UKUSETSHENZISWA KWE-FENO NGOKWEMTHOLAMPILO KU-ASTHMA

Ukuhunyushwa kwe-NO ekhishwe umoya ku-asthma

Indlela elula iphakanyisiwe ku-American Thoracic Society Clinical Practice Guideline ukuze kuhunyushwe i-FeNO:

• I-FeNO engaphansi kwama-25 ppb kubantu abadala kanye nengaphansi kwama-20 ppb ezinganeni ezingaphansi kweminyaka eyi-12 ubudala isho ukungabikho kokuvuvukala komoya okubangelwa yi-eosinophilic.
• I-FeNO engaphezu kwama-50 ppb kubantu abadala noma engaphezu kwama-35 ppb ezinganeni iphakamisa ukuvuvukala komoya okubangela i-eosinophilic.
• Amanani e-FeNO aphakathi kuka-25 no-50 ppb kubantu abadala (20 kuya ku-35 ppb ezinganeni) kufanele ahunyushwe ngokucophelela ngokubhekisele esimweni sezokwelapha.
• Ukwanda kwe-FeNO okunoshintsho olungaphezu kwamaphesenti angama-20 kanye noshintsho olungaphezu kwama-25 ppb (20 ppb ezinganeni) kusukela ezingeni elalizinzile ngaphambili kusikisela ukwanda kokuvuvukala komgudu womoya i-eosinophilic, kodwa kunezinhlobo eziningi zomehluko phakathi kwabantu ngabanye.
• Ukwehla kwe-FeNO okungaphezu kwamaphesenti angama-20 ngamanani angaphezu kwama-50 ppb noma ngaphezu kwama-10 ppb ngamanani angaphansi kwama-50 ppb kungaba yinto ebalulekile emtholampilo.

Ukuxilongwa kanye nokuhlukaniswa kwesifo sofuba

I-Global Initiative for Asthma yeluleka ngokumelene nokusetshenziswa kwe-FeNO ekuxilongweni kwe-asthma, njengoba ingase ingakhuphuki ku-asthma engeyona i-osinophilic futhi ingase ikhuphuke ezifweni ezingezona i-asthma, njenge-eosinophilic bronchitis noma i-allergy rhinitis.

Njengesiqondiso sokwelapha

Iziqondiso zomhlaba wonke ziphakamisa ukusebenzisa amazinga e-FeNO, ngaphezu kwezinye izivivinyo (isb., ukunakekelwa kwezokwelapha, imibuzo) ukuqondisa ukuqaliswa nokulungiswa kokwelashwa kokulawula i-asthma.

Sebenzisa ocwaningweni lwezokwelapha

I-nitric oxide ekhishwayo inendima ebalulekile ocwaningweni lwezokwelapha futhi cishe izosiza ekwandiseni ukuqonda kwethu nge-asthma, njengezici ezibangela ukwanda kwe-asthma kanye nezindawo kanye nezindlela zokusebenza kwemithi ye-asthma.

SEBENZISA KWEZINYE IZIFO ZOKUPHEFUMULA

I-Bronchiectasis kanye ne-cystic fibrosis

Izingane ezine-cystic fibrosis (CF) zinamazinga aphansi e-FeNO kunezilawuli ezihambisana kahle. Ngokuphambene nalokho, olunye ucwaningo luthole ukuthi iziguli ezine-bronchiectasis engeyona i-CF zazinamazinga aphezulu e-FeNO, futhi la mazinga ahlobene nezinga lokungajwayelekile okubonakala esifubeni se-CT.

Isifo samaphaphu esingaphakathi kanye ne-sarcoidosis

Esifundweni seziguli ezine-scleroderma, kwaphawulwa i-NO ephezulu ekhishwayo phakathi kweziguli ezinesifo samaphaphu esingaphakathi kwe-interstitial (ILD) uma kuqhathaniswa nalabo abangenayo i-ILD, kanti okuphambene nalokho kwatholakala kwesinye isifundo. Esifundweni seziguli ezingu-52 ezine-sarcoidosis, isilinganiso se-FeNO sasingu-6.8 ppb, okungaphansi kakhulu kwephuzu elinqunyiwe lika-25 ppb elisetshenziselwa ukubonisa ukuvuvukala kwe-asthma.

Isifo samaphaphu esingapheli esivimbayo

FE_NOamazinga akhuphuka kancane ku-COPD ezinzile, kodwa anganda ngesifo esibi kakhulu nangesikhathi sokubhebhetheka. Ababhemayo bamanje banamazinga aphansi e-FeNO angaba ngu-70%. Ezigulini ezine-COPD, amazinga e-FeNO angasiza ekutholeni ukuba khona kokuvinjelwa komoya okuguqukayo kanye nokunquma ukuphendula kwe-glucocorticoid, yize lokhu kungazange kuhlolwe ezivivinyweni ezinkulu ezingahleliwe.

Uhlobo lokukhwehlela lwe-asthma

I-FENO inokunemba okulinganiselwe kokuxilonga ekubikezeleni ukuxilongwa kwe-asthma yohlobo lokukhwehlela (i-CVA) ezigulini ezinokukhwehlela okungapheli. Ekubuyekezweni okuhleliwe kwezifundo ezingu-13 (iziguli zika-2019), ububanzi obuhle kakhulu bokuqeda i-FENO babungu-30 kuya ku-40 ppb (yize amanani aphansi aphawulwe ezifundweni ezimbili), kanti indawo efingqiwe ngaphansi kwe-curve yayingu-0.87 (95% CI, 0.83-0.89). Ukucaca kwakuphakeme futhi kuvumelana kakhulu kunokuzwela.

I-bronchitis engahambisani ne-asthma

Ezigulini ezine-bronchitis ye-eosinophilic engeyona i-asthmatic (NAEB), ama-eosinophils e-sputum kanye ne-FENO anda ngobubanzi obufana neziguli ezine-asthma. Ekubuyekezweni okuhleliwe kwezifundo ezine (iziguli ezingu-390) ezigulini ezinokukhwehlela okungapheli ngenxa ye-NAEB, amazinga afanele okunqunywa kwe-FENO ayengu-22.5 kuya ku-31.7 ppb. Ukuzwela okulinganisiwe kwakungu-0.72 (95% CI 0.62-0.80) kanti ukucaciswa okulinganisiwe kwakungu-0.83 (95% CI 0.73-0.90). Ngakho-ke, i-FENO iwusizo kakhulu ekuqinisekiseni i-NAEB, kunokuyikhipha.

Izifo zokuphefumula eziphezulu

Kokunye ukuhlola kweziguli ezingenazo izifo zamaphaphu eziyisisekelo, ukutheleleka kwezifo zokuphefumula okuphezulu okubangelwa amagciwane kwaholela ekwandeni kwe-FENO.

Umfutho wegazi ophezulu wamaphaphu

I-NO iyaziwa kahle njengomlamuleli we-pathophysiologic ku-pulmonary arterial hypertension (PAH). Ngaphezu kokwanda kwemithambo yegazi, i-NO ilawula ukwanda kwamaseli e-endothelial kanye ne-angiogenesis, futhi igcina impilo yemithambo yegazi iyonke. Ngokuthakazelisayo, iziguli ezine-PAH zinenani eliphansi le-FENO.

Kubonakala sengathi i-FENO inokubaluleka kokubikezela, kanye nokusinda okuthuthukisiwe ezigulini ezinezinga le-FENO elikhuphukayo ngokwelashwa (ama-calcium channel blockers, i-epoprostenol, i-treprostinil) uma kuqhathaniswa nalabo abangenalo. Ngakho-ke, amazinga aphansi e-FENO ezigulini ezine-PAH kanye nokuthuthukiswa kokwelashwa okusebenzayo kusikisela ukuthi kungaba yi-biomarker ethembisayo yalesi sifo.

Ukungasebenzi kahle kwe-ciliary okuyinhloko

I-NO yamakhala iphansi kakhulu noma ayikho ezigulini ezine-primary ciliary dysfunction (PCD). Ukusetshenziswa kwe-NO yamakhala ukuhlola i-PCD ezigulini ezisolakala ukuthi zine-PCD kuxoxwa ngakho ngokwehlukana.

Ezinye izimo

Ngaphezu komfutho wegazi ophezulu wamaphaphu, ezinye izimo ezihambisana namazinga aphansi e-FENO zifaka phakathi i-hypothermia, kanye ne-bronchopulmonary dysplasia, kanye nokusetshenziswa kotshwala, ugwayi, i-caffeine, nezinye izidakamizwa.