FENO在慢咳诊疗中的应用ppt课件

FeNO在慢性咳嗽诊疗中的应用,提纲,咳嗽常见，病因复杂，部分慢咳与过敏性炎症相关FeNO评价气道炎症简单易行、安全无创FeNO有助于慢性咳嗽的诊断和鉴别诊断FeNO有助于慢性咳嗽的诊断性治疗,因咳嗽就诊者占呼吸专科门诊患者的80以上,1.邓伟吾.国外医学呼吸系统分册.2005;25(1):70-2.2.Pratter MR, et al. Ann Internal Med.1993;119:977-83.3.Schroeder K, et al. Br Med J.2002;324(7333):329-31.,咳嗽的病理生理基础,任慈芳 中国实用儿科杂志 2004；19（12）：717-719,慢性咳嗽各种症状和病因重叠使诊断困难,C,E,G,A,B,慢性咳嗽病因复杂、鉴别诊断困难,Eur Respir J 2004; 24: 481-492,Chest. 2013 Mar;143(3):613-20.,慢性咳嗽病因分布,痰中嗜酸粒细胞(%),CVA/EB患者痰嗜酸粒细胞水平高于其他慢性咳嗽及正常人群,Birring SS et al. Am J Reapir Crit Care Med, 2004; 169: 15-19,0.3,4.2,0.3,0,0.4,0.8,1.2,1.6,2.0,2.4,2.8,3.2,3.6,4.0,CVA/EB,非哮喘性慢性咳嗽,不明原因慢性咳嗽,慢性咳嗽患者气道嗜酸粒细胞水平升高分布,4.4,正常,0.3,p30为界，诊断哮喘性慢咳的敏感性和特异性为75%和87%,38例慢性咳嗽患者。8例支气管哮喘患者的FeNO明显高于30例非哮喘患者及对照组。对于慢性咳嗽患者FeNO水平低，诊断哮喘的可能性很低。,Chatkin JM, et al. Am J Respir Crit Care Med., 1999 Jun;159(6):1810-3.,FeNO (ppb),117例慢咳患者，其中哮喘（14例）及EB（14例）FeNO中位水平均显著高于其他病因患者（82例）。哮喘及EB患者痰EOS与FeNO均相关（分别r=0.576 、r=0.493，均P0.05）,当FeNO的值40% increase from previous stable FeNO level. Chronic cough and/or wheeze and/or shortness of breath for 6 weeks. For example, rhinosinusitis, bronchiectasis, primary ciliary dyskinesia, anxiety-hyperventilation, cardiac disease, GERD, or vocal cord dysfunction. Dweik et al. Am J Respir Crit Care Med. 2011;184(5):602-615.3, Smith AD, Cowan JO, Filsell S, et al. Diagnosing asthma. Comparisons between exhaled nitric oxide measurements and conventional tests. Am j Respir Crit Care Med 2004;169:473-84, Smith AD, Cowan JO, Brassett KP, et al. Exhaled nitric oxide. A predictor of steroid response. Am J Respir Crit Care Med 2005;172:453e9,EMD/000585/00,NPV92% ,PPV82% ,小结,FeNO可作为嗜酸粒细胞性气道炎症相关慢性咳嗽病因（EB、