Hoʻohana lapaʻau o FENO i ka Asthma

Ka wehewehe ʻana o ka NO i hoʻokuʻu ʻia i loko o ka hānō

Ua hāpai ʻia kekahi ʻano hana maʻalahi ma ka American Thoracic Society Clinical Practice Guideline no ka wehewehe ʻana i ka FeNO:

• ʻO ka FeNO ma lalo o 25 ppb i nā mākua a ma lalo o 20 ppb i nā keiki ma lalo o 12 mau makahiki e hōʻike ana i ka nele o ka mumū o ke alaea eosinophilic.
• ʻOi aku ka FeNO ma mua o 50 ppb i nā mākua a i ʻole ma mua o 35 ppb i nā keiki e hōʻike ana i ka mumū o ke alaea eosinophilic.
• Pono e wehewehe pono ʻia nā waiwai o FeNO ma waena o 25 a me 50 ppb i nā pākeke (20 a 35 ppb i nā keiki) e pili ana i ke kūlana lapaʻau.
• ʻO ka piʻi ʻana o ka FeNO me kahi loli ma mua o 20 pakeneka a ʻoi aku ma mua o 25 ppb (20 ppb i nā keiki) mai kahi pae paʻa mua e hōʻike ana i ka hoʻonui ʻana o ka mumū ea eosinophilic, akā aia nā ʻokoʻa ākea ma waena o kēlā me kēia kanaka.
• ʻO ka emi ʻana o ka FeNO ma mua o 20 pakeneka no nā waiwai ma luna o 50 ppb a i ʻole ma mua o 10 ppb no nā waiwai ma lalo o 50 ppb he mea nui paha ia ma ke ʻano lapaʻau.

Ka ʻike ʻana a me ke ʻano o ka hānō

ʻAʻole paipai ka Global Initiative for Asthma i ka hoʻohana ʻana i ka FeNO no ka ʻike ʻana i ka hānō, no ka mea, ʻaʻole paha e hoʻokiʻekiʻe ʻia i ka hānō noneosinophilic a hiki ke hoʻokiʻekiʻe ʻia i nā maʻi ʻē aʻe ma mua o ka hānō, e like me ka bronchitis eosinophilic a i ʻole ka rhinitis allergic.

Ma ke ʻano he alakaʻi i ka lāʻau lapaʻau

Manaʻo nā kulekele honua e hoʻohana i nā pae FeNO, me nā loiloi ʻē aʻe (e like me ka mālama lapaʻau, nā nīnau nīnau) e alakaʻi i ka hoʻomaka ʻana a me ka hoʻoponopono ʻana i ka lāʻau hoʻomalu hānō.

Hoʻohana i ka noiʻi lapaʻau

He kuleana koʻikoʻi ko ka nitric oxide i hoʻopuka ʻia i loko o ka noiʻi lapaʻau a e kōkua paha i ka hoʻonui ʻana i ko mākou ʻike i ka hānō, e like me nā kumu e kuleana ai no ka hoʻonui ʻana o ka hānō a me nā wahi a me nā ʻano hana o nā lāʻau lapaʻau no ka hānō.

E hoʻohana i nā maʻi hanu ʻē aʻe

ʻO ka Bronchiectasis a me ka cystic fibrosis

ʻOi aku ka haʻahaʻa o nā pae FeNO o nā keiki me ka cystic fibrosis (CF) ma mua o nā kaohi i kūlike. I ka hoʻohālikelike ʻana, ua ʻike ʻia kekahi noiʻi he kiʻekiʻe nā pae o FeNO o nā maʻi me ka non-CF bronchiectasis, a ua pili kēia mau pae me ke kiʻekiʻe o ka ʻano ʻē i ʻike ʻia ma ka CT umauma.

ʻO ka maʻi māmā interstitial a me ka sarcoidosis

Ma kahi noiʻi o nā maʻi me ka scleroderma, ua ʻike ʻia kahi NO i hoʻokuʻu ʻia i waho i waena o nā maʻi me ka maʻi mama interstitial (ILD) i hoʻohālikelike ʻia me ka poʻe me ka ʻole o ILD, ʻoiai ua ʻike ʻia ke kū'ē ma kahi noiʻi ʻē aʻe. Ma kahi noiʻi o 52 mau maʻi me ka sarcoidosis, ʻo ka awelika o ka waiwai FeNO he 6.8 ppb, ʻoi aku ka liʻiliʻi ma mua o ka ʻoki o 25 ppb i hoʻohana ʻia e hōʻike i ka mumū o ka hānō.

Maʻi pulmonary obstructive mau loa

FE_NOʻAʻole i kiʻekiʻe iki nā pae i ka COPD paʻa, akā hiki ke piʻi me ka maʻi ʻoi aku ka koʻikoʻi a i ka wā o ka exacerbations. Loaʻa i nā mea puhi paka o kēia manawa ma kahi o 70 pakeneka ka haʻahaʻa o nā pae o FeNO. I nā poʻe maʻi me COPD, hiki ke kōkua nā pae FeNO i ka hoʻokumu ʻana i ke alo o ka pale ʻana o ke kahe ʻana o ka ea a hiki ke hoʻoholo i ka pane ʻana o ka glucocorticoid, ʻoiai ʻaʻole i loiloi ʻia kēia ma nā hoʻokolohua randomized nui.

ʻO ke ʻano o ka hānō o ke kuʻi

Loaʻa i ka FENO ka pololei o ka diagnostics i ka wānana ʻana i kahi hōʻailona o ka hānō ʻano ʻokoʻa (CVA) i nā poʻe maʻi me ka ʻū mau. Ma kahi loiloi ʻōnaehana o 13 mau haʻawina (2019 mau maʻi), ʻo ka pae ʻoki kūpono no FENO he 30 a 40 ppb (ʻoiai ua ʻike ʻia nā waiwai haʻahaʻa i ʻelua mau haʻawina), a ʻo ka wahi hōʻuluʻulu manaʻo ma lalo o ke kaʻina he 0.87 (95% CI, 0.83-0.89). ʻOi aku ke kiʻekiʻe o ka specificity a ʻoi aku ka kūlike ma mua o ka sensitivity.

ʻO ka bronchitis eosinophilic ʻaʻole hānō

I nā poʻe maʻi me ka bronchitis eosinophilic nonasthmatic (NAEB), ua hoʻonui ʻia nā eosinophils sputum a me FENO ma kahi pae like me nā poʻe maʻi me ka hānō. Ma kahi loiloi ʻōnaehana o ʻehā mau haʻawina (390 mau maʻi) i nā poʻe maʻi me ka ʻū mau ma muli o NAEB, ʻo nā pae ʻoki FENO kūpono loa he 22.5 a 31.7 ppb. ʻO ka ʻike i manaʻo ʻia he 0.72 (95% CI 0.62-0.80) a ʻo ka kikoʻī i manaʻo ʻia he 0.83 (95% CI 0.73-0.90). No laila, ʻoi aku ka pono o FENO e hōʻoia i ka NAEB, ma mua o ka hoʻokaʻawale ʻana.

Nā maʻi hanu kiʻekiʻe

Ma kekahi noiʻi o nā maʻi me ka ʻole o ka maʻi pulmonary kumu, ua hoʻonui ʻia ka FENO e nā maʻi viral respiratory o luna.

Ke koko kiʻekiʻe o ka puʻuwai

Ua ʻike maikaʻi ʻia ʻo NO ma ke ʻano he mea hoʻoponopono pathophysiologic i ka pulmonary arterial hypertension (PAH). Ma waho aʻe o ka vasodilation, hoʻoponopono ʻo NO i ka hoʻonui ʻana o nā cell endothelial a me ka angiogenesis, a mālama i ke olakino vascular holoʻokoʻa. ʻO ka mea hoihoi, he haʻahaʻa nā waiwai FENO o nā maʻi me PAH.

Me he mea lā he koʻikoʻi koʻikoʻi ko FENO, me ka hoʻomaikaʻi ʻana i ke ola ʻana i nā poʻe maʻi i piʻi aʻe ka pae FENO me ka lāʻau lapaʻau (nā mea pale i ke kahawai calcium, epoprostenol, treprostinil) i hoʻohālikelike ʻia me ka poʻe ʻaʻole. No laila, ʻo nā pae FENO haʻahaʻa i nā poʻe maʻi me PAH a me ka hoʻomaikaʻi ʻana me nā lāʻau lapaʻau kūpono e hōʻike ana he biomarker hoʻohiki paha ia no kēia maʻi.

Ka hana ʻino mua o ka ciliary

Haʻahaʻa loa a ʻaʻohe paha ka nasal NO i nā poʻe maʻi me ka hana ʻino ciliary mua (PCD). Kūkākūkā ʻia ka hoʻohana ʻana o ka nasal NO e nānā no ka PCD i nā poʻe maʻi me kahi kānalua lapaʻau o PCD.

Nā kūlana ʻē aʻe

Ma waho aʻe o ke koko kiʻekiʻe o ka pulmonary, ʻo nā kūlana ʻē aʻe e pili ana me nā pae FENO haʻahaʻa e komo pū ana me ka hypothermia, a me ka bronchopulmonary dysplasia, a me ka hoʻohana ʻana i ka waiʻona, ka paka, ka caffeine, a me nā lāʻau ʻē aʻe.