TY -的T1 -使用分数呼出oxi氮de to guide step-down treatment decisions in patients with asthma: a systematic review and individual patient data meta-analysis JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.02150-2019 VL - 55 IS - 5 SP - 1902150 AU - Wang, Kay AU - Verbakel, Jan Y. AU - Oke, Jason AU - Fleming-Nouri, Alexander AU - Brewin, Josh AU - Roberts, Nia AU - Harada, Norihiro AU - Atsuta, Ryo AU - Takahashi, Kazuhisa AU - Mori, Kazutaka AU - Fujisawa, Tomoyuki AU - Shirai, Toshihiro AU - Kawayama, Tomotaka AU - Inoue, Hiromasa AU - Lazarus, Stephen AU - Szefler, Stanley AU - Martinez, Fernando AU - Shaw, Dominick AU - Pavord, Ian D. AU - Thomas, Mike Y1 - 2020/05/01 UR - //www.qdcxjkg.com/content/55/5/1902150.abstract N2 - Background High exhaled nitric oxide fraction (FENO) levels are associated with greater risk of asthma exacerbation. However, it is not clear how FENO can be used to guide safe reductions in inhaled corticosteroid (ICS) doses in asthma patients. This study assesses the ability of FENO to guide ICS reductions.Methods Systematic searching of electronic databases identified prospective observational studies and randomised controlled trials which recruited participants with mild-to-moderate asthma aged ≥12 years and measured FENO before reducing ICS. We performed multilevel mixed-effects logistic regression in relation to acute exacerbations and estimated each participant's exacerbation risk using our logistic regression model.Results We included data from seven out of eight eligible studies, representing 384 participants. ICS doses were halved in four studies and withdrawn in three studies. A baseline FENO measurement of ≥50 ppb was associated with increased risk of exacerbations (crude OR 3.14, 95% CI 1.41–7.00, p=0.005; adjusted OR 3.08, 95% CI 1.36–6.98, p=0.007) and corresponded to an estimated exacerbation risk cut-off of 15%. Reducing ICS when estimated exacerbation risk was <15% versus <10% would result in fewer patients remaining on the same ICS dose (40 (10.4%) out of 384 versus 141 (36.7%) out of 384), but similar proportions of patients avoiding exacerbations (222 (91.4%) out of 243, 95% CI 87.1–94.6% versus 311 (90.4%) out of 344, 95% CI 86.8–93.3%).Conclusion In patients with mild-to-moderate asthma, gradual ICS reduction when FENO is <50 ppb may help decrease ICS use without increasing exacerbations. Future research should aim to validate these findings in larger populations.In nonsmoking patients with mild-to-moderate well-controlled asthma, stepping down treatment when FENO is <50 ppb reduces prescribing of inhaled corticosteroids without increasing exacerbations http://bit.ly/2SKaxSt ER -