哮喘合并鼻炎儿童的呼出气一氧化氮的临床研究

doi:10.3969/j.issn.1674-8115.2023.06.003

上海交通大学学报（医学版） ›› 2023, Vol. 43 ›› Issue (6): 673-679.doi: 10.3969/j.issn.1674-8115.2023.06.003

• 儿童哮喘专题 • 上一篇

哮喘合并鼻炎儿童的呼出气一氧化氮的临床研究

李鹏云¹(), 戴银芳¹, 陆燕红¹, 于兴梅¹, 徐丽娜¹, 第五建峰², 郝创利¹()

^1.苏州大学附属儿童医院呼吸科，苏州 215002
^2.陕西省旬邑县人民医院儿科，旬邑 711300

收稿日期:2023-02-28 接受日期:2023-06-01 出版日期:2023-06-28 发布日期:2023-06-28
通讯作者: 郝创利 E-mail:1214215251@qq.com;hcl_md@163.com
作者简介:李鹏云（1998—），女，住院医师，硕士生；电子信箱：1214215251@qq.com。
基金资助:
苏州市科技发展计划医疗器械与新医药（临床试验）-医工结合协同创新研究项目(SLJ201905);伊犁哈萨克自治州科技计划项目(yl2020lh03);伊犁州直医疗卫生类科技计划项目(YZ2021YD029);苏州市“临床医学专家团队”引进项目(SZYJTD201806)

Clinical study of exhaled nitric oxide in children with asthma and allergic rhinitis

LI Pengyun¹(), DAI Yinfang¹, LU Yanhong¹, YU Xingmei¹, XU Lina¹, DI Wujianfeng², HAO Chuangli¹()

^1.Department of Respiratory, Children's Hospital of Soochow University, Suzhou 215002, China
^2.Department of Pediatrics, Xunyi County Hospital, Shaanxi Province, Xunyi 711300, China

Received:2023-02-28 Accepted:2023-06-01 Online:2023-06-28 Published:2023-06-28
Contact: HAO Chuangli E-mail:1214215251@qq.com;hcl_md@163.com
Supported by:
Suzhou Science and Technology Development Plan Medical Device and New Medicine (Clinical Trial)-Medical and Industrial Cooperation Innovation Research Project(SLJ201905);Yili Kazak Autonomous Prefecture Science and Technology Plan Project(yl2020lh03);Medical and Health Science and Technology Plan Projects Directly under Ili Prefecture(YZ2021YD029);Suzhou "Clinical Medicine Expert Team" Introduction Project(SZYJTD201806)

摘要/Abstract

摘要：

目的·分析哮喘（asthma，AS）合并变应性鼻炎（allergic rhinitis，AR）儿童在AS不同临床分期下不同AR严重程度时的鼻呼出气一氧化氮（fractional concentration of nasally exhaled nitric oxide，FnNO）、口呼出气一氧化氮（fractional concentration of exhaled nitric oxide，FeNO）水平，为指导临床诊治提供依据。方法·纳入2021年4月至11月期间于苏州大学附属儿童医院呼吸科确诊为AS合并AR的儿童，选取同期至儿保科正常体检的健康儿童作为对照组。所有入组儿童均行FeNO、FnNO、外周血嗜酸细胞（eosinophil，EOS）检测，以评估患儿的病情严重程度。对比分析AS合并AR的儿童在AS不同临床分期下不同AR严重程度时的FeNO、FnNO水平及其与肺功能的相关性。结果·哮喘急性发作期儿童中鼻炎持续中重度的比例更高，哮喘临床缓解期儿童中的鼻炎间歇轻度比例更高。哮喘急性发作期的FeNO值高于慢性持续期、临床缓解期（调整后P=0.022、P=0.000），慢性持续期高于临床缓解期（调整后P=0.002）；哮喘急性发作期FnNO值高于临床缓解期（调整后P=0.044）。哮喘慢性持续期中，鼻炎持续轻度组及持续中重度组的FnNO水平高于间歇轻度组（调整后P=0.001、P=0.000）。在临床缓解期中，鼻炎持续轻度组及持续中重度组的FnNO水平高于间歇轻度组（调整后P=0.001、P=0.007）。在鼻炎间歇轻度组中，急性发作期的FnNO高于慢性持续期及临床缓解期（调整后P=0.010、P=0.019）。哮喘急性发作期的部分肺功能指标与FeNO、FnNO水平具有一定负相关性（均P<0.05），而慢性持续期的FEV₁/pred 与FeNO水平具有一定负相关性（P=0.010）。结论·AS急性发作期儿童的FeNO、FnNO水平更高，且AR症状积分更高；AS合并AR儿童的FeNO、FnNO水平与肺功能指标呈负相关。

关键词: 哮喘, 变应性鼻炎, 呼出气一氧化氮, 儿童

Abstract:

Objective ·To determine the levels of nasally exhaled nitric oxide (FnNO) combined with fractional concentration of exhaled nitric oxide (FeNO) in children with asthma (AS) complicated with allergic rhinitis (AR), and analyze the levels of FnNO and FeNO in different clinical stages of AS with different severities of AR, so as to provide basis for guiding clinical diagnosis and treatment. Methods ·Children diagnosed with AR with AS in the Department of Respiratory and Otolaryngology of Children's Hospital of Soochow University from April 2021 to November 2021 were included, and healthy children who visited the Department of Pediatrics for normal physical examination during the same period were enrolled as the control group. FeNO and FnNO were measured in all children to assess the severity of the children's diseases. The levels of FeNO and FnNO in children with AR and AS at different clinical stages of AS and their correlation with pulmonary function were compared and analyzed. Results ·The proportion of persistent moderate-to-severe rhinitis was higher in the acute exacerbation stage of AS, and the proportion of intermittent mild rhinitis was higher in the clinical remission stage of AS. The FeNO level in the acute exacerbation stage were higher than that in the chronic persistent stage and clinical remission stage of AS (adjusted P=0.022, 0.000), and higher in the chronic persistent stage than that in the clinical remission stage of AS (adjusted P=0.002). The FnNO level in the acute exacerbation stage was higher than that in the clinical remission stage of AS (adjusted P=0.044). In the chronic persistent stage of AS, the FnNO levels in the persistent mild group and persistent moderate-to-severe control group were higher than those in the intermittent mild group (adjusted P=0.001, 0.000). In the clinical remission stage of AS, the FnNO levels in the persistent mild group and persistent moderate to severe control group were higher than those in the intermittent mild group (adjusted P=0.001, 0.007). In the intermittent mild group of AR, the FnNO levels in the acute exacerbation stage were higher than those in the chronic persistent stage and clinical remission stage of AS (adjusted P=0.010, 0.019). Part of pulmonary functions in the acute exacerbation stage of AS children were negatively correlated with the FeNO and FnNO levels (all P<0.05), while FEV₁/pred in the chronic persistent stage was negatively correlated with FeNO level (P=0.010). Conclusion ·FeNO and FnNO levels increased in the acute exacerbation stage of AS, and symptom scores of AR also increased. FeNO and FnNO levels were negatively correlated with pulmonary function in AS with AR children.

Key words: asthma (AS), allergic rhinitis (AR), exhaled nitric oxide, children

中图分类号:

李鹏云, 戴银芳, 陆燕红, 于兴梅, 徐丽娜, 第五建峰, 郝创利. 哮喘合并鼻炎儿童的呼出气一氧化氮的临床研究[J]. 上海交通大学学报（医学版）, 2023, 43(6): 673-679.

LI Pengyun, DAI Yinfang, LU Yanhong, YU Xingmei, XU Lina, DI Wujianfeng, HAO Chuangli. Clinical study of exhaled nitric oxide in children with asthma and allergic rhinitis[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(6): 673-679.

图/表 5

参考文献 29

1	COMPALATI E, RIDOLO E, PASSALACQUA G, et al. The link between allergic rhinitis and asthma: the united airways disease[J]. Expert Rev Clin Immunol, 2010, 6(3): 413-423.
2	SAMITAS K, CARTER A, KARIYAWASAM H H, et al. Upper and lower airway remodelling mechanisms in asthma, allergic rhinitis and chronic rhinosinusitis: the one airway concept revisited[J]. Allergy, 2018, 73(5): 993-1002.
3	MENER D J, LIN S Y. Improvement and prevention of asthma with concomitant treatment of allergic rhinitis and allergen-specific therapy[J]. Int Forum Allergy Rhinol, 2015, 5(Suppl 1): S45-S50.
4	中华儿科杂志编辑委员会, 中华医学会儿科学分会呼吸学组, 中国医师协会儿科医师分会儿童呼吸专业委员会. 儿童支气管哮喘规范化诊治建议(2020年版)[J]. 中华儿科杂志, 2020, 58(9): 708-717.
	The Editorial Board, Chinese Journal of Pediatrics, the Subspecialty Group of Respiratory Diseases, the Society of Pediatrics, Chinese Medical Association, the Children's Respiratory Professional Committee, the Society of Pediatrics of Chinese Medical Doctor Association. Recommendations for diagnosis and management of bronchial asthma in children (2020)[J]. Chinese Journal of Pediatrics, 2020, 58(9): 708-717.
5	《中华耳鼻咽喉头颈外科杂志》编辑委员会鼻科组,中华医学会耳鼻咽喉头颈外科学分会鼻科学组、小儿学组,《中华儿科杂志》编辑委员会. 儿童变应性鼻炎诊断和治疗的专家共识 (2010年,重庆)[J]. 中华儿科杂志, 2011, 49(2): 116-117.
	The Subspecialty Group of Rhinology, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery, Subspecialty Group of Rhinology and Pediatrics, Dociety of Otprhinolaryngology Head and Neck Surgery, Chinese Medical Association, Editorial Board of Chinese Journal of Pediatrics. Guidelines for diagnosis and treatment of pediatric allergic rhinitis(2010, Chongqing)[J]. Chinese Journal of Pediatrics, 2011, 49(2): 116-117.
6	DWEIK R A, BOGGS P B, ERZURUM S C, et al. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FeNO) for clinical applications[J]. Am J Respir Crit Care Med, 2011, 184(5): 602-615.
7	ANTOSOVA M, MOKRA D, PEPUCHA L, et al. Physiology of nitric oxide in the respiratory system[J]. Physiol Res, 2017, 66(Suppl 2): S159-S172.
8	RIMMER J, HELLINGS P, LUND V J, et al. European position paper on diagnostic tools in rhinology[J]. Rhinology, 2019, 57(Suppl S28): 1-41.
9	LIPWORTH B, KUO C R, CHAN R. 2020 updated asthma guidelines: clinical utility of fractional exhaled nitric oxide (FeNO) in asthma management[J]. J Allergy Clin Immunol, 2020, 146(6): 1281-1282.
10	CINELLI M A, DO H T, MILEY G P, et al. Inducible nitric oxide synthase: regulation, structure, and inhibition[J]. Med Res Rev, 2020, 40(1): 158-189.
11	MATSUNAGA K, KUWAHIRA I, HANAOKA M, et al. An official JRS statement: the principles of fractional exhaled nitric oxide (FeNO) measurement and interpretation of the results in clinical practice[J]. Respir Investig, 2021, 59(1): 34-52.
12	吴琳琳, 黄晗, 叶乐平. 学龄期儿童哮喘检测呼出气一氧化氮、肺功能及外周血嗜酸性粒细胞的价值[J]. 临床肺科杂志, 2021, 26(10): 1501-1506.
	WU L L, HUANG H, YE L P. Value of exhaled nitric oxide,pulmonary function and peripheral blood eosinophils in school-age children with asthma[J]. Journal of Clinical Pulmonary Medicine, 2021, 26(10): 1501-1506.
13	王婧婧. 呼出气一氧化氮检测在儿童支气管哮喘中的应用[J]. 健康大视野, 2020(15): 8.
	WANG J J. Fractional exhaled nitric oxide for childhood bronchial asthma[J]. Healthy Vision, 2020(15): 8.
14	MOELLER A, CARLSEN K H, SLY P D, et al. Monitoring asthma in childhood: lung function, bronchial responsiveness and inflammation[J]. Eur Respir Rev, 2015, 24(136): 204-215.
15	MENZIES-GOW A, MANSUR A H, BRIGHTLING C E. Clinical utility of fractional exhaled nitric oxide in severe asthma management[J]. Eur Respir J, 2020, 55(3): 1901633.
16	XIE Z C, CHAI M R, GU W Q, et al. Changes in fractional exhaled nitric oxide, exhaled carbon monoxide and pulmonary function during the acute attack, treatment and remission phases of pediatric asthma[J]. Transl Pediatr, 2020, 9(6): 784-794.
17	KONRADSEN J R, SKANTZ E, NORDLUND B, et al. Predicting asthma morbidity in children using proposed markers of Th2-type inflammation[J]. Pediatr Allergy Immunol, 2015, 26(8): 772-779.
18	MOGENSEN I, ALVING K, JACINTO T, et al. Simultaneously elevated FeNO and blood eosinophils relate to asthma morbidity in asthmatics from NHANES 2007-12[J]. Clin Exp Allergy, 2018, 48(8): 935-943.
19	DE GOUW H W, HENDRIKS J, WOLTMAN A M, et al. Exhaled nitric oxide (NO) is reduced shortly after bronchoconstriction to direct and indirect stimuli in asthma[J]. Am J Respir Crit Care Med, 1998, 158(1): 315-319.
20	HO L P, WOOD F T, ROBSON A, et al. The Current single exhalation method of measuring exhales nitric oxide is affected by airway calibre[J]. Eur Respir J, 2000, 15(6): 1009-1013.
21	VAN MUYLEM A, MALINOVSCHI A, HACCURIA A, et al. Exhaled nitric oxide and its predictive power related to lung function and bronchial inflammation[J]. Biochem Pharmacol, 2020, 179: 114101.
22	HACCURIA A, VAN MUYLEM A, MALINOVSCHI A, et al. Small airways dysfunction: the link between allergic rhinitis and allergic asthma[J]. Eur Respir J, 2018, 51(2): 1701749.
23	CRYSTAL-PETERS J, NESLUSAN C, CROWN W H, et al. Treating allergic rhinitis in patients with comorbid asthma: the risk of asthma-related hospitalizations and emergency department visits[J]. J Allergy Clin Immunol, 2002, 109(1): 57-62.
24	CORREN J, MANNING B E, THOMPSON S F, et al. Rhinitis therapy and the prevention of hospital care for asthma: a case-control study[J]. J Allergy Clin Immunol, 2004, 113(3): 415-419.
25	ADAMS R J, FUHLBRIGGE A L, FINKELSTEIN J A, et al. Intranasal steroids and the risk of emergency department visits for asthma[J]. J Allergy Clin Immunol, 2002, 109(4): 636-642.
26	KHAN D A. Allergic rhinitis and asthma: epidemiology and common pathophysiology[J]. Allergy Asthma Proc, 2014, 35(5): 357-361.
27	BOUSQUET J, ANTO J M, BACHERT C, et al. Allergic rhinitis[J]. Nat Rev Dis Primers, 2020, 6(1): 95.
28	RICCA V, LANDI M, FERRERO P, et al. Minimal persistent inflammation is also present in patients with seasonal allergic rhinitis[J]. J Allergy Clin Immunol, 2000, 105(1 Pt 1): 54-57.
29	GREVE J M, DAVIS G, MEYER A M, et al. The major human rhinovirus receptor is ICAM-1[J]. Cell, 1989, 56(5): 839-847.

Item	Acute exacerbation stage (n=33)	Chronic persistent stage (n=32)	Clinical remission stage (n=34)	H/χ²	P value
Age/year	7.48±2.43	8.31±3.48	6.50 (5.00, 9.00)	1.329	0.514
Gender (male/female)/n(%)	24 (72.7)/9 (27.3)	24 (75.0)/8 (25.0)	21 (61.8)/13 (38.2)	1.582	0.453
Height/cm	129.00 (115.00, 139.50)	134.16±20.34	125.00 (117.75, 134.88)	1.369	0.504
Weight/kg	26.00 (20.50, 32.00)	28.00 (19.25, 43.00)	24.50 (21.00, 30.50)	0.475	0.789
Different severity of rhinitis/n(%)				9.644	0.047
Intermittent mild	10 (30.3)	14 (43.8)	21 (61.8)
Persistent mild	11 (33.3)	13 (40.6)	8 (23.5)
Persistent moderate-to-severe	12 (36.4)	5 (15.6)	5 (14.7)

Item	Acute exacerbation stage (n=33)	Chronic persistent stage (n=32)	Clinical remission stage (n=34)	H/χ²	P value
Age/year	7.48±2.43	8.31±3.48	6.50 (5.00, 9.00)	1.329	0.514
Gender (male/female)/n(%)	24 (72.7)/9 (27.3)	24 (75.0)/8 (25.0)	21 (61.8)/13 (38.2)	1.582	0.453
Height/cm	129.00 (115.00, 139.50)	134.16±20.34	125.00 (117.75, 134.88)	1.369	0.504
Weight/kg	26.00 (20.50, 32.00)	28.00 (19.25, 43.00)	24.50 (21.00, 30.50)	0.475	0.789
Different severity of rhinitis/n(%)				9.644	0.047
Intermittent mild	10 (30.3)	14 (43.8)	21 (61.8)
Persistent mild	11 (33.3)	13 (40.6)	8 (23.5)
Persistent moderate-to-severe	12 (36.4)	5 (15.6)	5 (14.7)

Item	Acute exacerbation stage (n=33)	Chronic persistent stage (n=32)	Clinical remission stage (n=34)	H/F	P value
EOS proportion/%	3.97±2.80	5.42±2.69	3.55 (2.13, 5.88)	5.437	0.066
EOS count/(×10⁹·L^-1)	3.40 (1.95, 5.45)	0.42±0.20	0.29 (0.19, 0.48)	1.916	0.384
FeNO/ppb	45.00 (31.50, 56.00)^①②	27.00 (13.25, 45.75)^③	12.50 (9.00, 17.25)	38.861	0.000
FnNO/ppb	664.03±244.13^④	573.22±261.69	516.29±224.41	3.128	0.048

Item	Acute exacerbation stage (n=33)	Chronic persistent stage (n=32)	Clinical remission stage (n=34)	H/F	P value
EOS proportion/%	3.97±2.80	5.42±2.69	3.55 (2.13, 5.88)	5.437	0.066
EOS count/(×10⁹·L^-1)	3.40 (1.95, 5.45)	0.42±0.20	0.29 (0.19, 0.48)	1.916	0.384
FeNO/ppb	45.00 (31.50, 56.00)^①②	27.00 (13.25, 45.75)^③	12.50 (9.00, 17.25)	38.861	0.000
FnNO/ppb	664.03±244.13^④	573.22±261.69	516.29±224.41	3.128	0.048

Item	Different severities of rhinitis			F value	P value
Item	Intermittent mild (n=45)	Persistent mild (n=32)	Persistent moderate-to-severe (n=22)	F value	P value
Different stages of asthma
Acute exacerbation stage (n=33)	596.70±211.16	614.27±243.68	765.75±255.02	1.725	0.195
Chronic persistent stage (n=32)	373.86±190.12^①	678.77±171.15^②	857.00±222.23^③	15.709	0.000
Clinical remission stage (n=34)	405.05±140.56^④	693.38±287.44^⑤	700.20±46.19^⑥	10.730	0.000
F value	5.510	0.347	0.643
P value	0.008	0.710	0.537

哮喘合并鼻炎儿童的呼出气一氧化氮的临床研究

Clinical study of exhaled nitric oxide in children with asthma and allergic rhinitis

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 5

参考文献 29

相关文章 15

编辑推荐

Metrics

Item	Acute exacerbation stage		Chronic persistent stage		Clinical remission stage
Item	r value	P value	r value	P value	r value	P value
FEV₁/pred/%	-0.393	0.024	-0.451	0.010	-0.321	0.064
FVC/pred/%	-0.477	0.005	-0.279	0.122	-0.184	0.298
FEV₁/FVC/pred/%	-0.015	0.936	-0.308	0.086	-0.324	0.061
PEF/pred/%	-0.367	0.036	-0.050	0.786	0.065	0.714
MEF₇₅/pred/%	-0.154	0.392	-0.197	0.279	-0.304	0.081
MEF₅₀/pred/%	-0.323	0.066	-0.329	0.066	-0.261	0.135
MEF₂₅/pred/%	-0.243	0.174	-0.320	0.074	-0.095	0.592
MMEF_75/25/pred/%	-0.358	0.041	-0.266	0.141	-0.248	0.158

[1]	温亚锦, 何雯, 韩晓, 张晓波. 不同严重程度支气管哮喘儿童肠道菌群差异的探索性分析[J]. 上海交通大学学报（医学版）, 2023, 43(6): 655-664.
[2]	王颖雯, 李小玲, 代佳佳, 刘芳, 黄剑峰, 王立波, 张晓波, 冯瑞. 儿童重症支气管哮喘的流行病学特征及危险因素：一项单中心前瞻性队列研究[J]. 上海交通大学学报（医学版）, 2023, 43(6): 665-672.
[3]	胡煜, 谢亮, 邹丹, 伏洪玲, 娄丽丽, 谢柯祺, 刘瀚旻. 孟鲁司特对哮喘中白三烯B4代谢的影响[J]. 上海交通大学学报（医学版）, 2023, 43(5): 580-591.
[4]	徐晓君, 叶敏捷, 王玉城, 王文霞, 钱胜, 叶丹弟, 潘乐乐, 胡欣, 尹晓莉, 李美花, 林光耀. 儿童首发精神分裂症患者和正常儿童前脉冲抑制的对照研究[J]. 上海交通大学学报（医学版）, 2023, 43(5): 606-610.
[5]	徐瀛濂, 田静, 张翔, 赵顺英. 气道上皮细胞在哮喘发病机制中的作用研究进展[J]. 上海交通大学学报（医学版）, 2023, 43(5): 619-623.
[6]	姜静, 卞勇, 郑吉建, 黄悦. 狭颅症儿童颅骨修补术中出血量的影响因素[J]. 上海交通大学学报（医学版）, 2023, 43(4): 453-458.
[7]	朱思宇, 董晓艳. 哮喘儿童小气道功能障碍的再认识[J]. 上海交通大学学报（医学版）, 2023, 43(4): 500-506.
[8]	邓云天, 熊文魁, 朱芮, 刘恩梅, 李雪梅, 钟朝晖. 生命早期环境因素暴露与儿童哮喘关系的病例对照研究[J]. 上海交通大学学报（医学版）, 2023, 43(1): 44-51.
[9]	罗雯懿, 陈琳, 袁理, 倪平, 蔡小满, 章雅青. 3~6岁先天性心脏病患儿术后心脏康复水平及其相关因素的Rasch分析[J]. 上海交通大学学报（医学版）, 2022, 42(9): 1303-1310.
[10]	李雯, 李苑, 叶海昀, 张笑笑, 乔彤, 李嫔. 1型糖尿病儿童眼底黄斑区早期微血管变化的观察[J]. 上海交通大学学报（医学版）, 2022, 42(9): 1311-1314.
[11]	户宜, 丁国栋. 上海地区学龄前儿童对羟基苯甲酸酯类物质暴露与肺功能的相关性研究[J]. 上海交通大学学报（医学版）, 2022, 42(8): 1103-1109.
[12]	邢正文, 吴滢, 王雪莉, 王庆煜, 王文婷, 李治, 张彬, 金晶. 儿童CIC重排肉瘤的临床病理特征[J]. 上海交通大学学报（医学版）, 2022, 42(8): 1151-1157.
[13]	康文慧, 陈仪婷, 赵安达, 李荣, 李生慧. 褪黑素在哮喘发病和病程中的作用机制研究进展[J]. 上海交通大学学报（医学版）, 2022, 42(5): 667-672.
[14]	陈仪婷, 赵安达, 李荣, 康文慧, 李生慧. 循环外泌体微RNA在支气管哮喘中的作用综述[J]. 上海交通大学学报（医学版）, 2022, 42(3): 375-380.
[15]	邢正文, 吴滢, 王雪莉, 王庆煜, 王文婷, 李治, 张彬, 金晶. 8例儿童卵巢颗粒细胞瘤临床病理特征及预后分析[J]. 上海交通大学学报(医学版), 2022, 42(2): 192-196.

Item	Acute exacerbation stage		Chronic persistent stage		Clinical remission stage
Item	r value	P value	r value	P value	r value	P value
FEV₁/pred/%	-0.378	0.030	-0.291	0.107	-0.043	0.809
FVC/pred/%	-0.422	0.014	-0.01	0.957	0.073	0.682
FEV₁/FVC/pred/%	-0.063	0.729	-0.144	0.431	-0.149	0.402
PEF/pred/%	-0.421	0.015	-0.063	0.731	0.117	0.509
MEF₇₅/pred/%	-0.041	0.819	-0.208	0.254	-0.176	0.318
MEF₅₀/pred/%	-0.215	0.230	-0.096	0.602	-0.102	0.567
MEF₂₅/pred/%	-0.104	0.564	-0.064	0.729	-0.019	0.913
MMEF_75/25/pred/%	-0.194	0.278	-0.119	0.516	-0.058	0.747

Item	Acute exacerbation stage		Chronic persistent stage		Clinical remission stage
Item	r value	P value	r value	P value	r value	P value
FEV₁/pred/%	-0.378	0.030	-0.291	0.107	-0.043	0.809
FVC/pred/%	-0.422	0.014	-0.01	0.957	0.073	0.682
FEV₁/FVC/pred/%	-0.063	0.729	-0.144	0.431	-0.149	0.402
PEF/pred/%	-0.421	0.015	-0.063	0.731	0.117	0.509
MEF₇₅/pred/%	-0.041	0.819	-0.208	0.254	-0.176	0.318
MEF₅₀/pred/%	-0.215	0.230	-0.096	0.602	-0.102	0.567
MEF₂₅/pred/%	-0.104	0.564	-0.064	0.729	-0.019	0.913
MMEF_75/25/pred/%	-0.194	0.278	-0.119	0.516	-0.058	0.747