UKUSETYENZISWA KWE-FENO NGOKWENKCILI KWI-ASTHMA

Ukutolikwa kwe-NO ephumayo kwi-asthma

Indlela elula iye yaphakanyiswa kwi-American Thoracic Society Clinical Practice Guideline ukuze kutolikwe i-FeNO:

• I-FeNO engaphantsi kwe-25 ppb kubantu abadala kunye ne-20 ppb kubantwana abangaphantsi kweminyaka eli-12 ubudala ithetha ukungabikho kokuvuvukala komoya okubangelwa yi-eosinophilic.
• I-FeNO engaphezulu kwe-50 ppb kubantu abadala okanye ngaphezulu kwe-35 ppb kubantwana ibonisa ukudumba komoya okubangelwa yi-eosinophilic.
• Amaxabiso e-FeNO aphakathi kwe-25 kunye ne-50 ppb kubantu abadala (20 ukuya kwi-35 ppb kubantwana) kufuneka atolikwe ngononophelo ngokubhekiselele kwimeko yeklinikhi.
• Ukunyuka kwe-FeNO enotshintsho olungaphezulu kwama-20 ekhulwini kunye nangaphezulu kwama-25 ppb (20 ppb kubantwana) ukusuka kwinqanaba elalizinzile ngaphambili kubonisa ukwanda kokudumba komoya okubangelwa yi-eosinophilic, kodwa kukho umahluko omkhulu phakathi kwabantu ngabanye.
• Ukwehla kwe-FeNO engaphezulu kwama-20 ekhulwini kwiixabiso ezingaphezu kwama-50 ppb okanye ngaphezulu kwe-10 ppb kwiixabiso ezingaphantsi kwama-50 ppb kunokuba yinto ebalulekileyo ngokwezonyango.

Ukuxilongwa kunye nokuchazwa kwesifo sesifuba

I-Global Initiative for Asthma icebisa ukuba kungasetyenziswa i-FeNO ekuxilongweni kwe-asthma, njengoko isenokungabi phezulu kwi-asthma engenaso i-osinophilic kwaye inokuphakanyiswa kwizifo ezingezizo i-asthma, ezifana ne-eosinophilic bronchitis okanye i-allergy rhinitis.

Njengesikhokelo sonyango

Izikhokelo zamazwe ngamazwe zicebisa ukusebenzisa amanqanaba e-FeNO, ukongeza kwezinye iimvavanyo (umz., unyango lweklinikhi, imibuzo) ukukhokela ukuqaliswa kunye nokulungiswa konyango lokulawula i-asthma.

Ukusetyenziswa kuphando lweklinikhi

I-nitric oxide ephumayo inendima ebalulekileyo kuphando lwezonyango kwaye inokunceda ekwandiseni ukuqonda kwethu nge-asthma, njengezinto ezibangela ukuba i-asthma ibe mandundu kunye neendawo kunye neendlela ezisebenzayo zamayeza e-asthma.

SEBENZISA KWEZINYE IZIFO ZOKUPHEFUMLA

I-Bronchiectasis kunye ne-cystic fibrosis

Abantwana abane-cystic fibrosis (CF) banamanqanaba aphantsi e-FeNO kuneendlela zokulawula ezihambelanayo ngokufanelekileyo. Ngokwahlukileyo koko, olunye uphando lufumanise ukuba izigulane ezine-bronchiectasis engeyiyo i-CF zazinamanqanaba aphezulu e-FeNO, kwaye la manqanaba ayenxulumene nomlinganiselo wokungaqhelekanga okubonakalayo kwi-CT yesifuba.

Isifo semiphunga esingaphakathi kwesisu kunye ne-sarcoidosis

Kuphononongo lwezigulana ezine-scleroderma, i-NO ephezulu ephumayo yaphawulwa phakathi kwezigulana ezine-interstitial lung disease (ILD) xa ithelekiswa nezo zingenayo i-ILD, ngelixa okwahlukileyo kwafunyaniswa kolunye uphando. Kuphononongo lwezigulana ezingama-52 ezine-sarcoidosis, ixabiso eliphakathi le-FeNO yayiyi-6.8 ppb, elingaphantsi kakhulu kune-cut-point ye-25 ppb esetyenziselwa ukubonisa ukudumba kwe-asthma.

Isifo semiphunga esingapheliyo

FE_NOamanqanaba aphakanyiswa kancinci kwi-COPD ezinzileyo, kodwa anokunyuka xa isifo sinzima ngakumbi nangexesha lokunyuka kwamanqanaba. Abantu abatshayayo ngoku banamanqanaba aphantsi e-FeNO amalunga nama-70 ekhulwini. Kwizigulane ezine-COPD, amanqanaba e-FeNO anokuba luncedo ekuqinisekiseni ukuba kukho ukuvaleka komoya okubuyela kwimeko yesiqhelo kunye nokufumanisa ukuba i-glucocorticoid isabela njani, nangona oku kungakhange kuhlolwe kuvavanyo olukhulu olucwangcisiweyo.

Uhlobo lokukhwehlela lwe-asthma

I-FENO inechaneko eliphakathi lokuxilonga ekuqikeleleni ukuxilongwa kwesifo sofuba esiguquguqukayo (i-CVA) kwizigulana ezinesikhwehlela esingapheliyo. Kuphononongo olucwangcisiweyo lwezifundo ezili-13 (izigulana zika-2019), uluhlu olufanelekileyo lokuphela kwe-FENO yayingama-30 ukuya kuma-40 ppb (nangona amaxabiso aphantsi aqatshelwe kwizifundo ezibini), kwaye indawo yesishwankathelo phantsi kwe-curve yayiyi-0.87 (95% CI, 0.83-0.89). Ukuchaneka kwakuphezulu kwaye kuhambelane ngakumbi kunobuntununtunu.

I-bronchitis engaphefumli i-eosinophilic bronchitis

Kwizigulane ezine-bronchitis ye-eosinophilic engeyiyo i-asthma (NAEB), ii-eosinophils ze-sputum kunye ne-FENO zonyuswa kuluhlu olufanayo nezigulane ezine-asthma. Kuphononongo olucwangcisiweyo lwezifundo ezine (izigulane ezingama-390) kwizigulane ezine-cough engapheliyo ngenxa ye-NAEB, amanqanaba afanelekileyo e-FENO ayengama-22.5 ukuya kuma-31.7 ppb. Uvakalelo oluqikelelweyo yayiyi-0.72 (95% CI 0.62-0.80) kwaye ukucaciswa okuqikelelweyo yayiyi-0.83 (95% CI 0.73-0.90). Ke ngoko, i-FENO iluncedo ngakumbi ekuqinisekiseni i-NAEB, kunokuyikhupha ngaphandle.

Izifo zokuphefumla eziphezulu

Kolunye uphando olwenziwe kwizigulane ezingenazo izifo zemiphunga, usulelo lwemiphunga oluphezulu olubangelwa yintsholongwane lubangele ukwanda kwe-FENO.

Uxinzelelo lwegazi oluphezulu lwemiphunga

I-NO iyaziwa kakuhle njengomlamli we-pathophysiologic kwi-pulmonary arterial hypertension (PAH). Ukongeza kwi-vasodilation, i-NO ilawula ukwanda kweeseli ze-endothelial kunye ne-angiogenesis, kwaye igcina impilo yemithambo yegazi iyonke. Okubangela umdla kukuba, izigulane ezine-PAH zine-FENO values ​​ephantsi.

Kubonakala ngathi i-FENO ikwanokubaluleka kokuxela kwangaphambili, kunye nokusinda okuphucukileyo kwizigulane ezinezinga le-FENO elinyukayo ngonyango (ii-calcium channel blockers, i-epoprostenol, i-treprostinil) xa kuthelekiswa nezo zingenayo. Ke ngoko, amanqanaba aphantsi e-FENO kwizigulane ezine-PAH kunye nokuphuculwa konyango olusebenzayo kubonisa ukuba isenokuba yi-biomarker ethembisayo yesi sifo.

Ukungasebenzi kakuhle kwe-ciliary yokuqala

I-NO yempumlo iphantsi kakhulu okanye ayikho kwizigulane ezine-primary ciliary dysfunction (PCD). Ukusetyenziswa kwe-NO yempumlo ukuhlola i-PCD kwizigulane ezirhanelwa ukuba zine-PCD kuxoxwa ngokwahlukeneyo.

Ezinye iimeko

Ukongeza kwi-pulmonary hypertension, ezinye iimeko ezinxulumene namanqanaba aphantsi e-FENO ziquka i-hypothermia, kunye ne-bronchopulmonary dysplasia, kunye nokusetyenziswa kotywala, icuba, i-caffeine, kunye nezinye iziyobisi.