Asthma is a chronic inflammatory disease of the airways, affecting over 350 million people worldwide and placing a significant burden on healthcare providers and wider society. Approximately 5–10% of asthma patients are diagnosed with severe asthma and typically are associated with increased risk of hospitalisation from exacerbations, increased morbidity, mortality and higher asthma-associated healthcare costs. Nitric oxide (NO) is an important regulator of immune responses and is a product of inflammation in the airways that is over-produced in asthma. Fractional exhaled NO (FeNO) is predominantly used as a predictor of response to inhaled corticosteroids (ICSs), to monitor adherence and as a diagnostic tool in ICS-naïve patients. In the UK, the National Institute for Health and Care Excellence (NICE) guidelines recommend the use of FeNO for the initial diagnosis of patients with suspected asthma. In the USA, American Thoracic Society (ATS) guidelines recommend FeNO as part of the initial diagnosis of asthma and for monitoring of airway inflammation. FeNO has also been shown to be a predictive factor for asthma exacerbations, with higher levels being associated with a greater number of exacerbations. In addition, higher levels of FeNO have been shown to be associated with a decline in lung function. FeNO testing is a cost-effective procedure and has been shown to improve patient management when combined with standard assessment methods. Recent evidence suggests that FeNO may also be useful as a surrogate biomarker for the assessment and management of severe asthma and to predict responsiveness to some biological therapies. The optimisation of FeNO testing methods in a variety of clinical settings, as a non-invasive, readily available, and affordable technology, could play an important role in advancing effective asthma control http://bit.ly/2FN6P3j

中文翻译：

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呼出气一氧化氮 (FeNO) 在重度哮喘管理中的临床应用

哮喘是一种慢性气道炎症性疾病，影响全球超过 3.5 亿人，并给医疗保健提供者和更广泛的社会带来重大负担。大约 5-10% 的哮喘患者被诊断出患有重度哮喘，并且通常与因急性加重住院的风险增加、发病率、死亡率增加以及与哮喘相关的医疗保健费用增加有关。一氧化氮 (NO) 是免疫反应的重要调节剂，是哮喘患者过度产生的气道炎症的产物。呼出气分数 (FeNO) 主要用作吸入皮质类固醇 (ICS) 反应的预测指标、监测依从性和作为 ICS 初治患者的诊断工具。在英国，美国国家健康与护理卓越研究所 (NICE) 指南推荐使用 FeNO 对疑似哮喘患者进行初步诊断。在美国，美国胸科学会 (ATS) 指南推荐 FeNO 作为哮喘初始诊断和气道炎症监测的一部分。FeNO 也已被证明是哮喘发作的预测因素，较高的水平与更多的哮喘发作相关。此外，较高水平的 FeNO 已被证明与肺功能下降有关。FeNO 检测是一种具有成本效益的程序，与标准评估方法相结合，已被证明可以改善患者管理。最近的证据表明，FeNO 还可用作评估和管理严重哮喘以及预测对某些生物疗法的反应的替代生物标志物。在各种临床环境中优化 FeNO 检测方法，作为一种无创、易于获得且价格合理的技术，可以在促进有效哮喘控制方面发挥重要作用 http://bit.ly/2FN6P3j