.87 (95% CI, 0.83-0.89). Kunyatsoongorora kwaive kwakakwira uye kwakafanana kupfuura kunzwa.

Bronchitis isingararami neasthma

Muvarwere vane nonasthmatic eosinophilic bronchitis (NAEB), ma eosinophils e sputum ne FENO anowedzera zvakafanana nevarwere vane asthma. Muongororo yakarongeka yezvidzidzo zvina (varwere mazana matatu nemakumi mapfumbamwe) muvarwere vane chikosoro chisingaperi nekuda kweNAEB, huwandu hwakanaka hweFENO hwakachekwa hwaive 22.5 kusvika 31.7 ppb. Kunzwa kwakafungidzirwa kwaive 0.72 (95% CI 0.62-0.80) uye kutsanangurwa kwakafungidzirwa kwaive 0.83 (95% CI 0.73-0.90). Saka, FENO inobatsira zvikuru kusimbisa NAEB, pane kuibvisa.

Utachiona hwepamusoro hwekufema

Mune imwe ongororo yakaitwa pavarwere vasina chirwere chemapapu, hutachiona hwehutachiona hwepamusoro hwekufema hwakakonzera kuwedzera kweFENO.

Kukwira kweropa zvakanyanya mumapapu

NO inozivikanwa zvikuru semubatsiri wezvirwere zve pulmonary arterial hypertension (PAH). Pamusoro pekuwanda kweropa, NO inodzora kuwanda kwemasero e endothelial uye angiogenesis, uye inochengetedza hutano hwetsinga dzese. Zvinonakidza kuti varwere vane PAH vane FENO yakaderera.

FENO inoita kunge ine kukosha kwekufanotaura, nekuvandudzika kwehupenyu hwevarwere vane huwandu hweFENO hwakakwira nekurapwa (calcium channel blockers, epoprostenol, treprostinil) zvichienzaniswa neavo vasina. Saka, huwandu hwakaderera hweFENO muvarwere vane PAH uye kuvandudzika kwekurapwa kunoshanda zvinoratidza kuti inogona kunge iri chiratidzo chinovimbisa chechirwere ichi.

Kusashanda zvakanaka kwe ciliary yekutanga

NO yemhino yakaderera zvikuru kana kuti haipo muvarwere vane dambudziko guru rekushaya simba kwemushonga (PCD). Kushandiswa kweNO yemhino kuongorora PCD muvarwere vane fungidziro yekiriniki yePCD kunokurukurwa zvakasiyana.

Mamwe mamiriro ezvinhu

Kuwedzera kune BP yemapapu, mamwe mamiriro ane chekuita nemazinga akaderera eFENO anosanganisira hypothermia, uye bronchopulmonary dysplasia, pamwe nekushandisa doro, fodya, caffeine, nezvimwe zvinodhaka.