imikhiqizo

UKUSETSHENZISWA KOMTHOLAMPILO KWE-FENO ESEMFUMENI

Ukuhunyushwa kwe-Exhaled NO ku-asthma

indlela elula iye yahlongozwa ku-American Thoracic Society Clinical Practice Guideline ukuze kuchazwe i-FeNO:

• I-FeNO engaphansi kwama-25 ppb kubantu abadala futhi engaphansi kuka-20 ppb ezinganeni ezingaphansi kweminyaka engu-12 isho ukungabikho kokuvuvukala kwe-eosinophilic airway.
• I-FeNO enkulu kune-50 ppb kubantu abadala noma enkulu kune-35 ppb ezinganeni iphakamisa ukuvuvukala kwe-eosinophilic airway.
• Amanani e-FeNO aphakathi kuka-25 no-50 ppb kubantu abadala (20 kuya ku-35 ppb ezinganeni) kufanele ahunyushwe ngokucophelela ngokubhekisela esimweni somtholampilo.
• I-FeNO ekhuphukayo enoshintsho olukhulu kunamaphesenti angu-20 kanye nangaphezulu kuka-25 ppb (20 ppb ezinganeni) kusukela ezingeni elizinzile ngaphambilini iphakamisa ukwanda kokuvuvukala kwe-eosinophilic airway, kodwa kunomehluko obanzi phakathi kwabantu ngabanye.
• Ukwehla kwe-FeNO okukhulu kunamaphesenti angu-20 kumanani angaphezu kuka-50 ppb noma ngaphezulu kuka-10 ppb amanani angaphansi kuka-50 ppb kungase kubaluleke ngokomtholampilo.

Ukuxilongwa kanye nezimpawu ze-asthma

I-Global Initiative ye-Asthma yeluleka ngokumelene nokusetshenziswa kwe-FeNO ekuxilongweni kwesifuba somoya, njengoba ingase ingakhushulwanga ku-asthma ye-noneosinophilic futhi ingase iphakame ezifweni ngaphandle kwesifuba somoya, njenge-eosinophilic bronchitis noma i-rhinitis yokungezwani komzimba.

Njengomhlahlandlela wokwelashwa

Iziqondiso zamazwe ngamazwe ziphakamisa ukusebenzisa amazinga e-FeNO, ngaphezu kokunye ukuhlola (isb, ukunakekelwa komtholampilo, imibuzo) ukuze kuqondiswe ukuqaliswa kanye nokulungiswa kokwelashwa kwesilawuli se-asthma.

Sebenzisa ocwaningweni lomtholampilo

I-nitric oxide ekhishwayo inendima ebalulekile ocwaningweni lomtholampilo futhi cishe izosiza ekwandiseni ukuqonda kwethu isifuba somoya, njengezici ezibangela ukushuba kwesifuba somoya kanye neziza kanye nezindlela zokwenza imithi yesifuba somoya.

SEBENZISA KWEZINYE IZIFO ZOKUPHUMELELA

I-Bronchiectasis kanye ne-cystic fibrosis

Izingane ezine-cystic fibrosis (CF) zinamazinga e-FeNO aphansi kunezilawuli ezifaniswe ngokufanelekile.Ngokuphambene, ucwaningo olulodwa lwathola ukuthi iziguli ezine-non-CF bronchiectasis zazinamazinga aphakeme e-FeNO, futhi la mazinga ayehlotshaniswa nezinga lokungajwayelekile elibonakala esifubeni se-CT.

I-Interstitial Lung Disease kanye ne-sarcoidosis

Ocwaningweni lweziguli ezine-scleroderma, i-NO ekhishwe kakhulu yaphawulwa phakathi kweziguli ezine-interstitial lung disease (ILD) uma kuqhathaniswa nalezo ezingenayo i-ILD, kuyilapho okuphambene kwatholakala kolunye ucwaningo.Ocwaningweni lweziguli ezingama-52 ezine-sarcoidosis, inani eliphelele le-FeNO lalingu-6.8 ppb, elingaphansi kakhulu kwephuzu lokusika le-25 ppb elisetshenziselwa ukukhombisa ukuvuvukala kwesifuba somoya.

Isifo se-Chronic obstructive pulmonary

FE_NOamazinga aphakeme kancane ku-COPD ezinzile, kodwa angase ande ngesifo esibi nakakhulu nangesikhathi sokubhebhetheka.Ababhemayo bamanje banamazinga aphansi acishe abe ngamaphesenti angama-70 e-FeNO.Ezigulini ezine-COPD, amazinga e-FeNO angase abe usizo ekusunguleni ukuba khona kokuvinjelwa kokugeleza komoya okubuyisela emuva nokunquma ukuphendula kwe-glucocorticoid, nakuba lokhu kungazange kuhlolwe ekuhlolweni okukhulu okungahleliwe.

I-asthma ehlukile

I-FENO inokunemba okusesilinganisweni kokuxilonga ekubikezeleni ukuhlonzwa kwe-cough variant asthma (CVA) ezigulini ezinokukhwehlela okungapheli.Ekubuyekezweni okuhlelekile kwezifundo eziyi-13 (iziguli zango-2019), ibanga elifanelekile lokunqanyulwa kwe-FENO lalingama-30 kuye kwangama-40 ppb (nakuba amanani aphansi aphawulwe ezifundweni ezimbili), futhi indawo efingqiwe ngaphansi kwejika yayingu-0.87 (95% CI, 0.83-0.89).Ukucaciswa bekuphakeme futhi kuhambisana kakhulu kunokuzwela.

I-Nonasthmatic eosinophilic bronchitis

Ezigulini ezine-nonasthmatic eosinophilic bronchitis (NAEB), i-sputum eosinophils kanye ne-FENO akhuphuka ebangeni elifana neziguli ezinesifuba somoya.Ekubuyekezweni okuhlelekile kwezifundo ezine (iziguli ezingama-390) ezigulini ezinokukhwehlela okungapheli ngenxa ye-NAEB, amazinga aphezulu okunqanyulwa kwe-FENO ayengama-22.5 kuya ku-31.7 ppb.Ukuzwela okulinganiselwe kwakungu-0.72 (95% CI 0.62-0.80) nokucaciswa okulinganiselwe kwaba ngu-0.83 (95% CI 0.73-0.90).Ngakho, i-FENO iwusizo kakhulu ukuqinisekisa i-NAEB, kunokungayifaki.

Izifo eziphezulu zokuphefumula

Kwesinye isifundo seziguli ezingenaso isifo se-pulmonary, izifo ezibangelwa amagciwane eziphefumulayo zaholela ekwandeni kwe-FENO.

Umfutho wegazi ophakeme wamaphaphu

U-NO uqashelwa kahle njengomxhumanisi we-pathophysiologic ku-pulmonary arterial hypertension (PAH).Ngaphezu kwe-vasodilation, i-NO ilawula ukwanda kwamaseli e-endothelial kanye ne-angiogenesis, futhi igcina impilo yonke yemithambo.Kuyathakazelisa ukuthi iziguli ezine-PAH zinamanani aphansi e-FENO.

I-FENO ibonakala inokubaluleka kokubikezela, ngokusinda okuthuthukisiwe ezigulini ezinokukhuphuka kwezinga le-FENO ngokwelashwa (i-calcium channel blockers, epoprostenol, treprostinil) uma kuqhathaniswa nalabo abangenayo.Ngakho-ke, amazinga aphansi e-FENO ezigulini ezine-PAH kanye nokuthuthukiswa ngemithi ephumelelayo kuphakamisa ukuthi kungase kube i-biomarker ethembisayo yalesi sifo.

Ukungasebenzi kahle kwe-ciliary

I-NO yekhala iphansi kakhulu noma ayikho ezigulini ezine-primary ciliary dysfunction (PCD).Ukusetshenziswa kwe-NO yamakhala ukuze kuhlolwe i-PCD ezigulini ezinezinsolo zomtholampilo ze-PCD kuxoxwa ngazo ngokwehlukana.

Ezinye izimo

Ngaphandle komfutho wegazi ophakeme wamaphaphu, ezinye izimo ezihlobene namazinga aphansi e-FENO zihlanganisa i-hypothermia, ne-bronchopulmonary dysplasia, kanye nokusetshenziswa kotshwala, ugwayi, i-caffeine, nezinye izidakamizwa.