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Η μέτρηση του εκπνεόμενου μονοξειδίου του αζώτου (FeNO) στην διάγνωση και αντιμετώπιση του Βρογχικού Άσθματος

Ο προσδιορισμός του εκπνεόμενου μονοξειδίου του αζώτου(eNO) αποτελεί μία μη επεμβατική μέθοδο για την εκτίμηση της φλεγμονής των αεροφόρων οδών στο βρογχικό άσθμα. Η θέση της στην διάγνωση και την παρακολούθηση του βρογχικού άσθματος εξακολουθεί να αποτελεί αντικείμενο συζητήσης μεταξύ των ειδικών.


Nα υπενθυμίσουμε πως τον Σεπτέμβριο του 2011 δημοσιεύθηκε σχετική κατευθυντήρια οδηγία από την Αμερικάνικη Πνευμονολογική Εταιρεία (ATS) :

Dweik RA, et al; American Thoracic Society Committee on Interpretation of Exhaled Nitric Oxide Levels (FENO) for Clinical Applications.

An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications.

Am J Respir Crit Care Med. 2011 Sep 1;184(5):602-15.

In the setting of chronic inflammatory airway disease including asthma, conventional tests such as FEV(1) reversibility or provocation tests are only indirectly associated with airway inflammation. Fe(NO) offers added advantages for patient care including, but not limited to (1) detecting of eosinophilic airway inflammation, (2) determining the likelihood of corticosteroid responsiveness, (3) monitoring of airway inflammation to determine the potential need for corticosteroid, and (4) unmasking of otherwise unsuspected nonadherence to corticosteroid therapy.

Η πρόσβαση στην οδηγία είναι ελεύθερη από τον ακόλουθο διαδικτυακό σύνδεσμο :


Επιπλέον, το 2005 είχε δημοσιευθεί μία κοινή σύσταση από την Αμερικάνικη και την Ευρωπαϊκή Πνευμονολογική Εταιρεία (ATS/ERS) με θέμα την τυποποίηση της μέτρησης του εκπνεόμενου μονοξειδίου του αζώτου :

American Thoracic Society; European Respiratory Society. ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005.

Am J Respir Crit Care Med. 2005 Apr 15;171(8):912-30.

Η πρόσβαση στην οδηγία είναι ελεύθερη από τον ακόλουθο διαδικτυακό σύνδεσμο :


Πρόσφατα – τον Αύγουστο και Σεπτέμβριο του 2012 – δημοσιεύθηκαν δύο ανασκοπήσεις με θέμα την κλινική χρήση του μονοξειδίου του αζώτου στο βρογχικό άσθμα,τις οποίες μπορείτε να διαβάσετε ελεύθερα από το διαδίκτυο :

Ludviksdottir D, Diamant Z, Alving K, Bjermer L, Malinovschi A.

1) Clinical aspects of using exhaled NO in asthma diagnosis and management.

Clin Respir J. 2012 Aug 17.

In several studies, FE(NO) measurements provided additional information on aspects of asthma including phenotyping, corticosteroid-responsiveness and disease control. Thus, if correctly applied and interpreted, FE(NO) can aid asthma diagnosis, identify patients at risk of exacerbation and support customized treatment decisions. A simple and reliable tool to quantify peripheral nitric oxide will further aid to identify patients with small airways inflammation.

Η πρόσβαση είναι ελεύθερη από τον ακόλουθο διαδικτυακό σύνδεσμο :

Munakata M.

2) Exhaled Nitric Oxide (FeNO) as a Non-Invasive Marker of Airway Inflammation.

Allergol Int. 2012 Sep;61(3):365-72.

Nitric oxide (NO), previously very famous for being an environmental pollutant in the field of pulmonary medicine, is now known as the smallest, lightest, and most famed molecule to act as a biological messenger. Furthermore, recent basic researches have revealed the production mechanisms and physiological functions of nitric oxide in the lung, and clinical researches have been clarifying its tight relation to airway inflammation in asthma. On the bases of this knowledge, fractional nitric oxide (FeNO) has now been introduced as one of the most practical tools for the diagnosis and management of bronchial asthma.

Η πρόσβαση είναι ελεύθερη από τον ακόλουθο διαδικτυακό σύνδεσμο :


Σχετικά άρθρα με ιδιαίτερο βιβλιογραφικό ενδιαφέρον για τον ρόλο της μέτρησης του μονοξειδίου του αζώτου στην προσέγγιση του βρογχικού άσθματος και ελεύθερη πρόσβαση στο διαδίκτυο :

Sandrini A, Taylor DR, Thomas PS, Yates DH.

Fractional exhaled nitric oxide in asthma: an update.

Respirology. 2010 Jan;15(1):57-70.

In asthma, clinical symptoms and lung function are insensitive in reflecting the underlying airway inflammation, and monitoring of this process has only recently become available. Fractional exhaled nitric oxide (Fe(NO)) is now recognized as a reliable surrogate marker of eosinophilic airway inflammation and offers the advantage of being completely non-invasive and very easy to obtain. This review summarizes the clinical use of Fe(NO) in asthma. It covers the relationship between Fe(NO) and the underlying eosinophilic inflammation, the pathophysiology and production of Fe(NO), technical aspects of Fe(NO) measurement and potential confounding factors in interpreting levels. Fe(NO) reference values and the role of Fe(NO) in asthma assessment, diagnosis and management are also discussed.

Η πρόσβαση είναι ελεύθερη από τον ακόλουθο διαδικτυακό σύνδεσμο :

Baraldi E, de Jongste JC; European Respiratory Society/American Thoracic Society (ERS/ATS) Task Force.

Measurement of exhaled nitric oxide in children, 2001.

Eur Respir J. 2002 Jul;20(1):223-37.

Measurement of fractional exhaled nitric oxide in exhaled air is an exciting innovative technique that gives new insights in to the pathophysiology of lung disease and asthma in particular, with many potential clinical applications. Careful standardisation of measurement techniques will facilitate the use of this new measurement in paediatric respiratory medicine: this Task Force was set up for this purpose. Methodologies, for use in all age groups, are already available and there are abundant questions relating to interpretation and application of fractional exhaled nitric oxide waiting to be addressed. Noninvasiveness and instantaneous results potentially make it a suitable monitoring instrument for use in children. Exhaled nitric oxide measurement has definitely found its way into clinical research in paediatric respiratory medicine. Evidence for clinically-useful applications is accumulating, and the merits of this new technique must now be demonstrated in larger studies, using standardised methodology in an appropriate setting.

Η πρόσβαση είναι ελεύθερη από τον ακόλουθο διαδικτυακό σύνδεσμο :

Paiola G, Tenero L, Piacentini G.

The measurement of exhaled nitric oxide in routine practice.

Eur Ann Allergy Clin Immunol. 2009 Oct;41(5):131-5.

Exhaled nitric oxide (NO) is considered the most easily available clinical test to indirectly assess the level of eosinophilic airway inflammation in asthma, and to predict the efficacy of anti-inflammatory treatment with inhaled corticosteroids (ICS). It is possible to measure the level of exhaled NO using online or offline methods. The most widely used online method employs techniques that enable NO in exhaled air to be measured in a single exhalation, calculating the value at the end-expiratory plateau. Because of the correlation between the level of exhaled NO with the level of eosinophilic inflammation in the airway of asthmatic patients, it has been proposed as a clinical marker in the practice of respiratory and allergy physicians with differing targets. In particular it is considered to be highly effective in the diagnosis of allergic asthma, to be capable of identifying those patients with a higher response probability to inhaled corticosteroids, and to a lesser extent, to be of value in contributing to the management of the disease. The possibility of easily taking measurements of FeNO in an office setting even by relatively young children, and the availability of a portable device, opens a significant perspective for the routine use of FeNO evaluation in daily practice.

Η πρόσβαση είναι ελεύθερη από τον ακόλουθο διαδικτυακό σύνδεσμο :

Kharitonov SA, Barnes PJ.

Clinical aspects of exhaled nitric oxide.

Eur Respir J. 2000 Oct;16(4):781-92.

There has been intense research into the role nitric oxide (NO) plays in physiological and pathological mechanisms and its clinical significance in respiratory medicine. Elevated levels of exhaled levels of exhaled NO in asthma and other inflammatory lung diseases lead to many studies examining NO as potential markers of airway inflammation, enabling repeated noninvasive and standardized monitoring of airway inflammation. In airway inflammation, NO is not merely a marker but may have anti-inflammatory and pro-inflammatory effects. Significant correlation has been found between exhaled NO and skin test scores in steroid naive asthmatic patients, allowing to discriminate patients with and without airway responsiveness. Exhaled NO is significantly elevated in acute asthma, or steroid-resistant severe asthma, or when the maintenance dose of inhaled steroids is reduced, and quickly reduced down to the levels in patients with stable asthma after steroid treatment. Exhaled NO has been successfully used to monitor anti-inflammatory treatment with inhaled corticosteroids in asthma. Exhaled NO is extremely sensitive and rapid marker of the dose-dependent effect of steroid treatment, or asthma deterioration, which is increased to any changes in lung function, provocative concentration causing a 20% fall in forced expiratory volume, sputum eosinophilia or asthma symptoms. Exhaled NO is not increased in stable chronic obstructive pulmonary disease (COPD), but patients with unstable COPD, or bronchiectasis have high NO levels. Exhaled and nasal NO are diagnostically low in cystic fibrosis and primary pulmonary dyskinesia. Analysis of exhaled air, including nitric oxide, is feasible and could provide a noninvasive method for use in monitoring and management of lung diseases.

Η πρόσβαση είναι ελεύθερη από τον ακόλουθο διαδικτυακό σύνδεσμο :

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