TY - JOUR T1 -使用部分呼出一氧化氮指导哮喘患者降压治疗决策:系统回顾和个体患者数据荟萃分析JF -欧洲呼吸杂志》乔和J - 10.1183/13993003.02150 -2019欧元六世- 55 - 5 SP - 1902150 AU -王,凯盟——Verbakel Jan y盟——好的,杰森盟——Fleming-Nouri亚历山大盟等,Josh AU -罗伯茨,Nia AU - Harada Norihiro盟——Atsuta盟,高桥良森一久，藤泽一隆，白井友之，川山俊博，井上友隆，拉扎勒斯，斯蒂芬，斯坦利，费尔南多，肖，多明尼，伊恩，d。高呼出性一氧化氮(FENO)水平与哮喘加重风险增加相关。然而，目前尚不清楚FENO如何用于指导哮喘患者吸入皮质类固醇(ICS)剂量的安全减少。本研究评估FENO引导ICS减少的能力。方法系统检索电子数据库，确定前瞻性观察性研究和随机对照试验，招募年龄≥12岁的轻中度哮喘患者，在减少ICS前测量FENO。我们进行了与急性加重相关的多水平混合效应logistic回归，并使用我们的logistic回归模型估计每个参与者的加重风险。我们收集了8项合格研究中的7项数据，代表384名参与者。四项研究中ICS剂量减半，三项研究中撤回。基线FENO测量值≥50 ppb与加重风险增加相关(粗比值比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 -