Orally exhaled nitric oxide levels are related to the degree of blood eosinophilia in atopic children with mild-intermittent asthma. M. Silvestri, D. Spallarossa, V. Frangova Yourukova, E. Battistini, B. Fregonese, G.A. Rossi. #ERS Journals Ltd 1999. ABSTRACT: Increased levels of nitric oxide have been found in expired air of patients with asthma, and these are thought to be related to the airway inflammatory events that characterize this disorder. Since, in adults, bronchial inflammatory changes are present even in mild disease, the present study was designed to evaluate whether a significant proportion of children with mild-intermittent asthma could have increased exhaled air NO concentrations.Twenty-two atopic children (aged 11.1 0.8 yrs) with mild-intermittent asthma, treated only with inhaled b 2 -adrenoreceptor agonists on demand and 22 age-matched controls were studied.NO concentrations in orally exhaled air, measured by chemiluminescence, were significantly higher in asthmatics, as compared to controls (19.4 3.3 parts per billion (ppb) and 4.0 0.5 ppb, respectively; p<0.01). Interestingly, 14 out of 22 asthmatic children had NO levels >8.8 ppb (i.e. >2 standard deviations of the mean in controls). In asthmatic patients, but not in control subjects, statistically significant correlations were found between exhaled NO levels and absolute number or percentage of blood eosinophils (r=0.63 and 0.56, respectively; p<0.01, each comparison). In contrast, exhaled NO levels were not correlated with forced expiratory volume in one second (FEV1) or forced expiratory flows at 25±75% of vital capacity (FEF25±75%) or forced vital capacity (FVC), either in control subjects, or in asthmatic patients (p>0.1, each correlation).These results suggest that a significant proportion of children with mild-intermittent asthma may have airway inflammation, as shown by the presence of elevated levels of nitric oxide in the exhaled air. The clinical relevance of this observation remains to be established. Eur Respir J 1999; 13: 321±326.

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Macleod/Swyer-James syndrome is an uncommon and complex disease characterized by roentgenographic hyperlucency of one lung or lobe due to loss of the pulmonary vascular structure and to alveolar overdistension. This syndrome seems to be an acquired disease that follows viral bronchiolitis and pneumonitis in childhood. It must be differentiated from many other causes of unilateral lung "transradiancy" on the chest roentgenogram, such as those related to congenital bronchial and/or vascular abnormalities. We here describe an 11-year-old patient with Macleod/Swyer-James syndrome and bronchiectasis resulting in severe recurrent bronchopulmonary infections. Despite the severe impairment of pulmonary function, the patient underwent resection of the right lung with progressive improvement of clinical and physiologic parameters.

C Co om mm mo on n v va ar ri ia ab bl le e i im mm mu un no od de ef fi ic ci ie en nc cy y p pr re es se en nt ti in ng g i in n a a g gi ir rl l a as s l lu un ng g i in nf fi il lt tr ra at te es s a an nd d m me ed di ia as st ti in na al l a ad de en no op pa at th hi ie es s l le ea ad di in ng g t to o s se ev ve er re e " "s su up pe er ri io or r v ve en na a c ca av va al l" " s sy yn nd dr ro om me e We describe the case of a girl, progressively developing CVID, whose first clinical manifestations were noninfectious diffuse pulmonary infiltrates and rapidly developing hilar and mediastinal lymphadenopathies causing a severe " "superior vena caval syndrome" ". Histological evaluation of surgical samples showed follicular and paracortical hyperplasia of the lymph nodes and poorly organized, non-necrotizing, noninfectious, " "reactive" " granulomata in lymph nodes and pulmonary tissue. Daily treatment with azathioprine and prednisone induced resolution of the intrathoracic abnormalities but was associated with a progressive decrease of circulating IgG and IgA levels and natural killer (NK) lymphocytes that was not related to treatment.This case demonstrates that granulomatous inflammatory changes may be the first manifestations of common variable immunodeficiency, and that this disorder must be included in the differential diagnosis of lymphoid interstitial pneumonitis and of bilateral mediastinal lymph node enlargement leading to superior vena caval syndrome.