Childhood asthma: exhaled nitric oxide in relation to clinical symptoms

Artlich, A.; Busch, Thilo; Lewandowski, K.; Jonas, S.; Gortner, Ludwig; Kj, Falke

doi:10.1183/09031936.99.13614029

Cited by 53 publications

(40 citation statements)

References 32 publications

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“…Unfortunately the number of patients presenting with acute exacerbation was too low to allow definitive conclusions to be drawn. However the trend observed is in agreement with the work of ARTLICH et al [19], who demonstrated that eNO was related to clinical symptoms in asthmatic children.…”

Section: Discussionsupporting

confidence: 93%

Elevated nitrite in breath condensates of children with respiratory disease

Formanek¹,

Inci²,

Lauener³

et al. 2002

European Respiratory Journal

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The aim of the study was to determine the differences in nitrite, in the exhaled breath condensates of healthy children and those children with asthma, cystic fibrosis (CF) and nonasthmatic, episodic cough.Breath condensates were obtained from 66 children (43 males:23 females, 3.1-16 yrs) and included 29 asthmatics, 12 clinically stable CF patients, 12 children with cough but not asthma and 13 healthy volunteers. The collected condensate was assayed colourimetrically using the Griess reaction to determine nitrite concentrations.Patients with CF (median: 5-95% percentiles; 2.02: 0.43-6.37 mM) or asthma (2.10: 0.63-5.45 mM) had significantly higher levels of nitrite compared to healthy subjects (0.41: 0.13-1.83 mM; pv0.05) or subjects with cough (0.75: 0.03-1.75 mM; pv0.05).Airway inflammation, as assessed by the nitrite in breath condensates, is present in children with asthma and cystic fibrosis, but not those children with nonasthmatic, episodic cough. Nitrite can be conveniently, cheaply and rapidly measured in breath condensates of children as young as 3 yrs of age, and may prove useful for the assessment of airway inflammation in children with respiratory disease.

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Section: Discussionsupporting

confidence: 93%

Elevated nitrite in breath condensates of children with respiratory disease

Formanek¹,

Inci²,

Lauener³

et al. 2002

European Respiratory Journal

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“…BARALDI et al [4] collected FENO from infants using a TB technique and found that levels were increased during exacerbations of wheeze and returned to values similar to healthy children after treatment with inhaled corticosteroids. There have been no reports of TB FENO in untreated wheezing infants when they are well, although TB levels have previously been found to discriminate between both children [18,19] and adults [17] with and without asthma. These studies are likely to have included more homogenous groups than in the present study.…”

Section: Discussionmentioning

confidence: 99%

Comparison of single-breath and tidal breathing exhaled nitric oxide levels in infants

Franklin¹,

Turner²,

Mutch³

et al. 2004

Eur Respir J

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The aim of this study was to compare two different methods, tidal breathing (TB) and single-breath (SB), for measuring fractional exhaled nitric oxide (FENO) in infants.FENO was measured in 71 infants with either recurrent wheeze (n=32), recurrent cough (n=16) or no symptoms (healthy, n=23) using both methods. For TB measurements five breaths were collected into a gas sampling bag (off-line reservoir sampling). The SB method was modified from the raised volume rapid thoracoabdominal technique. Agreement between the two methods was investigated and both methods were used to compare FENO in infants with and without symptoms.Flow dependence of SB FENO was demonstrated using two expiratory flows (11 and 40 mL?s -1 ). There was a moderate correlation (r=0.60) but poor agreement between levels using the TB and SB methods. A significant difference in FENO between healthy children and children with wheeze was found using the SB but not the TB method.Due to lower expiratory flow and reduced nasal nitric oxide contamination the singlebreath technique may be more sensitive than the tidal breathing method for detecting differences in exhaled nitric oxide between infants with and without respiratory symptoms. BARALDI et al. [4] showed that FENO measurements were raised in acutely wheezing infants and reduced to normal after inhaled steroid treatment, while the current authors have previously reported increased FENO in clinically stable infants with a history of wheeze [5]. Conversely, RATJEN et al. [6] reported that FENO was reduced in infants who presented with first-time wheezy bronchitis. These findings suggest that FENO may be able to differentiate between viralinduced and recurrent wheezing in infants.In infants FENO has been measured during tidal breathing (TB) [4,6,7] as well as using a modified single breath (SB) technique [5]. As infants are unable to actively cooperate with breath collections TB measurements seem to offer the simplest way to measure FENO in this age group. However, various important methodological issues, such as expiratory flow and nasal NO contamination, cannot be controlled during TB. The SB method controls for flow and excludes nasal NO contamination, however, it requires the child to be sedated and can only be performed with specialised equipment. The aim of the present study was to compare FENO in wheezy and healthy infants using both TB and SB methods. The current authors hypothesised that there would be a poor agreement but a good correlation between levels collected using the two methods. Furthermore, since most populations of wheezy infants are heterogenous and only a proportion are likely to have asthma, the authors hypothesised that, due to lower expiratory flows and reduced nasal NO contamination with the SB technique, it would be more sensitive than the TB method to detect a group mean shift in FENO. Methods Subjects and protocolA total of 23 healthy and 32 recurrent wheezy infants had FENO measured using both TB and SB techniques. Infants were classified as recurrent whee...

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“…However, in this case the differences in our study between controls and wheezy infants might have been underestimated. Another limitation of our study was that we collected mixed oral and nasal FE NO by collecting expired gas in a single-compartment face mask, therefore we could not distinguish between NO derived from upper and lower airways (29). This might introduce variability and explain some of the overlap between groups.…”

Section: Discussionmentioning

confidence: 99%

Exhaled Nitric Oxide Differentiates Airway Diseases in the First Two Years of Life

et al. 2006

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Fractional exhaled nitric oxide (FE NO ) levels are increased in children and adults with asthma, whereas low levels have been found in cystic fibrosis and primary ciliary dyskinesia. The aim of this study was to investigate whether FE NO measurements could distinguish between children below the age of 2 with different airway diseases. FE NO measurements were performed in 118 infants aged between 4.6 and 25.2 mo: 74 infants with recurrent wheezing (RW), 24 with bronchopulmonary dysplasia (BPD), and 20 with cystic fibrosis (CF). FE NO was measured also in 100 healthy controls aged between 1.1 and 7.7 mo. Geometric mean (95% confidence interval) FE NO values were 10.4 (9.1-12.0) parts per billion (ppb) in healthy infants, 18.6 (15.6 -22.2) ppb in wheezy infants, 11.7 (8.2-16.8) ppb in BPD infants and 5.9 (3.4 -10.1) ppb in CF infants. FE NO in wheezers was higher than in controls, BPD, and CF (p ϭ 0.009, p ϭ 0.038, and p Ͻ 0.001, respectively). Atopic wheezers showed higher FE NO than nonatopic wheezers (p ϭ 0.04). CF infants had lower FE NO than healthy controls and BPD infants (p ϭ 0.003 and p ϭ 0.043, respectively). FE NO values in BPD and control infants were not different. We conclude that FE NO is helpful to differentiate various airway diseases already in the first 2 y of life. T he fractional concentration of nitric oxide in exhaled air (FE NO ) has been suggested as a marker of bronchial eosinophilic inflammation. Increased FE NO levels have been found in asthmatic adults (1) and children with symptoms of asthma and atopy (2). Guidelines for the measurement of FE NO are available for both adults and children (3,4), and normal values for healthy children between 4 and 17 y of age have been recently published (5). Although in the last decade there has been a growing interest in measuring FE NO in noncooperative young children as well, few studies have investigated FE NO as a marker of bronchial inflammation in children below the age of 2 y. It has been shown that infants with recurrent wheeze have elevated levels of FE NO during exacerbations that rapidly decrease after steroid therapy (6), suggesting that eosinophilic airway inflammation is present in early childhood wheeze. Low FE NO levels have been found in infants with CF (7), primary ciliary dyskinesia (8) and rhinorrhea (9). A recent study by Baraldi and co-workers (10) showed that school-age children with BPD and airflow limitation had lower FE NO levels than healthy matched controls and asthmatic children, suggesting that airflow limitation in children with BPD might not be related to ongoing inflammation as is the case in asthma. It is well known that infants with BPD have an early inflammatory response followed by chronic inflammation and airways remodeling (11-13). Only one study previously reported high FE NO levels in infants with chronic lung disease (14).The aim of the present study was to measure FE NO in infants below the age of 2 y and to evaluate whether FE NO could be used to differentiate airways diseases in the first 2 y of ...

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Childhood asthma: exhaled nitric oxide in relation to clinical symptoms

Cited by 53 publications

References 32 publications

Elevated nitrite in breath condensates of children with respiratory disease

Elevated nitrite in breath condensates of children with respiratory disease

Comparison of single-breath and tidal breathing exhaled nitric oxide levels in infants

Exhaled Nitric Oxide Differentiates Airway Diseases in the First Two Years of Life

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