소아 아토피 천식 환자에서 호기 NO 농도와 천식 조절 점수 및 폐기능검사 결과 사이의 연관성

김정옥 ( Jeong Ok Kim ),우성일 ( Sung Il Woo ),한윤수 ( Youn Soo Hahn ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2011 소아알레르기 및 호흡기학회지 Vol.21 No.1

목적: FeNO는 천식 환자에서 기도 염증을 반영하는 것으로 알려져 있다. 이 연구에서는 FeNO와 천식 조절 점수 및 폐기능검사 결과 사이의 연관성에 대해 알아보고자 하였다. 방법: 아토피 천식으로 진단되고 연구 시작 전 흡입 스테로이드를 최소 1개월 이상 사용하지 않은 8세 이상 16세미만의 소아 123명을 대상으로 하였다. 8-12세 소아에서는 childhood asthma control test (C-ACT) 점수를 12세 이상의 소아에서는 asthma control test (ACT) 점수를 측정하였으며, 모든 소아에 대해 폐기능검사와 FeNO 측정을 실시하였다. 결과: 아토피 천식 소아에서 FeNO의 기하학적 평균(19.2 parts per billion [ppb]; 95% CI, 17.2-21.4)은 정상 소아들 (7.5 ppb; 95% CI, 7.0-8.0)에 비해 유의하게 높았다. (P<.001) ACT 점수나 C-ACT 점수는 대상군 소아의 82%에서 20점 이상이었으며, %FEV1, FEV1/FVC, %FEF25-75%와 유의한 상관관계를 나타내었다. 그러나 FeNO는 천식 조절 점수나 폐기능검사 결과와 유의한 상관관계를 보이지 않았다. 나이, 성별, 신체질량지수 또는 부모 흡연 여부에 따른 FeNO의 차이는 관찰되지 않았다. 결론: 소아 아토피 천식 환자에서 FeNO는 천식 조절점수나 폐기능검사 결과와 연관성을 보이지 않았다. 따라서 소아 아토피 천식 환자에서 천식 조절 점수 측정이나 폐기능검사와 함께 기도 염증 정도를 반영하는 FeNO의 측정이 필요하다고 판단된다. Purpose: Fractional exhaled nitric oxide (FeNO) has been proposed as a tool for assessing airway inflammation in patients with atopic asthma. We evaluated the relationship between FeNO with asthma control test (ACT) scores and spirometry values in children with atopic asthma. Methods: One hundred twenty-six children with atopic asthma, 8-16 years of age, were included in the study. None of the participants received regular controller therapy for at least 4 weeks before the study. The ACT (for children >12 years of age) or the Childhood Asthma Control Test (C-ACT; for children between the ages of 8 and 11 years of age), FeNO measurements and pulmonary function tests were performed. Results: The geometric mean of the FeNO in children with atopic asthma (16.1 parts per billion [ppb]; 95% CI, 14.5-17.8 ppb) was significantly higher than that healthy controls (7.5 ppb; 95% CI, 7.0-8.1 ppb; P<0.001). ACT or C-ACT scores were >20 in 82% of enrolled patients and correlated with the %FEV1, FEV1/FVC, and %FEF25-75. However, FeNO was not related to %FEV1, FEV1/FVC, %FEF25-75, and scores for asthma controls. FeNO levels in asthmatic children were not significantly different with respect to age, gender, BMI, and tobacco exposure. Conclusion: FeNO was not related to the spirometry values and scores for asthma control. Measurement of FeNO may be a complementary tool in the assessment of asthma control. [Pediatr Allergy Respir Dis(Korea) 2011;21:24-31]

소아 아토피 천식 환자에서 호기 NO 농도와 천식 조절 점수 및 폐기능검사 결과 사이의 연관성

김정옥,한윤수,우성일 대한 소아알레르기 호흡기학회 2011 Allergy Asthma & Respiratory Disease Vol.21 No.1

Purpose:Fractional exhaled nitric oxide (FeNO) has been proposed as a tool for assessing airway inflammation in patients with atopic asthma. We evaluated the relationship between FeNO with asthma control test (ACT) scores and spirometry values in children with atopic asthma. Methods:One hundred twenty-six children with atopic asthma, 8-16 years of age, were included in the study. None of the participants received regular controller therapy for at least 4 weeks before the study. The ACT (for children >12 years of age) or the Childhood Asthma Control Test (C-ACT; for children between the ages of 8 and 11 years of age), FeNO measurements and pulmonary function tests were performed. Results:: The geometric mean of the FeNO in children with atopic asthma (16.1 parts per billion [ppb]; 95% CI, 14.5-17.8 ppb) was significantly higher than that healthy controls (7.5 ppb; 95% CI, 7.0-8.1 ppb; P<0.001). ACT or C-ACT scores were >20 in 82% of enrolled patients and correlated with the %FEV_1, FEV_1/FVC, and %FEF_(25-75). However, FeNO was not related to %FEV_1, FEV_1/FVC, %FEF_(25-75), and scores for asthma controls. FeNO levels in asthmatic children were not significantly different with respect to age, gender, BMI, and tobacco exposure. Conclusion:FeNO was not related to the spirometry values and scores for asthma control. Measurement of FeNO may be a complementary tool in the assessment of asthma control. 목적:FeNO는 천식 환자에서 기도 염증을 반영하는 것으로 알려져 있다. 이 연구에서는 FeNO와 천식 조절 점수 및 폐기능검사 결과 사이의 연관성에 대해 알아보고자 하였다. 방법:아토피 천식으로 진단되고 연구 시작 전 흡입 스테로이드를 최소 1개월 이상 사용하지 않은 8세 이상 16세 미만의 소아 123명을 대상으로 하였다. 8-12세 소아에서는 childhood asthma control test (C-ACT) 점수를 12세 이상의 소아에서는 asthma control test (ACT) 점수를 측정하였으며, 모든 소아에 대해 폐기능검사와 FeNO 측정을 실시하였다. 결과:아토피 천식 소아에서 FeNO의 기하학적 평균 (19.2 parts per billion [ppb]; 95% CI, 17.2-21.4)은 정상 소아들 (7.5 ppb; 95% CI, 7.0-8.0)에 비해 유의하게 높았다.(P<.001) ACT 점수나 C-ACT 점수는 대상군 소아의 82%에서 20점 이상이었으며, %FEV_1, FEV_1/ FVC, %FEF_(25-75)%와 유의한 상관관계를 나타내었다. 그러나 FeNO는 천식 조절 점수나 폐기능검사 결과와 유의한 상관관계를 보이지 않았다. 나이, 성별, 신체질량지수, 또는 부모 흡연 여부에 따른 FeNO의 차이는 관찰되지 않았다. 결론:소아 아토피 천식 환자에서 FeNO는 천식 조절 점수나 폐기능검사 결과와 연관성을 보이지 않았다. 따라서 소아 아토피 천식 환자에서 천식 조절 점수 측정이나 폐기능검사와 함께 기도 염증 정도를 반영하는 FeNO의 측정이 필요하다고 판단된다.

Comparison of low and high FENO in COPD patients

( Sung Jun Chung ),( Jang Won Sohn ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Introduction: The FENO is a biomarker of neutrophilic airway inflammation. Recently, high peripheral eosinophil count is an issue to COPD patients due to treatment could be differently challenged. COPD with high FENO patients could be a predictor of corticosteroid inhaler. Methods: A total of 133 patients who were performed FENO between January, 2010 to July, 2019 in Hanyang Medical center due to COPD were retrospectively evaluated. We enrolled the patients who were current or ex-smoker with a low value of FEV1/FVC in spirometry. Results: Of the 133 patients, the median value of FENO was 21ppb. We classified the patients into arbitrary based on FENO levels 22 and compared low and high FENO group. 65 had low FENO and 68 had high FENO. The peripheral eosinophil count was 167 (100-306) in low FENO patients and 167 (104-307) in high FENO patients. There was no significant difference in the peripheral eosinophil count between the two groups (P = 0.869). In treatment outcome, there was no significant difference in the acute exacerbation between two groups. (P = 0.344). Conclusion: The treatment outcomes in low and high FENO group had no significant difference. There was no significant relation between peripheral eosinophil and value of FENO (R = 0.02)

천식 의심 환자에서 기관지 확장제 반응 및 만니톨 기도과민성과 호기산화질소의 연관성

오상유 ( Sang-yu Oh ),이민형 ( Min-hyung Lee ),오다은 ( Da-eun Oh ),최길순 ( Gil-soon Choi ),김석현 ( Seok-hyeon Kim ),박영찬 ( Young-chan Park ),김희규 ( Hee-kyoo Kim ) 대한내과학회 2017 대한내과학회지 Vol.92 No.5

목적: 호기산화질소(FeNO)는 천식에서 기도 염증의 비침습적 지표로서 활용되어 왔다. 또한, 호기산화질소(FeNO) 측정은 천식 평가에 유용한 도구로 인식되고 되고 있다. 이 연구의 목적은 천식 의심 환자에서 기관지확장제 반응(BDR) 및 만니톨 기도 과민성(AHR) 여부에 따른 FeNO의 차이를 알아보고자 하였다. 방법: FeNO를 측정한 기관지 천식 의심 환자들(≥ 13세)중 BDR 및 AHR 검사를 시행한 대상자들 두 군으로 구분하였고 각 군에서의 나이, 폐활량, 호산구, 혈청 총 IgE, 아토피 상태 등을 수집하였다. 또한, 각 FEV1 및 FEF25-75%을 기준으로 하여 각 검사 결과에 따라 FeNO 값을 비교 및 상관분석을 시행하였고 검사 양성을 예측하기 위한 ROC 곡선을 구하였다. 결과: BDR 검사군 124명, 만니톨 AHR 검사군 145명으로 총 259명의 환자들을 분석하였고 양 군의 평균 나이는 각각 52.8세와 35.3세였다. 환자의 BDR 여부, AHR 여부, 아토피여부, 혈액 호산구 분율(4% 기준)과 총 IgE 값(300 IU/mL 기준)에 따른 FeNO 값은 유의한 차이가 있었다. 또한, BDR 및 AHR 검사에서 FEV1의 기관지 확장제 사용 후 최종 증가 정도 및 PD15 값과 FeNO와의 상관관계가 FEF25-75%의 최종 증가 정도 및 PD15 값보다 더 높았다. BDR 및 AHR 양성을 예측하기 위한 위한 최적의 FeNO 결정값은 각각 38.5와 29.5ppb였다. 결론: 천식 의심 환자에 있어 FeNO는 BDR 및 AHR과 연관이 있었으며 양성 여부를 예측할 수 있는 보조적인 진단역할에 도움이 될 것으로 보인다. Background/Aims: Exhaled nitric oxide (NO) has been extensively investigated as a marker of airway inflammation in asthma, and fractional exhaled nitric oxide (FeNO) is recognized as a useful tool for its evaluation. The aim of this study was to investigate the relationships between FeNO levels and bronchodilator response (BDR), and between FeNO and mannitol-induced airway hyperresponsiveness (AHR), in patients with suspected asthma. Methods: Clinical variables were collected from patients aged ≥ 13 years with suspected bronchial asthma and measured levels of FeNO. These levels were compared with patient values for forced expiratory volume in the first second (FEV1) and forced expiratory flow at 25 and 75% of the pulmonary volume (FEF_25-75%) in bronchodilator response tests under control conditions, and during bronchial provocation with mannitol. Correlations and receiver operating characteristic (ROC) curves between FeNO levels and each test were assessed. Results: A total of 259 patients were included in the analysis. The mean ages of the two test groups were 41.1 and 47.8 years, respectively. FeNO levels were strongly correlated with bronchodilator response (%) and with the mannitol dose producing a 15% fall in FEV1 (PD15). On the other hand, FeNO levels were only weakly correlated with FEF_25-75%. The optimal cut-off values for FeNO to predict a positive BDR and AHR were 38.5 and 29.5 parts per billion, respectively. Conclusions: This study suggests that FEV1 and FEF_25-75% airway responses correlate with FeNO levels in patients with suspected bronchial asthma. FeNO levels may help to predict positive responses to BDR and AHR. (Korean J Med 2017;92:458-466)

Reference Values and Determinants of Fractional Concentration of Exhaled Nitric Oxide in Healthy Children

조현주,정영호,Song-I Yang,이은,김형영,서주희,권지원,김병주,김효빈,이소연,송대진,김우경,장광천,심정연,홍수종 대한천식알레르기학회 2014 Allergy, Asthma & Immunology Research Vol.6 No.2

Purpose: Measurement of the fractional concentration of exhaled nitric oxide (FeNO) is a quantitative, noninvasive, simple, safe method of assessingairway inflammation. While FeNO measurement has been standardized, reference values for elementary school children are scarce. The aim ofthis study was to establish reference values for FeNO in children. Methods: FeNO was measured in elementary school children at 6-12 years ofage in Seoul, Korea, following American Thoracic Society guidelines and using a chemiluminescence analyzer (NIOX Exhaled Nitric Oxide MonitoringSystem, Aerocrine, Sweden). A total of 1,252 children completed a modified International Study of Asthma and Allergy in Children (ISAAC) questionnaire;FeNO was measured in 1,063 children according to the protocol and in 808 children defined as healthy controls. Results: Mean FeNOwere 10.32 ppb, 16.58 ppb, and 12.36 ppb in non-atopic, atopic, and all 808 healthy controls, respectively. FeNO was not associated with age andgender. The FeNO reference equations were determined by multiple linear regression analysis, taking into account the variables of age, height, weight,total IgE, eosinophil percent, and bronchial hyper-responsiveness (methacholine PC20). FeNO=0.776+0.003×total IgE+0.340×eosinophil percent;coefficient of determination (R2)=0.084 in the 501 healthy non-atopic controls. FeNO=-18.365+1.536×eosinophil percent, R2=0.183 in the 307healthy atopic controls; and FeNO=-7.888+0.130×Height+0.004×total IgE+1.233×eosinophil percent, R2=0.209 in the 808 all healthy controls. Eosinophil percent was correlated with FeNO in all healthy controls. FeNO was not associated with BMI. Conclusion: This study provides referencevalues for FeNO that can be used to evaluate airway inflammation in elementary school children. Determinants that could most accurately predictFeNO in healthy school-age children were assessed.

우리나라 소아 알레르기비염 환자에서 호기산화질소의 측정

문승현 ( Seung Hyun Moon ),장해지 ( Hae Ji Jang ),박윤성 ( Yoon Sung Park ),이우연 ( Woo Yeon Lee ),임대현 ( Dae Hyun Lim ),김정희 ( Jeong Hee Kim ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.6

Purpose: Fractional exhaled nitric oxide (FeNO) is useful for the diagnosis of allergic rhinitis (AR) as well as bronchial asthma (BA). However, FeNO may differ according to race, age, and other determinants. There have been few studies about FeNO in Korean children with AR. The aims of this study were to evaluate the value of FeNO in AR and to compare FeNO, and determinants of FeNO levels between AR, BA, and combined AR and BA. Methods: This study included 647 children aged 5 to 17. The children were classified into 5 groups after performing the skin test, FeNO measurement, the pulmonary function test, and the methacholine challenge test: those with nonallergic rhinitis (NAR), those with AR, those with BA, and those with combined AR and BA, and healthy controls,. Results: The values of FEV1 (forced expiratory volume in one second) %predicted were 94.4%±12.6%, 93.8%±20.7%, 90.0%±17.4% in AR, BA, and combined AR and BA, respectively. The values of FeNO in AR (32.3±25.0 ppb), BA (31.1±20.5 ppb), and combined AR and BA (34.5±30.4 ppb) were significantly higher compared to those of NAR (16.8±13.5 ppb) and controls (15.9±12.5 ppb). There was no significant difference in FeNO among AR, BA, and combined AR and BA. FeNO was significantly higher in patients with ≥4 positive results (36.6±29.2 ppb) than in those with <4 positive skin test results (27.6±20.7 ppb). When the receiver operating characteristic curve analysis for prediction of AR showed 0.756 of area under the curve, the cutoff level of FeNO was 16 ppb. Conclusion: In this study, children with AR had increased levels of FeNO. It is suggested that AR may have eosinophilic bronchial inflammation without BHR or clinical asthma. (Allergy Asthma Respir Dis 2015;3:439-445)

아토피 천식 소아에서 기관지확장제 반응과 천식 조절 및 호기 NO 농도 사이의 연관성

박주현 ( Jooh Yun Park ),이윤경 ( Youn Kyung Lee ),김헌 ( Heon Kim ),한윤수 ( Youn Soo Hahn ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.1

Purpose: Because bronchodilator response (BDR) is variable among asthmatic patients, there are practical limitations in using BDR to assess asthma control. We investigated the relationships of BDR with asthma control status and fractional exhaled nitric oxide (FeNO) in children with atopic asthma. Methods: One hundred ninety-one patients aged 8 to 16 years with atopic asthma were enrolled. Pulmonary function tests including BDR and FeNO were serially measured 10 times or more over 2 years when subjects were not receiving controller medications. During the last year of follow-up, the loss of asthma control was assessed in all participants. Results: We identified 114 children (60%) with at least 1 positive BDR (≥12%) over the 2-year observation period. Higher levels of BDRs and higher rates of positive BDRs were associated with lower lung function and lower methacholine PC20 (provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second). The loss of asthma control occurred in 106 of individuals (93%) who had positive BDRs, as compared to 52 of 77 (68%) with negative BDRs (P<0.001). There was no difference in FeNO levels between individuals with positive and negative BDRs. However, among children with negative BDRs, those developing the loss of asthma control had higher maximal FeNO levels and higher rates of FeNO>21 parts per billion than those who maintained asthma control (all P<0.001). Conclusion: Positive BDRs are linked to a higher probability of asthma control loss in children with atopic asthma. In addition, high FeNO is associated with asthma control loss in asthmatic children with negative BDRs.

Impact of the Exhaled Nitric Oxide and Inhaled Corticosteroid Use on Acute Exacerbation of Chronic Obstructive Pulmonary Disease

( Bo-guen Kim ),( Hye Yun Park ),( Sun Hye Shin ),( Yong Suk Jo ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-

Background Fractional exhaled nitric oxide (FeNO) is a useful biomarker for detecting eosinophilic airway inflammation. However, in chronic obstructive pulmonary disease (COPD), the role of FeNO remains controversial. Therefore, we aimed to assess whether high FeNO itself and Resultant treatment change into ICS-containing regimen is associated with acute exacerbation (AE) of COPD patients. Methods We retrospectively analyzed 205 COPD patients from March 2016 to December 2019 in two referral hospitals. Patients who previously diagnosed with asthma were excluded. All patients were followed-up over six months after FeNO measurement. The patients whose FeNO value more than 50 parts per billion [ppb] were defined into high FeNO group. Multivariable analysis with logistic regression was used to identify factors associated with AE of COPD. Results The mean FeNO value for all patients was 30 (20-45) ppb. Of all patients, 39 (19.0%) patients were in high FeNO group with mean FeNO value of 73 (58-97) ppb. In the high FeNO group, 23 (23/39, 59%) patients changed treatment after the measurement of FeNO and all received ICS-containing treatment regimen. In multivariate analysis, high FeNO was not associated with AE while only history of exacerbation in the previous year was associated with AE (adjusted odds ratio [aOR], 2.250; 95% confidence interval [CI], 1.150-4.403; p = 0.018). A subgroup analysis was performed with a high FeNO group; the ICS use was not a significant factor related to AE. Conclusions In COPD patients, high FeNO did not affect the risk of AE, and changing into ICS-containing treatment in high FeNO did not prevent AE.

Exhaled nitric oxide in stable Chronic Obstructive Pulmonary Disease : clinical implication on use of Inhaled corticosteroids

조용숙,최준수,이진국,유광하,박혜윤,박용범 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-

Background and Objective: Fractional exhaled nitric oxide (FENO) is regarded as potential biomarkers for identifying eosinophilic inflammation in chronic obstructive pulmonary disease (COPD). We aimed to evaluate the clinical implication of FENO and how it affects prescription behaviour of inhaled corticosteroids in Korean COPD cohort. Methods: We analysed the level of FENO and its association with clinical features in two COPD cohorts. Changes of prescription rate of Inhaled corticosteroids (ICS) before and after FENO measurement were identified. Results: A total of 216 COPD patients divided into high (≥ 25 ppb, N=111) and low (<25 ppb, N=105) FENO group. Compared to low FENO group, odds ratio (95% CI) for previous history of asthma and/or accompanied wheezing were 1.92 (1.03-3.58) and 2.49 (1.08-5.72), respectively. ICS was prescribed to 79 and 68 patients before and after FENO measurement and more frequently to high FENO group than low group. Among 137 patients without ICS before, 56 of 71 patients in high FENO group were newly prescribed ICS after FENO measurements. On the other hands, among 79 patients with ICS before, 17 of 39 patients in low FENO group were excluded from ICS prescription after FENO measurements. Conclusion: FENO help clinician to distinguish eosinophilic phenotype of COPD and affect clinician’s decision on whether use of ICS or not. Further studies are needed to identify how this affects the patient’s outcome such as exacerbation risk and ICS responder prediction.

천식 소아에서 호기산화질소 농도와 기도 과민성, 혈액 호산구 수, 혈청 호산구 양이온 단백 농도와의 상관관계

서현석 ( Hyeon Seok Seo ),정보현 ( Bo Hyun Chung ),박하늘 ( Ha Neul Park ),서성철 ( Sung Chul Seo ),( Bauer Siegfried ),송대진 ( Dae Jin Song ),정지태 ( Ji Tae Choung ),유영 ( Young Yoo ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2012 소아알레르기 및 호흡기학회지 Vol.22 No.3

Purpose: The measurement of fraction of nitric oxide (FeNO) is a noticeable tool that reflects airway inflammation in asthmatic patients. We wanted to find out the relationship between pulmonary function, bronchial hyperresponsiveness (AHR), blood eosinophilic inflammatory markers and FeNO level before and after methacholine bronchoprovocation test in asthmatic patients. Methods: Fifty-five children, who visited the Allergy Clinic of Korea University Anam Hospital from March 2011 to February 2012, due to asthmatic symptoms, such as history of episodic wheezing or dyspnea during the previous year and resolved after using bronchodilators, were enrolled. We performed the baseline pulmonary function and methacholine bronchoprovocation test in the enrolled patients. Blood eosinophil counts and blood eosinophil cationic protein (ECP) were measured. FeNO levels were measured before and after the methacholine bronchoprovocation test. Results: The mean FeNO levels (36.3 ppb) fell after methacholine bronchoprovocation test (25.7 ppb). Forced expiratory volume in one second (FEV1) %pred inversely correlated both with FeNO level before (R2=0.07, P =0.029) and after (R2=0.059, P =0.01) methacholine bronchoprovocation test. The provocative concentration, causing a 20% decrease in FEV1 to methacholine (methacholine PC20) inversely correlated both with FeNO levels before (R2=0.086, P =0.001) and after (R2=0.141, P =0.001) the challenge. FeNO level measured at bronchoconstriction state significantly correlated with blood eosinophil counts (R2=0.112, P =0.028). Serum ECP levels correlated FeNO level, neither before nor after bronchoprovocation. Conclusion: The baseline FeNO levels were higher in asthmatic children. However, FeNO levels rather decreased after methacholine induced bronchoconstriction. Repeated spirometry maneuver was considered to have an effect on reducing FeNO levels. FeNO correlated with pulmonary function, airway AHR and blood eosinophil counts.