Exhaled nitric oxide in childhood asthma: a review

Abstract

As an 'inflammometer', the fraction of nitric oxide in exhaled air (Fe(NO)) is increasingly used in the management of paediatric asthma. Fe(NO) provides us with valuable, additional information regarding the nature of underlying airway inflammation, and complements lung function testing and measurement of airway hyper-reactivity. This review focuses on clinical applications of Fe(NO) in paediatric asthma. First, Fe(NO) provides us with a practical tool to aid in the diagnosis of asthma and distinguish patients who will benefit from inhaled corticosteroids from those who will not. Second, Fe(NO) is helpful in predicting exacerbations, and predicting successful steroid reduction or withdrawal. In atopic asthmatic children Fe(NO) is beneficial in adjusting steroid doses, discerning those patients who require additional therapy from those whose medication dose could feasibly be reduced. In pre-school children Fe(NO) may be of help in the differential diagnosis of respiratory symptoms, and may potentially allow for better targeting and monitoring of anti-inflammatory treatment.

Exhaled NO: Determinants and Clinical Application in Children With Allergic Airway Disease

“…FeNO is currently used as a noninvasive biomarker for assessment of airway inflammatory status in respiratory diseases such as asthma. 2 Airway inflammation plays a pivotal role in asthma and a number of other respiratory diseases. 2 Accordingly, FeNO has gained substantial clinical and scientific interest since it is seen as a safer and less invasive alternative tool to bronchoscopy or induced sputum for diagnosis, monitoring, or predicting the response to the treatment of airway inflammation, especially in children.…”

“…2 Airway inflammation plays a pivotal role in asthma and a number of other respiratory diseases. 2 Accordingly, FeNO has gained substantial clinical and scientific interest since it is seen as a safer and less invasive alternative tool to bronchoscopy or induced sputum for diagnosis, monitoring, or predicting the response to the treatment of airway inflammation, especially in children. 3 Therefore, this review focuses on the clinical application of FeNO in children with allergic airway disease and the environmental and other factors that need to be considered when interpreting the results from FeNO measurements.…”

Biomarkers in asthma and allergic rhinitis

“…Major advantages of standardized eNO samplings are reproducible, non-invasive, online measurements achievable in almost all patients of over 4-5 years [137]. The drawbacks consist of many (endogenous and exogeneous) factors affecting NO measures [119,138].…”

NO kidding: exhaled nitric oxide fraction in preschool children

“…Along with exhaled CO 2 , exhaled NO is the only biomarker that has made it from bench to bedside. Handheld analysers are available, which measure NO in a fast, noninvasive manner, and FeNO has been tested in the diagnosis and monitoring of asthma as well as for guiding treatment in schoolchildren and adults with asthma [5]. However, only a few studies have assessed the possible role of FeNO in wheezing preschool children or in preschool children at high risk of developing asthma.…”

“…For two decades nitric oxide in exhaled air (fraction of exhaled nitric oxide (FeNO)) has been used as a biomarker reflecting eosinophilic airways inflammation [5]. Along with exhaled CO 2 , exhaled NO is the only biomarker that has made it from bench to bedside.…”