Messung der Atemwegsentzündung in der pneumologischen Praxis - Anwendung und Interpretation

Zusammenfassung

Entzündungsprozesse sind sowohl beim Asthma als auch bei der COPD von wesentlicher Bedeutung. In der Praxis werden diese Erkrankungen häufig mit Kortikosteroiden behandelt. Eine Messung von Art und Ausmaß der Atemwegsentzündung im Rahmen der Diagnostik, Verlaufskontrolle und Optimierung der Therapie erfolgt aber meist nicht, obwohl mittlerweile eine Reihe von Studien belegen, dass Patienten von einer solchen Messung profitieren können. Bei vielen Atemwegserkrankungen ist die eosinophile Entzündung von besonderer Bedeutung. Sie findet sich nicht nur bei Allergen-induzierten Erkrankungen, sondern kann auch bei chronisch-obstruktiver Bronchitis, z. B. während einer Exazerbation, auftreten und spricht in der Regel gut auf eine Kortikosteroidbehandlung an. Frühzeitige Informationen über Art und Ausmaß einer Entzündung erleichtern deshalb nicht nur die differenzialdiagnostische Einordnung einer Erkrankung, sondern könnten auch den Behandlungserfolg steigern. Der nicht-invasive Nachweis einer eosinophilen Atemwegsentzündung mittels Sputuminduktion ist für den klinischen Alltag zu aufwendig. Eine eosinophile Entzündung korreliert aber gut mit der Konzentration des ausgeatmeten Stickstoffmonoxids. Für dessen Nachweis gibt es mittlerweile speziell für die klinische Praxis entwickelte Analysatoren, die es erlauben, durch eine sehr einfache, z. B. auch für Kinder geeignete Methode, innerhalb weniger Minuten eine Analyse durchzuführen. Im ersten Teil dieses Reviews sollen zunächst einige für die adäquate Interpretation von Stickstoffmonoxid-Werten in der täglichen Praxis wichtige Grundlagen erörtert werden. Ausgehend von den bisher zur Einschätzung der klinischen Wertigkeit der Stickstoffmonoxidanalyse publizierten Arbeiten sollen im zweiten Teil die klinischen Möglichkeiten und Grenzen der Methode diskutiert werden.

Abstract

Airway inflammation plays a major role in the pathology of both asthma and COPD and is the target of corticosteroid treatment. In daily routine practise, however, airway inflammation is still not often considered by pneumologists to support the diagnostic process or to aid in disease management, despite studies showing that patients could benefit. Eosinophilic airway inflammation is of special interest, as it is not restricted to allergen-induced airway diseases, and because it generally responds well to anti-inflammatory treatment with corticosteroids. Therefore, the early detection of this kind of underlying inflammatory process can have a positive impact on finding a diagnosis as well as for disease management. The non-invasive detection of eosinophilic airway inflammation using induced sputum is too time consuming and therefore too expensive in outpatient settings. As sputum eosinophils correlate with the concentration of exhaled nitric oxide (FeNO), its measurement could serve as a more economic alternative, especially as new small handheld analysers are available now, that allow the rapid FeNO analysis, even in children. This review will cover some basics and technical aspects of FeNO measurements, which should be known to correctly interprete results in clinical practise. In the second part, the clinical value and the limits of FeNO measurements, as well as the potential interpretation of results are discussed based on recently published literature.

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