Nitric oxide in children with persistent asthma

Jentzsch, Nulma Souto; Bourgeois, M. Le; Blic, J. de; Scheinmann, P.; Waernessyckle, Serge; Camargos, Paulo Augusto Moreira

doi:10.2223/jped.1472

Cited by 7 publications

(8 citation statements)

References 18 publications

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“…Several groups have demonstrated a correlation between spirometric evidence of airway obstruction and elevated FeNO in children;(4) however, most studies have not shown any correlation between elevated FeNO and impairment of FEV 1 or FEV 1 /FVC. (28;29) In this study, we found no significant correlation between FeNO and any measurement of lung function at 6 or 8 years of age. This confirms the notion that FeNO measures a different aspect of atopic airway disease than spirometry, and is potentially a more sensitive test for allergic airway disease in this age group,(6;7;30) where the vast majority of asthmatic children have normal lung function.…”

Section: Discussioncontrasting

confidence: 64%

Fractional exhaled nitric oxide measurements are most closely associated with allergic sensitization in school-age children

Jackson

Virnig

Gangnon

et al. 2009

Journal of Allergy and Clinical Immunology

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Background Factors affecting fractional exhaled nitric oxide (FeNO) in early childhood are incompletely understood. Objective To examine the relationships between FeNO and allergic sensitization, total IgE, atopic dermatitis, rhinitis, asthma, and lung function (spirometry) in children. Methods Children at high-risk of asthma and other allergic diseases due to parental history were enrolled at birth and followed prospectively. FeNO was measured by online technique at ages 6 and 8 years. Relationships among FeNO, various atopic characteristics, and asthma were evaluated. Results Reproducible FeNO measurements were obtained in 64% (135 of 210) of 6 year old and 93% (180 of 194) of 8 year old children. There was seasonal variability in FeNO. Children with aeroallergen sensitization at age 6 and 8 years had increased levels of FeNO compared to those not sensitized [geometric mean (6 years, 10.9 vs. 6.7 ppb, p<0.0001; 8 years, 14.6 vs. 7.1 ppb, p<0.0001)]. FeNO was higher in children with asthma than in those without asthma at 8 years, but not 6 years of age (6 years, 9.2 vs. 8.3 ppb, p = 0.48; 8 years, 11.5 vs. 9.2 ppb, p = 0.03). At 8 years of age, this difference was no longer significant in a multivariate model that included aeroallergen sensitization (p=0.33). There were no correlations between FeNO and spirometric indices at 6 or 8 years of age. Conclusion These findings underscore the importance of evaluating allergen sensitization status when FeNO is used as a potential biomarker in the diagnosis and/or monitoring of atopic diseases, particularly asthma. Clinical Implications When FeNO is utilized as a biomarker for the diagnosis and/or monitoring of atopic diseases such as asthma, the presence or absence of allergic sensitization should be carefully considered. Capsule Summary This pediatric cohort study evaluates the relationships between FeNO and various atopic characteristics. The results suggest that allergic sensitization should be evaluated when FeNO is used as a biomarker in clinical or research settings.

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Section: Discussioncontrasting

confidence: 64%

Fractional exhaled nitric oxide measurements are most closely associated with allergic sensitization in school-age children

Jackson

Virnig

Gangnon

et al. 2009

Journal of Allergy and Clinical Immunology

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“…Among 18 patients (72%) treated with CI who had normal spirometric parameters, we found FeNO level of ≥20 ppb, regardless of the clinical control, similar to that observed by Jentzsch et al , 24 who analyzed 45 children and adolescents with persistent asthma, and by Kovesi et al 25 who have studied 1,135 students. Both studies found high levels of FeNO in patients with clinical and spirometric normality, which demonstrates that the normal respiratory function does not reflect the absence of inflammation in the airway and that, even with normal spirometric values, it is not possible to affirm that a patient has asthma adequately controlled.…”

Section: Discussionsupporting

confidence: 89%

Associação Entre a Fração Exalada De Óxido Nítrico E Dados Da Espirometria E O Controle Clínico Da Asma Em Crianças E Adolescentes

Salviano

Taglia-Ferre

Lisboa

et al. 2018

Rev. paul. pediatr.

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Objective: To evaluate the association between fraction of exhaled nitric oxide (FeNO) values and forced expiratory volume in the first second (FEV1) and the level of asthma control, as proposed by the Global Initiative for Asthma (GINA), in asthmatic children and adolescents attended at the National Institute of Women, Children and Adolescents Health Fernandes Figueira of Fundação Oswaldo Cruz (IFF/FIOCRUZ).Methods: This was a cross-sectional study, with a review of medical records of 90 asthmatics between 7 and 17 years old, who were followed up at the IFF/FIOCRUZ Asthma Outpatient Clinic and were referred to perform respiratory function tests (RFT)between March 2013 and September 2014. After classification according to GINA, patients performed complete spirometry and FeNO measurement. Subsequently, they were separated into two groups: regular and non-regular inhaled corticosteroid (ICS) use, regardless of the ventilatory pattern in spirometry. Results: The association between FEV1 values and the degree of asthma control according to GINA (p=0.001) was observed in all patients, regardless of ICS use, but there was no association between FEV1 and levels of FeNO.Conclusions: The correlation observed between GINA and FEV1 reinforces the importance of spirometry in the clinical follow-up of these patients. Although no association was found between the value of FeNO and the degree of asthma control and FEV1, FeNO may be an early method to detect airway inflammation, even before the symptoms and spirometric changes.

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“…Na prática clínica, a obtenção desses parâ-metros não é difícil; no entanto, o clínico deve estar atento à possibilidade de que a ausência desses sintomas não implica nem na normalização espirométrica nem na ausência de inflamação nas vias aéreas. Jentzsch et al 13 Um outro questionário, mais sucinto, está disponível para uso clínico. Trata-se do Teste de controle da asma (Asthma Control Test, ACT), cuja aplicação é mais simples do que a do PAQLQ-A por conter apenas cinco perguntas, com cinco alternativas de resposta para cada uma 17 .…”

Section: Avaliação Clínica E Qualidade De Vidaunclassified

“…Além disso, a FeNO correlaciona-se com o grau de hiperresponsividade brônquica (r = -0,64) 37 , a reversibilidade ao broncodilatador e atopia 7,10,13 . Jentzsch et al 13 avaliaram 45 crianças e adolescentes com asma persistente e constataram que a FeNO foi superior nas atópicas quando comparadas com aquelas não atópicas, a saber, 16,7 e 5,3 ppb, respectivamente (p < 0,01). Nesse estudo, chamam a atenção os valores elevados da FeNO em pacientes que apresentavam normalidade clínica e espirométrica.…”

Section: Avaliação Da Intensidade Do Processo Inflamatório Na Asmaunclassified

Assessing clinical and spirometric control and the intensity of the inflammatory process in asthma

Andrade¹,

Chatkin²,

Camargos³

2010

J Pediatr (Rio J)

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Objectives: To review the role of clinical assessment, quality of life assessment, spirometry, bronchial responsiveness test and inflammatory markers for asthma assessment. Sources: Search run on MEDLINE and LILACS.Summary of the findings: Clinical assessment aids with assessing asthma control and is widely recommended. However, patients may have airway inflammation and obstruction despite normal clinical findings. Spirometry quantifies the degree of airway obstruction and helps with diagnosis, while the bronchial responsiveness test may be indicated for when asthma is suspected but spirometry is normal. The results of assaying the inflammatory markers in exhaled breath condensate, induced sputum, bronchoalveolar lavage and bronchial biopsy specimens are abnormal in asthma patients, but these are complex techniques almost always restricted to research. Fractional exhaled nitric oxide (FeNO) is elevated in patients with asthma, is reproducible and noninvasive and reduces with treatment. Studies have investigated using FeNO to help with adjusting inhaled corticoid dosages, but the benefits are not clear. Conclusions:A range of different methods are needed to accurately assess disease control, all with their advantages and limitations. Clinical and functional assessment is useful for diagnosing asthma, but is of limited use for precisely evaluating the intensity of the inflammatory process in the airways. More randomized and controlled studies with adequate statistical power should be carried out to investigate the true utility of noninvasive inflammatory markers, especially FeNO, for asthma management.J Pediatr (Rio J). 2010;86(2):93-100: Asthma, inflammation, quality of life, bronchial hyperresponsiveness, nitric oxide, spirometry, exhaled breath condensate, induced sputum. ResumoObjetivos: Revisar o papel da avaliação clínica, da qualidade de vida, da espirometria, do teste de broncoprovocação e dos marcadores inflamatórios na avaliação da asma. Fonte dos dados: Pesquisa nas bases MEDLINE e LILACS. Síntese dos dados:A avaliação clínica auxilia na avaliação do controle da asma e é amplamente preconizada. No entanto, os pacientes podem apresentar obstrução e inflamação das vias aéreas a despeito da normalidade clínica. A espirometria quantifica o grau de obstrução das vias aéreas e auxilia no diagnóstico, enquanto a broncoprovocação pode ser indicada na suspeita de asma com espirometria normal. Já os marcadores inflamatórios do condensado do ar exalado, do escarro induzido e do lavado broncoalveolar, além dos fragmentos da biópsia brônquica, encontram-se alterados na asma e são métodos complexos, quase sempre restritos às pesquisas. A fração exalada de óxido nítrico (FeNO) é elevada nos pacientes com asma, reprodutível e não invasiva, reduzindo-se com o tratamento. O uso da FeNO como auxiliar no ajuste de doses do corticoide inalatório tem sido estudado, mas as vantagens ainda não estão claras. Conclusões:Vários métodos são necessários para avaliar de forma acurada o controle da asma, e todos têm vantagens...

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Nitric oxide in children with persistent asthma

Abstract: Results suggest that clinical and functional stability of asthma among atopic patients does not necessarily reflect an efficient control over the inflammatory process and a higher probability for recurrence after discontinuation of anti-inflammatory therapy.

Cited by 7 publications

References 18 publications

Fractional exhaled nitric oxide measurements are most closely associated with allergic sensitization in school-age children

Fractional exhaled nitric oxide measurements are most closely associated with allergic sensitization in school-age children

Associação Entre a Fração Exalada De Óxido Nítrico E Dados Da Espirometria E O Controle Clínico Da Asma Em Crianças E Adolescentes

Assessing clinical and spirometric control and the intensity of the inflammatory process in asthma

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