Serum interleukin-33 combined with FEF75% z-score and FeNO improves the diagnostic accuracy of asthma in children

Abstract Objective To investigate the diagnostic efficacy of serum IL-33 single indicator and combined indicators for asthma in children. Methods 132 children were initially diagnosed with asthma during acute exacerbation and 100 healthy children were included. Serum IL-33 concentration differences were compared between asthmatic and normal children. Correlations between IL-33 with pulmonary function parameters, FeNO, peripheral blood EOS counts and serum total IgE were analyzed in asthmatic children. ROC curves were used to assess IL-33 diagnostic efficacy and its combined indicators. To prevent overfitting of the predictive model, the hold-out cross-validation method was used. Results (1) Serum IL-33 concentrations were significantly higher in children with asthma than in normal children (p < 0.001). (2) IL-33 concentration was negatively correlated with FVC z-score, FEV1 z-score and FEF75% z-score in asthmatic children (p < 0.05). (3) The area under the ROC curve of IL-33 was 0.821, which was higher than those of FeNO, FVC z-score, and FEV1 z-score. (4) Cross-validation of the combined indicators showed that IL-33 significantly improved asthma diagnostic efficacy. The combination of IL-33, FEF75% z-score, and FeNO showed the highest diagnostic efficacy, with the AUC, sensitivity, and specificity of the combined indicator being 0.954, 90.1%, and 89. 0%, respectively, and good extrapolation of the predictive model. Conclusion Serum IL-33 is higher in children with asthma and increases with the severity of pulmonary ventilation obstruction. A single indicator of serum IL-33 demonstrates moderate diagnostic accuracy, and its combination with FEF75% z-score and FeNO significantly improves the diagnostic accuracy in childhood asthma.

Helicobacter pylori Infection Do Not Influence the Determination of Fractional Exhaled Nitric Oxide / 胃肠病学

Background: Helicobacter pylori (Hp) infection induces inflammation in gastric mucosa, and the production of nitric oxide (NO) may increase in response to the inflammation. However, the correlations between NO concentration in exhaled air and the severity of gastric inflammation and Hp infection are not clear. Aims: To explore the influence of Hp infection on fractional exhaled nitric oxide (FeNO), an indicator of airway inflammation, and the relationship between FeNO and severity of gastric inflammation. Methods: Adult patients who accepted

The level of fractional exhaled nitric oxide and its influencing factors in chronic obstructive pulmonary disease / 中国医师杂志

Objective:To analyze the level of fractional exhaled nitric oxide (FeNO) and its influencing factors in patients with chronic obstructive pulmonary disease (COPD).Methods:678 patients with stable COPD(COPD group), 281 patients with asthma-COPD overlap(COPD with asthma group) and 120 healthy nonsmoker controls (healthy control group) were recruited from the outpatient clinics of Xiangya Second Hospital of Central South University and the 1st People′s Hospital of Huaihua from November 2016 to December 2021. The gender, smoking status, age, height, weight, body mass index (BMI), FEV 1% predicted value (FEV 1% pred), forced expiratory volume in 1 second/forced vital capacity (FEV 1/FVC%), and FeNO value among the three groups were compared. Multiple linear regression analysis was performed to analyze the influencing factors of FeNO levels in COPD patients. Results:There was no significant difference in gender, smoking status, age, height, weight and BMI among the three groups (all P>0.05). The FEV 1% and FEV 1/FVC% in COPD group were lower than those in healthy group and COPD combined with asthma group (all P<0.05). The FeNO in COPD group was lower than that in COPD and asthma group, but higher than that in healthy group (all P<0.05). Univariate analysis showed that FeNO levels in COPD patients were associated with height, BMI, Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) classification, and Chronic Obstructive Pulmonary Disease Assessment Test (CAT) score (all P<0.05). Multiple linear regression analysis showed that FeNO level was positively correlated with height ( β=0.094, P=0.014), CAT score ( β=0.129, P=0.001), and negatively correlated with BMI ( β=-0.093, P=0.016). There was no significant correlation between GOLD grading and FeNO level ( P>0.05). Conclusions:The level of FeNO in patients with COPD is higher than that in healthy subjects, which is related to height, BMI and CAT.

Application of fractional exhaled nitric oxide and nasal nitric oxide in control evaluation of bronchial asthma and diagnosis of allergic rhinitis in children / 中国当代儿科杂志

OBJECTIVES@#To study the association of fractional exhaled nitric oxide (FeNO) and nasal nitric oxide (nNO) with asthma control and their value in the diagnosis of allergic rhinitis in children.@*METHODS@#A total of 186 children aged 5-12 years, who attended the outpatient service of the Department of Respiration, Shanghai Children's Hospital due to bronchial asthma and/or allergic rhinitis or who underwent physical examination, were enrolled as subjects, with 52 children in the asthma group, 60 children in the asthma+allergic rhinitis group, 36 children in the allergic rhinitis group, and 38 children in the control group. FeNO, nNO, and pulmonary function were compared between groups.@*RESULTS@#The asthma+allergic rhinitis, asthma, and allergic rhinitis groups had a significantly higher level of FeNO than the control group (P<0.05). The asthma+allergic rhinitis and allergic rhinitis groups had a significantly higher level of nNO than the asthma and control groups (P<0.05). The uncontrolled asthma and partially controlled asthma groups had significantly higher levels of FeNO and nNO than the completely controlled asthma group (P<0.05). The receiver operating characteristic (ROC) curve analysis showed that nNO had an area under the ROC curve of 0.91, with a sensitivity of 80.0% and a specificity of 89.5% in the diagnosis of allergic rhinitis in children with asthma (P<0.05).@*CONCLUSIONS@#The combined measurement of nNO and FeNO can be used to evaluate the control of asthma, and the measurement of nNO can help with the diagnosis of allergic rhinitis in children with bronchial asthma.

Research progress in the application of impulse oscillometry and fractional exhaled nitric oxide in idiopathic pulmonary fibrosis / 中国医师杂志

Impulse oscillometry (IOS) and exhaled nitric oxide fraction determination (FeNO) are two detection methods to evaluate lung function, which can provide important functional information not captured in standardized lung function tests. These two methods may be promising disease assessment and detection tools for idiopathic pulmonary fibrosis (IPF). Therefore, it is necessary to standardize IOS and FeNO methods. This paper reviews the research progress of IOS and FeNO in IPF, and discusses the limitations of these two detection methods and their application value in IPF.

The predictive value of serum EOS ％ and FeNO in stable phase of COPD for the therapeutic effect of glucocorticoids / 中国医师杂志

Objective To investigate the predictive value of peripheral blood eosinophil percentage (EOS％) and exhaled nitric oxide (FeNO) on the efficacy of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD) at stable stage.Methods A total of 78 patients with stable COPD during the outpatient clinic from January 2017 to December 2018 were enrolled.EOS％,FeNO,and pulmonary function indicators [forced vital capacity (FVC),forced expiratory volume in 1 sec (FEV1),peak expiratory flow (PEF)] were measured after ICS-free elution.The questionnaire was used to assess the severity of the symptoms.The above indicators were reviewed after 4 weeks of ICS treatment.According to the improvement of pulmonary function and chronic obstructive pulmonary disease assessment (CAT) improvement,the patients were divided into effective and ineffective groups.Pearson correlation analysis and receiver operating characteristic (ROC) curve were used to analyze the predictive value of EOS％ and FeNO for ICS.Results After ICS treatment,EOS％ and FeNO were lower,FVC,FEV1,and PEF were higher than before,and CAT score was lower than before (P ＜ 0.05).There was a positive correlation between EOS％ and FeNO levels before treatment and the FEV1 improvement (r =0.412,0.397,P ＜ 0.05),and no correlation with the improvement of FVC,PEF and CAT scores (P ＞ 0.05).The FeNO level in the effective group was higher than that in the ineffective group before and after ICS treatment,with statistically significant difference (P ＜ 0.05).The pre-treatment EOS％ level and post-treatment EOS％were not significantly different between the two groups (P ＞ 0.05);the area under the ROC curve for EOS％ prediction of ICS efficacy before treatment was 0.531 (P ＞0.05),with critical value 3.13％,the sensitivity 57.1％ and specificity 52.4％,respectively.The area under the ROC curve of FeNO for ICS treatment before treatment was 0.628 (P ＜ 0.05),with critical value 30.00％,sensitivity and specificity (64.6％ and 91.0％) respectively.Conclusions For patients with stable COPD,EOS％ and FeNO levels are positively correlated with the improvement of FEV1 after ICS treatment.Both of them can predict the efficacy of ICS to a certain extent,and FeNO has higher predictive value than EOS％,which can be applied to clinical practice.

Serum levels of interleukin-18, interleukin-33 and fractional exhaled nitric oxide in children with acute respiratory syncytial virus bronchiolitis / 中国医师进修杂志

Objective To observe the changes of interleukin-18 (IL-18),interleukin-33 (IL-33) and fractional exhaled nitric oxide (FeNO) in children with acute respiratory syncytial virus (RSV) bronchiolitis,and explore the potential mechanism of the transformation from acute RSV bronchiolitis to recurrent wheezing.Methods Fifty-three children with RSV bronchiolitis (RSV bronchiolitis group),32 children with repeated wheeze (repeated wheeze group) and 30 children receiving regular physical examination (healthy control group) from January 2016 to January 2017 in Cangzhou People's Hospital of Hebei Province were selected.The serum IL-18 and IL-33 at the time of inclusion and 2,3 months after inclusion were detected by enzyme linked immunosorbent assay,the FeNO at the same time was detected by multiple breathing technique,and the indexes were compared.The correlation between FeNO and IL-33,IL-18 was analyzed by Spearman method.Results The IL-18 at the time of inclusion and 2,3 months after inclusion in RSV bronchiolitis group and repeated asthmatic group were significantly higher than those in healthy control group:(10.89 ± 1.54) and (14.86 ± 5.54) ng/L vs.(7.26 ± 3.25) ng/L,(13.74 ± 4.16) and (15.45 ± 5.75) ng/L vs.(7.28 ± 3.56) ng/L,(11.38 ± 6.21) and (14.86 ± 5.28) ng/L vs.(7.18 ± 3.41) ng/L,those in repeated asthmatic group were significantly higher than those in RSV bronchiolitis group,and there were statistical differences (P＜0.05).The IL-33 levels at the time of inclusion and 2,3 months after inclusion in RSV bronchiolitis group and repeated asthmatic group were significantly higher than those in healthy control group:(17.68 ± 5.25) and (13.14 ± 5.01) ng/L vs.(3.69 ± 1.61) ng/L,(15.68 ± 4.16) and (15.11 ± 5.24) ng/L vs.(3.28 ± 1.56) ng/L,(13.87 ± 6.21) and (14.11 ± 5.14) ng/L vs.(3.18 ± 1.41) ng/L,IL-33 levels at the time of inclusion in RSV bronchiolitis group were significantly higher than those in repeated asthmatic group,and there were statistical differences (P＜0.05).The FeNO levels at the time of inclusion and 2,3 months after inclusion in repeated asthmatic group were significantly higher than those in RSV bronchiolitis group and healthy control group:(13.14 ± 4.47) ppb vs.(1.89 ± 1.54) and (7.26 ± 4.25) ppb,(14.75 ± 5.15) ppb vs.(7.74 ± 4.16) and (7.28 ± 4.12) ppb,(13.68 ± 5.62) ppb vs.(11.38 ± 6.21) and (7.18 ± 3.41) ppb;compared with that in healthy control group,FeNO at the time of inclusion in RSV bronchiolitis group was significantly decreased,and at 3 months was significantly increased,and there were statistical differences (P＜0.05).Correlation analysis result showed that FeNO at 2 and 3 months after inclusion in RSV bronchiolitis group had positive correlation with IL-18 level at the time of inclusion and 2,3 months after inclusion (P＜0.05),and negative correlation with IL-33 (P＜0.05);FeNO at 2 and 3 months after inclusion in repeated asthmatic group showed positive correlation with IL-18 at the same time (P＜0.05),and was negatively correlated with IL-33 level (P＜0.05);there was no correlation between FeNO and IL-18,IL-33 in healthy control group (P＞0.05).Conclusions IL-18 and IL-33 may be involved in the pathogenesis of acute RSV bronchiolitis and recurrent wheezing,and the concentration of IL-18 and IL-33 is correlated with the level of FeNO.Its potential mechanism needs further study.

Current status of asthma control and influencing factors of occupational sensitizer-induced asthma / 中国职业医学

OBJECTIVE: To investigate the asthma control status of occupational sensitizer-induced asthma(OSIA) and explore the influencing factors. METHODS: A total of 50 OSIA patients were selected as study subjects by judgment sampling method. Asthma Control Test(ACT) and Asthma Quality of Life Questionnaire were used to investigate the asthma control status and the quality of life of patients. The fractional exhaled nitric oxide(FeNO) level, pulmonary function, peripheral blood eosinophil ratio(EOS%)and serum total immunoglobulin E(IgE) level of the patients were measured. RESULTS: Among the 50 cases of OSIA patients, 27(54.0%) cases were well controlled, and 23(46.0%) cases were non-fully controlled. The patients with allergic rhinitis, with no inhaled corticosteroids treatment and with poor compliance were risk factors of the non-fully controlled OSIA(all P<0.05). The scores of ACT and the quality of life, and the percentage of the first second forced expiratory volume(FEV_1%) decreased(all P<0.05), while the level of FeNO increased(P<0.05) in the non-fully controlled group compare with the well-controlled group. There was no statistical significance in EOS% and serum total IgE level between the two groups(both P>0.05).CONCLUSION: Allergic rhinitis, lack of inhaled corticosteroids treatment and poor compliance are the influencing factors that affect the control of OSIA. The combinational scores of ACT and quality of life, FeNO, FEV_1% and other indicators can reflect the status of OSIA and assess the level of asthma control, and help guiding OSIA diagnosis and treatment plans.

Effects of Indoor Air Purifiers on Children with Asthma

PURPOSE: To evaluate the effects of air purifiers on the concentrations of indoor air pollutants and on asthma control in children.MATERIALS AND METHODS: In this randomized crossover trial, daily use of an air purifier filter was compared with a matched placebo with the filter off. Thirty elementary school students who had asthma were enrolled and randomly allocated to one of two groups. The primary endpoints were changes in indoor air quality, asthma severity, lung function, airway inflammatory, urine microbiome, and phthalate after the installation of air purifiers. PM(2.5) and CO₂ were measured as indoor air pollutants. Asthma severity was assessed in terms of both symptom and medication scores acquired using a daily questionnaire. The higher the score, the better the symptom or the less frequent the use of medication. Peak expiratory flow rate and fractional exhaled nitric oxide were also measured.RESULTS: The mean age of the enrolled patients was 9.2±1.98 years. The mean concentration of PM2.5 was 17.0 µg/m³ in the filter-off condition, but significantly lower at 9.26 µg/m³ in the filter-on condition. Medication scores were 6.9 for the filter-off and 7.12 for the filter-on conditions, reflecting a statistically significant decrease in the frequency of medications used during air purifier operation. Bacterial richness, as determined using the Chao 1 index, was markedly lower in the filter-on than the filter-off condition.CONCLUSION: This study suggests that air purifiers benefit medication burden in children with asthma by reducing PM(2.5) levels.

Monitoring metrics for short-term exposure to ambient ozone and pulmonary function and airway inflammation in healthy young adults / 北京大学学报(医学版)

OBJECTIVE@#To assess the associations of different monitoring metrics for short-term exposure to ambient ozone (O3) with pulmonary function and airway inflammation in healthy young adults.@*METHODS@#A total of 97 healthy young college students were recruited and followed in a panel study conducted from December 2017 to June 2018. Each participant underwent 3 follow-up visits, and lung function and fractional exhaled nitric oxide (FeNO) were measured at each visit. Ambient air pollutant concentrations were obtained from the environment monitoring station of Beijing closest to the participant residences, and meteorological data were collected from China Meteorological Data Service Center. Linear mixed-effect models were applied to assess the associations between different monitoring metrics for ambient O3 short-term exposure with pulmonary function or airway inflammation in the healthy young adults.@*RESULTS@#During the study period, the P50 (P25, P75) values for ambient O3 concentration expressed as daily 1-hour maximum (O3-1 h max), daily maximum 8-hour average (O3-8 h max) and 24-hour average (O3-24 h avg) were 102.5 (76.8, 163.0) μg/m3, 91.1 (68.3, 154.3) μg/m3 and 61.6 (36.9, 81.7) μg/m3, respectively. The different monitoring metrics for short-term exposure to ambient O3 were significantly associated with reduced forced expiratory volume in the first second (FEV1) and increased FeNO. An interquartile range (IQR) increase in 6-d moving average of O3-1 h max (IQR=71.5 μg/m3) was associated with a 6.2% (95%CI: －11.8%, －0.5%) decrease in FEV1 and a 63.3% (95%CI: 13.8%, 134.3%) increase in FeNO. An IQR increase in 7-d moving average of O3-8 h max (IQR=62.0 μg/m3) was associated with a 6.2% (95%CI: －11.6%, －0.7%) decrease in FEV1and a 75.5% (95%CI: 19.3%, 158.0%) increase in FeNO. An IQR increase in 5-d moving average of O3-24 h avg (IQR=32.9 μg/m3) was associated with a 3.7% (95%CI: －7.1%, －0.2%) decrease in FEV1and a 25.3% (95%CI: 3.6%, 51.6%) increase in FeNO. There was no significant association between the three monitoring metrics for O3 exposure and peak expiratory flow (PEF).@*CONCLUSION@#Short-term exposure to ambient O3 was associated with decreased lung function and increased airway inflammation among the healthy young adults, and daily 1-hour maximum was more sensitively to the respiratory effects of O3.

Exhaled Nitric Oxide in Patients with Stable Chronic Obstructive Pulmonary Disease: Clinical Implications of the Use of Inhaled Corticosteroids / 결핵

Best time for detecting experiment of fractional exhaled nitric oxide in young wheezing children / 中华实用儿科临床杂志

Objective To study the correlation between fractional exhaled nitric oxide (FeNO) and lung function in young children for acute attack of wheezing,and to compare the FeNO in different stages in order to explore the best suitable time for the experiment of FeNO in young children by the method of on-line tidal breathing.Methods Recurrent wheezing children aged 1-5 year old were selected who were underwent the test at lung function laboratory from January 2016 to March 2018,at Guangzhou Women and Children's Medical Center.The children aged less than 5 years old were detected for FeNO in both stages of acute exacerbation and 2 weeks after treatment,and the children aged less than 3 years were also detected for the tidal lung function in the acute exacerbation stage.According to time ratio of reaching tidal peak flow to total expiratory time(TPTEF/TE) and ratio of volume at tidal peak flow to total tidal volume (VPEF/VE),the children aged less than 3 years were divided into 4 groups (normal group,mild group,moderate group and severe group).Results The FeNO of the normal group [9.85 (5.17,19.62) ppb] and mild group[13.00 (7.00,23.30) ppb] were significantly higher than that of the severe group [3.10 (2.20,5.25)ppb],and the differences were statistically significant (all P ＜ 0.05).And there was a positive correlation between TPTEF/TE and FeNO(r =0.304,P ＜ 0.05),VPEF/VE and FeNO(r =0.320,P ＜ 0.05),tidal volume per kilogram (VT/kG) and FeNO(r =0.293,P ＜ 0.05)and a negative correlation between respiration rate(RR) and FeNO (r =-0.449,P ＜ 0.05).The FeNO in the stage of acute exacerbation was significantly lower than that in the stage of 2 weeks after treatment[(10.49± 8.49) ppb vs.(20.41 ± 9.13) ppb],and there was a significant difference among them(t =-5.79,P ＜ 0.01).Conclusions If researchers want to use the method of on-line breathing to test FeNO in young children with wheezing,they should choose the time of 2 weeks after treatment,and analyze the results combined with the lung function.

Diagnostic value study of fractional exhaled nitric oxide (FeNO) in infants with recurrent wheezing / 国际儿科学杂志

Objective To analyze the correlation between the fractional exhaled nitric oxide (FeNO) levels and blood eosinophil (EOS) count and the frequency of wheeze in infants with recurrent wheezing.Methods From February 2015 to August 2016 in the General Hospital of Northern War Zone,outpatient department of Pediatrics treatment and hospitalization of age less than or equal to 3 year old children with recurrent wheezing,101 cases were induded as the research object.On the basis of asthma predictive index (API) score were divided into API positive group (n =55) and API negative group (n =46),according to the wheeze frequency of the two groups children were divided into 3 ～ 4 times wheezing groups and more than 5 times.Select 37 cases of healthy children as control group.The concentration of FeNO and blood EOS count are detected in all the children.The correlation between the three groups of children with FeNO concentration,the correlation between FeNO and blood EOS count,the correlation between the the frequency of wheeze and FeNO in experimental groups were analyzed.Results (1) API positive group mean FeNO (19.3 ± 6.2) ppb was significantly higher than API negative group (7.7 ± 2.9) ppb,there was no difference (P ＞ 0.05).API negative group mean FeNO (7.7 ± 2.9) ppb is lower than the normal control group (9.5 ± 2.0) ppb,there was no difference (P ＞0.05).(2) API positive group mean EOS count (124.7 ± 1.6) x 106/L is higher than API negative group (86.1 ± 1.9) x 106/L,there was significant difference (P ＜ 0.01);(3) There was a correlation between FeNO level and blood EOS count in API positive group,there was no correlation between FeNO level and blood EOS count in API negative group and con~ol group.(4) No statistical differences were found in ≤4 times wheezing groups and more than 5 times of the mean FeNO.Conclusion There is no significant difference in the mean value of FeNO between different times of wheezing in children with recurrent wheezing.The combination of medical history,EOS,FeNO and API might be used to predict the wheezing episode of infants.

Application of fractional exhaled nitric oxide in stepped treatment of chronic persistent asthma / 第二军医大学学报

[Abstract] Objective To explore the feasibility of fractional exhaled nitric oxide (FeNO) dynamic changes in guiding stepped treatment of patients with chronic persistent asthma. Methods From Jan. 2016 to Dec. 2017, chronic persistent asthma patients, who were admitted to Shanghai Dahua Hospital of Xuhui District, were enrolled and randomly divided into study and control groups. All patients were given standardized treatment according to Global Initiative for Asthma in 2014 (GINA 2014) and evaluated every 3 months to adjust their medications. The control group was adjusted according to the recommended protocol from GINA 2014, while the study group was adjusted according to the results of FeNO on the basis of the recommended protocol from GINA 2014. All patients were followed for 1 year. The complete control rate, failure rate of de-escalation treatment, Asthma Control Questionnaire (ACQ) score and lung function were compared between the two groups. Results Atotal of 207 patients were enrolled in this study, including 103 cases in the control group and 104 cases in the study group. The condition of the patients was effectively controlled in both study and control groups. There were no significant differences in total control rate, ACQ score or lung function between the two groups (all P0.05), while the failure rate of de-escalation therapy was significantly lower in the study group than that in the control group (7.28% [11/151] vs 13.66% [25/183], P0.05). In addition, the doses of controlled drugs and short-acting on-demand remission drugs in 4-6 months, 7-9 months and 10-12 months were significantly less in the study group than those in the control group (all P 0.05). Conclusion In the treatment of chronic persistent asthma, the dynamic monitoring of FeNO can effectively guide the medication, decrease the failure rate of treatment, and reduce the doses of controlled drugs and short-acting on-demand remission drugs.

Usefulness of bronchodilator response as an index of asthma control in children

PURPOSE: Assessing asthma control is important for proper management, and various indices for objective assessment of asthma control, such as fractional exhaled nitric oxide (FeNO) and asthma control test (ACT) score have been proposed. Recently, bronchodilator response (BDR) was reported as a marker of poor asthma control in adults. This study aimed to assess the usefulness of BDR as a biomarker for childhood asthma. METHODS: A total of 305 children diagnosed with asthma were included. Spirometry with bronchodilator test was done at the time of diagnosis and about 14 months after asthma treatment. All children were evaluated by childhood asthma control test (c-ACT) and FeNO after asthma treatment. The patients were divided into 2 groups according to BDR results: the positive and negative BDR groups. Various biomarkers for asthma control, such as c-ACT, FeNO and changes of forced expiratory volume in 1 second (FEV1), were compared between the 2 groups. RESULTS: Of the 305 patients, 143 (46.9%) were positive and 162 (53.1%) were negative for BDR. The BDR-positive group showed lower FEV1. In the BDR positive group, FEV1 was significantly increased after asthma treatment, especially in children with airflow limitation which was defined as below 80% of FEV1 or atopy. In atopic children, BDR showed a significant negative correlation with c-ACT and a positive correlation with FeNO. CONCLUSION: In asthmatic children with airflow limitation at the time of diagnosis, BDR can be a useful index for predicting improvement in lung function by asthma maintenance treatment. BDR could be a reliable marker for the assessment of asthma control in atopic children.

Exposure to Microbial Contaminants in Metalworking Fluids (MWF) and the Fractional Exhaled Nitric Oxide (FeNO) Levels among Machining Industry Workers

Abstract@#Introduction: Water based Metalworking fluids (MWF) are commonly used in machining industries and are excellent media for microorganism growth. The study aimed at determining the relationship between the airway inflammation as indicated by fractional exhaled nitric oxide (FeNO) with the microbial contaminants of MWF in aerosol and bulk sample as well as the workers’ reported respiratory health symptoms. Methods: This cross sectional study was carried out on 138 machining workers. Their FeNO were measured using NIOX-MINO instrumentation. The microbial assessments of bacteria and fungus were carried out on the MWF bulk samples and the aerosol using a sampler DUO SAS SUPER 360TM. Results: Findings showed significant difference in the FeNO levels in workers from various job sections (p=0.01). Significant relationships found between high FeNO levels with their closeness to the machines (p=0.03), high number of machines in the workplaces (p=0.02), high environmental bacteria colonies (p=0.04), longer employment years (p<0.001) and more frequent cough reported (p=0.03). Conclusion: Risk factors in the workplace which contributed to higher airway inflammation include their short distance and high number of machines, high environmental bacteria colonies in aerosol and bulk samples as well as longer employment years. Exposures to MWF had also resulted in significantly increased coughing among the respondents.

Best time for detecting experiment of fractional exhaled nitric oxide in young wheezing children / 中华实用儿科临床杂志

Objective@#To study the correlation between fractional exhaled nitric oxide (FeNO) and lung function in young children for acute attack of wheezing, and to compare the FeNO in different stages in order to explore the best suitable time for the experiment of FeNO in young children by the method of on-line tidal breathing.@*Methods@#Recurrent wheezing children aged 1-5 year old were selected who were underwent the test at lung function laboratory from January 2016 to March 2018, at Guangzhou Women and Children′s Medical Center.The children aged less than 5 years old were detected for FeNO in both stages of acute exacerbation and 2 weeks after treatment, and the children aged less than 3 years were also detected for the tidal lung function in the acute exacerbation stage.According to time ratio of reaching tidal peak flow to total expiratory time(TPTEF/TE )and ratio of volume at tidal peak flow to total tidal volume (VPEF/VE), the children aged less than 3 years were divided into 4 groups (normal group, mild group, moderate group and severe group).@*Results@#The FeNO of the normal group[9.85(5.17, 19.62) ppb] and mild group[13.00(7.00, 23.30) ppb] were significantly higher than that of the severe group [3.10(2.20, 5.25) ppb], and the differences were statistically significant(all P<0.05). And there was a positive correlation between TPTEF/TE and FeNO(r=0.304, P<0.05), VPEF/VE and FeNO(r=0.320, P<0.05), tidal volume per kilogram(VT/kG)and FeNO(r=0.293, P<0.05)and a negative correlation between respiration rate(RR)and FeNO(r=-0.449, P<0.05). The FeNO in the stage of acute exacerbation was significantly lower than that in the stage of 2 weeks after treatment[(10.49±8.49) ppb vs.(20.41±9.13) ppb], and there was a significant difference among them(t=-5.79, P<0.01).@*Conclusions@#If researchers want to use the method of on-line breathing to test FeNO in young children with wheezing, they should choose the time of 2 weeks after treatment, and analyze the results combined with the lung function.

Re-evaluation of the diagnostic value of fractional exhaled nitric oxide & its impact in patients with asthma

Background & objectives: The diagnostic value of fractional exhaled nitric oxide (FeNO) in patients with asthma remains controversial. This study was aimed to re-evaluate the diagnostic value of FeNO in specific groups with asthma and identify potential factors associated with FeNO. Methods: FeNO measurement and bronchial provocation test (BPT) or bronchodilator test (BDT) were performed in patients with suggestive symptoms for asthma. Correlation analysis was performed, and receiver-operating characteristic (ROC) curves and area under the curve (AUC) were calculated to evaluate the accuracy of FeNO in diagnosis. Results: A total of 265 (66.3%) patients with asthma were identified in 400 individuals suspected to have asthma from October 2014 to June 2015. Positive correlations of gender (r=0.138, P=0.005), atopy (r=0.598, P <0.001) and rhinitis (r=0.485, P <0.001) but negative correlations of age (r=?0.220, P <0.001) and the cumulative methacholine dosage with a 20 per cent decrease in forced expiratory volume in one second (r=?0.197, P <0.001) with FeNO were found. AUC of FeNO in whole population and patients with atopy and rhinitis was 0.728 [95% confidence interval (CI) 0.675-0.781, P <0.001] and 0.752 (95% CI 0.640-0.865, P <0.001), while the cut-offs were 23.5 and 44.5 parts per billion (ppb), respectively, rendering sensitivities, specificities, positive predictive value and negative predictive value of 79.9, 54.7, 77.9, 58.1 and 78.7, 67.9, 89.2 and 48.7 per cent, respectively. The cut-off of FeNO with specificity of 90 per cent (FeNO90) for all patients and a sub-group of patients with atopy and rhinitis was 59.5 and 90.5 ppb, respectively, while FeNO90decreased by 12 ppb with every 10 years. Interpretation & conclusions: Our findings show that the diagnostic value of FeNO varies in different groups of patients with asthma, thus, the cut-off point should be adjusted in different asthmatic sub-populations. A cut-off point of FeNO with a specificity >90 per cent could decrease the false-positive rate.

Study of the early diagnosis and treatment of bronchiectasis combined with chronic obstructive pulmonary disease / 中国医师进修杂志

Objective To assess the influence and early diagnosis treatment of bronchiectasis using severity score in patients with chronic obstructive pulmonary disease (COPD) combined with bronchiectasis. Methods Sixty patients with bronchiectasis in stable stage were selected from July 2016 to August 2017. The patients were divided into simple bronchiectasis group (32 cases) and bronchiectasis combined with COPD group (28 cases). The general clinical features, chest high-resolution CT (HRCT), pulmonary function, fractional exhaled nitric oxide (FENO) and bronchiectasis severity score between 2 groups were compared. The changes of the indexes 6 months after treatment with inhaled salmeterol fluticasone (50 μg/250 μg) in bronchiectasis combined with COPD group were observed. Results The bronchiectasis severity score and FENO in bronchiectasis combined with COPD group were significantly higher than those in simple bronchiectasis group: (4.82 ± 0.91) scores vs. (2.88 ± 0.83) scores and (39.04 ± 9.57) nmol/L vs. (28.66 ± 6.12) nmol/L, and there were statistical differences (P＜0.01). The forced expired volume in one second as a percentage of expected value (FEV1% Pred) and forced vital capacity as a percentage of expected value (FVC%Pred) in bronchiectasis combined with COPD group were significantly lower than those in simple bronchiectasis group: (61.36 ± 5.23)% vs. (71.28 ± 6.67)% and (61.57 ± 7.60)% vs. (72.84 ± 7.19)% , and there were statistical differences (P＜0.01). In bronchiectasis combined with COPD group, there were statistical differences in the bronchiectasis severity score, FEV1% Pred, FVC% Pred and FENO 6 months after treatment with inhaled salmeterol fluticasone and before treatment (P＜0.05). There was a negative correlation between FEV1% Pred and bronchiectasis severity score before and after treatment (r＝-0.802 and-0.618, P＜0.05); and there was a positive correlation between the FENO and bronchiectasis severity score (r ＝ 0.728 and 0.586, P＜0.05). Conclusions The pathogenetic condition of bronchiectasis combined with COPD is severe compared with simple bronchiectasis. Inhaled salmeterol fluticasone is effective in patients with bronchiectasis combined with COPD.

Association between Respirable Dust Exposure and Respiratory Health among Cement Workers

@#Introduction: Cement industry contributes to the major constituent of airborne dust in the atmosphere. This study aims to determine the level of respirable cement dust exposure associated with workers’ respiratory health. A cross-sectional study was carried out among 84 administration workers as the comparative group and 84 manufacturing workers as the exposed group. Method: A set of validated questionnaires was used to obtain some pertained background information as well as respiratory symptoms among the respondents. Personal Air Sampling Pump was used for assessing personal exposure towards cement dust in 8 hours. For lung function performance, a Spirometry test was carried out and Fractional Exhaled Nitric Oxide (FENO) test was conducted to assess airway inflammation. Results: The median for personal exposure level to respirable dust of manufacturing workers was 2.68 (5.90) mg/ m3 with range 0.351 to 10.60 mg/m3. The lung function abnormality among the manufacturing workers was FVC% (PR=3.82, 95% CI=1.52-9.58) and FEV1% (PR=5.16, 95% CI=1.65-16.10). Cough was reported to occur the most likely among the manufacturing workers (PR=2.40, 95% CI=1.12-5.15). After adjusting the smoking status, the prevalence of phlegm and cough were 35.7% and 29.8% respectively. 16.7% of manufacturing workers recorded a high level of FENO. The increasing exposure to respirable dust significantly reduces the FVC% of manufacturing workers (r=-0.36, p=0.05). Conclusion: The personal exposure to respirable cement dust increases the risk of lung impairment by highly developing respiratory health symptoms, reducing lung function level and increasing the higher level of airway inflammation among highly exposed workers.