Exaled nitric oxide and air trapping correlation in asthmatic children

Mappa, Luigi; Cardinale, Fabio; Camodeca, R; Tortorella, Ml; Pietrobelli, Angelo; Armenio, Lucio; Boner, Attilio

doi:10.1111/j.1398-9995.2005.00905.x

Cited by 11 publications

(4 citation statements)

References 32 publications

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“…This suggests that eosinophilic airway inflammation is already present in these infants with atopic wheeze. In agreement with the study of Mappa et al (23), we also found a correlation between FE NO levels and FRCp in wheezy infants, suggesting that air trapping in the lungs is related to airway inflammation.…”

Section: Discussionsupporting

confidence: 82%

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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Section: Discussionsupporting

confidence: 82%

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

et al. 2006

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“…However, they also demonstrated that FeNO was not correlated with spirometry measurements. 14 No correlation was identified with the FeNO level and asthma severity in this study. Farrente et al indicated that the heterogeneity of problematic severe asthma greatly limits the utility of FeNO alone as a biomarker of inflammation.…”

Section: Discussioncontrasting

confidence: 56%

Fractional Exhaled Nitric Oxide (FeNo) in Different Asthma Phenotypes

Gemicioğlu

Müsellim

Doğan

et al. 2014

Allergy�Rhinol (Providence)

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Fractioned exhaled nitric oxide (FeNO) is a noninvasive marker of inflammation in asthmatic patients. FeNO can be used to monitor airway inflammation, but individual responses make tailored interventions based on FeNO difficult. The correlation between the asthma control test (ACT), FEV1, and FeNO was evaluated in this study to ascertain the correct usage of FeNO with different asthma phenotypes regarding their control, allergy, comorbidity, obesity, age, smoking status, and severity. ACT, pulmonary function, and FeNO in 416 asthmatic patients on combined therapy were retrospective evaluated. Correlations between these parameters and the FeNO levels in different asthma phenotypes were calculated. In the study population, FeNO was 31.8 ± 28.5 parts per billion (ppb), FEV1 was 83.4 ± 19% and ACT was 19 ± 5.2. ACT scores were negatively correlated with FeNO (r = −0.31; p = 0.002). FeNO was different in patients with positive and negative skin-prick test (p < 0.05), with and without allergic rhinitis (p < 0.01), and with and without allergic conjunctivitis (p < 0.01). Significantly higher FeNO levels were found with logistic regression analysis only in patients with a history of emergency room visits (ERVs) (p = 0.024). The rate of the ERV of the patients with an ACT score more than or equal to 20 and with a FeNO value of more than 35 ppb was 22.9%, but with a FeNO value of less than 35 ppb was 6.5% (p = 0.004). Allergy and allergic comorbidities may lead to an increase in FeNO levels. Patients with a history of ERV have markedly higher FeNO levels, although they have an ACT score more than or equal to 20.

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“…In the present study, no correlation was found between FeNO and FVC in the restricted group. These results are consistent with those reported by Mappa et al ( 28 ), in which it was demonstrated that there was no correlation between FeNO levels and FVC, but there was a correlation between FeNO and air trapping, as measured through FRC, RV, and RV/TLC in asthmatic children. The present study did not perform plethysmography, but a mild positive correlation between the FeNO and %ΔFVC values was found.…”

Section: Discussionsupporting

confidence: 93%

“Poor Effort” Does Not Account for Reduced Forced Vital Capacity in Asthmatic Children

2021

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Purpose: Poor forced vital capacity (FVC) effort has been considered to be the main reason for FVC reduction by the ATS/ERS guideline; however, this has rarely been mentioned in previous studies. The present study aims to determine whether reduced FVC in asthmatic children is correlated to poor FVC effort.Methods: A total of 209 asthmatic children within 5–13 years old were included and divided into reduced FVC (“restricted,” n = 66) and typical obstruction group (“obstructed,” n = 143). Forced expiratory flows before and after bronchodilation were recorded in asthmatic children. The differences in clinical characteristics, spirometric results, FVC effort, and bronchodilator response were compared between two groups. Exhalation time (ET) was divided into effective ET (ETe) and plateau ET (ETp) by the start point of exhalation plateau on the time-volume curve. FVC effort was assessed by ET, ETp, and back extrapolated volume (EV)/FVC (%).Results: Asthmatic children in the restricted group had significantly higher slow vital capacity (SVC)/FVC (%), higher EV/FVC (%), shorter ET, shorter ETe, and longer ETp, when compared with those with obstructed. In the obstructed group, ET (r = 0.201, P = 0.016) and ETe (r = 0.496, P < 0.001) positively correlated with FVC, and ETp (r = −0.224, P = 0.007) negatively correlated with FVC. In the restricted group, FVC positively correlated with ETe (r = 0.350, P = 0.004) but not ET and ETp. FVC z-score significantly correlated with total IgE (n = 51, r = −0.349, P = 0.012) and with FEF25−75% z-score (n = 66, r = 0.531, P < 0.001) in the restricted group. The further logistic regression revealed that the risk of restricted increased by 1.12 (95% CI, 1.04–1.22, P = 0.005) with every 1% increase in %ΔFVC. In subjects with restricted and bronchodilation tests, %ΔFVC was significantly associated with FeNO (n = 29, r = 0.386, P = 0.039), FEF25−75% z-score (n = 29, r = −0.472, P = 0.010), and SVC/FVC (%) (n = 19, r = 0.477, P = 0.039) but not with EV/FVC (%), ET, ETe, or ETp (P > 0.05).Conclusion: These findings suggested that “poor FVC effort” does not account for the FVC reduction in asthmatic children. Short ET and high SVC/FVC (%) are characteristics of reduced FVC.

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Exaled nitric oxide and air trapping correlation in asthmatic children

Cited by 11 publications

References 32 publications

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

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

Fractional Exhaled Nitric Oxide (FeNo) in Different Asthma Phenotypes

“Poor Effort” Does Not Account for Reduced Forced Vital Capacity in Asthmatic Children

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