Clinical application of exhaled nitric oxide measurement in pediatric lung diseases

Manna, Angelo; Caffarelli, Carlo; Varini, Margherita; Dascola, Carlotta Povesi; Montella, Silvia; Maglione, Marco; Sperlì, Francesco; Santamaria, Francesca

doi:10.1186/1824-7288-38-74

Cited by 37 publications

(31 citation statements)

References 157 publications

(138 reference statements)

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“…Moreover, the recent availability of hand-held analyzers equipped for nNO measurement, combined with low cost and simple use of the devices, has made nNO determination widespread in primary practice. While fractional exhaled nitric oxide (FeNO) analysis is well validated at any age for measuring airways inflammation, namely in bronchial asthma, [10][11][12][13][14][15][16][17][18] nNO has by far less application in the assessment of pediatric upper airways disorders. Data from studies of nNO measurement in children are relatively scarce except for those supporting its use as screening tool for primary ciliary dyskinesia (PCD).…”

Section: Introductionmentioning

confidence: 99%

Clinical application of nasal nitric oxide measurement in pediatric airway diseases

Manna

Montella

Maniscalco³

et al. 2014

Pediatric Pulmonology

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Nitric oxide plays an important role in several physiological and pathophysiological processes in the respiratory tract. Different ways to measure nasal nitric oxide levels in children are currently available. The possibility of obtaining nasal nitric oxide measurement from relatively young children, combined with the availability of portable devices that can be used even in the office setting, opens new perspectives for nasal nitric oxide analysis in the pediatric daily practice. This review presents a synopsis about the current clinical applications of nasal nitric oxide measurement in the pediatric clinical practice. A total of 3,775 articles on the topic were identified, of which 883 duplicates were removed, and 2,803 were excluded based on review of titles and abstracts. Eighty-nine full text articles were assessed for eligibility and 32 additional articles were obtained from the reference lists of the retrieved studies. Since very low nasal nitric oxide levels are found in the majority of patients with primary ciliary dyskinesia, most publications support a central role for nasal nitric oxide to screen the disease, and indicate that it is a very helpful first-line tool in the real-life work-up in all age groups. Decreased nasal nitric oxide concentration is also typical of cystic fibrosis, even though nasal nitric oxide is not as low as in primary ciliary dyskinesia. In other upper airway disorders such as allergic rhinitis, rhinosinusitis, nasal polyposis, and adenoidal hypertrophy, clinical utility of nasal nitric oxide is still critically questioned and remains to be established. Since nNO determination is flow dependent, a general consensus from the major investigators in this area is highly desirable so that future studies will be performed with the same flow rate. A shared nNO methodology will enable to overcome the challenges that lie ahead in incorporating nNO measurement into the mainstream clinical setting of pediatric airway diseases.

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Section: Introductionmentioning

confidence: 99%

Clinical application of nasal nitric oxide measurement in pediatric airway diseases

Manna

Montella

Maniscalco³

et al. 2014

Pediatric Pulmonology

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“…It is reported that common variants in the NO synthesis pathway genes jointly contribute to differences in exhaled nitric oxide (FeNO) levels in children, which is a biomarker of airway inflammation, most likely through differential gene expression [24-26]. In Gravesande et al’ s study, the T allele is associated with lower NO levels, which demonstrates that the Glu298Asp polymorphism is functionally relevant and could be a reason for the low FeNO levels [27].…”

Section: Discussionmentioning

confidence: 99%

Analysis of nitric oxide synthase gene polymorphisms in neonatal respiratory distress syndrome among the Chinese Han population

Shen

Wang

et al. 2014

Ital J Pediatr

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AimTo evaluate the association of NOS1 and NOS3 gene polymorphisms with the risk/severity of neonatal respiratory distress syndrome (RDS) among preterm infants.MethodsThe patient group was 189 preterm infants diagnosed with RDS. The control group was 227 preterm neonates who did not develop RDS. NOS genotyping was performed using an improved multiplex ligation detection reaction (iMLDR) technique based on LDR.ResultsIt was found that genotype and allele frequencies of rs2682826 of the NOS1 gene and rs1799983 of the NOS3 gene were not significantly different between the RDS group and the control group. However, when the preterm infants were divided into two and three groups based on gestational age and birth weight, a study of the SNP rs1799983 of the NOS3 gene showed that the GG genotype and G allele frequencies were significantly increased in the RDS groups, the GT genotype and A allele were less frequent among the RDS groups in 26–32.9 weeks of gestational age and in a birth weight subgroup of <1.5 Kg.ConclusionOur study raises the possibility that a genetic variation of NOS3 could be implicated in the pathophysiology of RDS in the Chinese Han population, especially in very preterm and very low birth weight infants.

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“…Respiratory NO production is increased in patients with asthma and allergic rhinitis and exhaled FeNO levels can be used as a marker of lung inflammation in these populations (typically > 25 ppm) [13]. As many of the MD subjects in this study are highly atopic, it would be expected that FeNO levels would be elevated; however, despite their underlying atopic disease, the mitochondrial study subjects demonstrated statistically lower levels of FeNO than the non-atopic age matched controls (Tables 1 and 2).…”

Section: Discussionmentioning

confidence: 99%

“…This level is used as a marker of lung inflammation in patients with asthma, allergic rhinitis, and bronchiectasis to monitor therapy, ie the higher the FeNO level, the higher the inflammation [13]. In contrast, FeNO levels are decreased in several known disease populations including primary pulmonary hypertension, primary cilliary dyskinesia and cystic fibrosis.…”

Section: Introductionmentioning

confidence: 99%

Decreased exhaled nitric oxide levels in patients with mitochondrial disorders

et al. 2013

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Abstract:Background: Nitric oxide (NO) deficiency may occur in mitochondrial disorders (MD) and can contribute to the pathogenesis of the disease. It is difficult and invasive to measure systemic nitric oxide. NO is formed in the lungs and can be detected in expired air. Currently, hand-held fractional exhaled nitric oxide (FeNO) measurement devices are available enabling a fast in-office analysis of this non-invasive test. It was postulated that FeNO levels might be reduced in MD.Methods: Sixteen subjects with definite MD by modified Walker criteria (4 to 30 years of age) and sixteen healthy control subjects of similar age, race and body mass index (BMI) underwent measurement of FeNO in accordance with the American Thoracic Society guidelines.Results: Sixteen patient-control pairs were recruited. The median FeNO level was 6.5 ppm (IQR: 4-9.5) and 10.5 ppm (IQR: 8-20.5) in the MD and control groups, respectively. In 13 pairs (81%), the FeNO levels were lower in the MD cases than in the matched controls (p=0.021). Eleven (69%) cases had very low FeNO levels ( 7ppm) compared to only 1 control (p=0.001). All cases with enzymatic deficiencies in complex I had FeNO 7ppm.Conclusions: Single-breath exhaled nitric oxide recordings were decreased in patients with MD. This pilot study suggests that hand-held FeNO measurements could be an attractive non-invasive indicator of MD. In addition, measurement of FeNO could be used as a parameter to monitor therapeutic response in this population.

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Clinical application of exhaled nitric oxide measurement in pediatric lung diseases

Cited by 37 publications

References 157 publications

Clinical application of nasal nitric oxide measurement in pediatric airway diseases

Clinical application of nasal nitric oxide measurement in pediatric airway diseases

Analysis of nitric oxide synthase gene polymorphisms in neonatal respiratory distress syndrome among the Chinese Han population

Decreased exhaled nitric oxide levels in patients with mitochondrial disorders

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