Exhaled nitric oxide in diagnosis and management of respiratory diseases

Abba, Abdullah A.

doi:10.4103/1817-1737.56009

Cited by 54 publications

(28 citation statements)

References 96 publications

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“…31 Many physiological and pathological factors can determine exhaled NO levels. 32,33 Concentrations of exhaled NO are easily detectable by non-invasive measures and as an association between BO syndrome after lung transplantation and the levels of fractional exhaled NO was reported 34 we tried to identify any changes regarding FeNO in BO after hematopoietic SCT. Surprisingly, in contrast to the Munich Lung Transplant Group we found decreased levels of FeNO in our BO-patients and regardless of the time point during the course of the disease it was possible to differentiate between BO-and non-BO-patients post-hematopoietic SCT by using a threshold level for FeNO.…”

Section: Discussionmentioning

confidence: 99%

Bronchiolitis obliterans after allogeneic hematopoietic SCT: further insight—new perspectives?

Ditschkowski

Elmaagacli

Koldehoff

et al. 2013

Bone Marrow Transplant

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Bronchiolitis obliterans (BO) is a late non-infectious pulmonary complication after allogeneic hematopoietic SCT. Among 982 patients after myeloablative hematopoietic SCT between January 2000 and October 2010, 68 were diagnosed with BO according to NIH criteria. The median onset of BO was 18 months post transplant, 5-year cumulative incidence was 5.8% and 5-year mortality 41%. BO prevalence rate was 10% among all long-term surviving hematopoietic SCT recipients and 12% among chronic GVHDpatients. Chronic GVHD, peripheral SCT and ABO blood group incompatibility were identified as risk factors associated with BO. IgG levels were significantly decreased at the onset of BO (6.7 g/L ± 0.7, P ¼ 0.001), the mean exhaled NO concentrations were lower in BO-patients than in stem cell recipients without BO (14 p.p.b.±0.9 vs 20 p.p.b.±2.1) or healthy controls (25 p.p.b.±2.4, Po0.001). Hypoxia-inducible factor 1 alpha (HIF-1a) was significantly elevated in BO as compared with healthy controls or GVHD-patients without lung involvement (340 ± 61 vs 127 ± 22 vs 140 ± 32, P ¼ 0.02). Calculated 5-year survival was superior in female than in male BO-patients (86 vs 45%, P ¼ 0.04). These results emphasize the relevance of BO as serious late complication with substantial mortality and point to essential pathophysiological changes due to regulatory responses to hypoxia. Keywords: bronchiolitis obliterans; nitric oxide; allogeneic; GVHD; HIF-1a; SCT INTRODUCTION Allogeneic hematopoietic SCT has been shown to provide longterm disease-free survival for otherwise fatal malignant or nonmalignant hematological disorders. With increasing survival rates due to toxicity reduced hematopoietic SCT methods, advanced GVHD-management and improved anti-infectious therapy and prophylaxis, a distinct increment in late transplant related complications can be observed. Pulmonary complications develop in 30-60% of allogeneic hematopoietic SCT recipients and are considered as a major cause of morbidity and mortality. 1,2 Late-onset non-infectious pulmonary complications 3 beginning 3 months after transplantation with an incidence of 10-15% are considered as life-threatening complications significantly limiting the quality of life. 4,5 Although late-onset non-infectious pulmonary complications classification is rather undefined, the most common categorizations include bronchiolitis obliterans (BO), bronchiolitis obliterans organizing pneumonia and interstitial pneumonia. 6,7 According to the NIH consensus criteria, BO is considered to be the only pulmonary manifestation of chronic GVHD. 8 The reported incidence of BO in allogeneic hematopoietic SCT recipients ranges from 2-10% and mortality rates have been assessed between 13 and 23%. 9,10 BO is prevalent in 2-5.5% of hematopoietic SCT recipients and in up to 14% of hematopoietic SCT recipients with chronic GVHD. 11 Patients diagnosed with BO have a 5-year survival rate of only 45% vs 75% in patients without BO. 9 Advanced disease stages at transplantation, preceding GVHD, older donor and recipient age, M...

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Section: Discussionmentioning

confidence: 99%

Bronchiolitis obliterans after allogeneic hematopoietic SCT: further insight—new perspectives?

Ditschkowski

Elmaagacli

Koldehoff

et al. 2013

Bone Marrow Transplant

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“…In fact, the considerable inter-subject variability hampers the clinical interpretation of FeNO measurements [4,5]. Two important FeNO modifiers are atopy and rhinitis [6].…”

Section: Introductionmentioning

confidence: 99%

Effects of atopy and rhinitis on exhaled nitric oxide values ‐ a systematic review

Linhares

Jacinto

Pereira³

et al. 2011

Clinical & Translational All

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BackgroundAtopy and rhinitis are among the factors affecting exhaled nitric oxide (FeNO) values and may contribute to difficulties in the clinical interpretation of FeNO measurements. However, data assessing their effects on FeNO values had never been summarized. This review aims to evaluate the effect of atopy and rhinitis in FeNO values in otherwise healthy individuals.MethodsA systematic review was performed in Pubmed, Scopus and ISI Web of Knowledge. A two-step selection process was completed, and from 2357 references 19 were included. The inclusion criteria were: participants without known diseases other than rhinitis; atopy assessement by SPT or Specific IgE; and FeNO measurements according to ATS/ERS recommendations.ResultsThe 8 articles measuring FeNO in children showed higher values in both allergic rhinitis and atopic children when compared with healthy children. The 11 articles performed in adults observed higher FeNO in AR patients comparatively with either healthy or atopic individuals. However, adult healthy and atopic individuals had similar FeNO values.ConclusionsFeNO values are higher in individuals with rhinitis and/or atopy without other health problems. These effects are small, seem to be independent and should be further studied using multivariate models. The effect of atopy was observed only in children. The combined effect of atopy and rhinitis produced higher FeNO values in adults. These results support that both atopy and rhinitis should be considered when interpreting or when defining FeNO reference values.

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“…[7] In the lungs it plays a part in the pathophysiology of many conditions including asthma, chronic obstructive pulmonary disease, bronchiectasis, primary ciliary dyskinesia, pulmonary hypertension, infections, lung injury, and transplant. [8] It has been shown by many workers that the degree of eosinophilic inflammation in the airways is mirrored by the fraction of exhaled nitric oxide (FENO) in breath of humans and that the levels are elevated in asthmatics. [9,10] In asthma, there is no correlation between the degree of symptoms, physical signs, physiological measures of airway obstruction, and the severity of inflammation.…”

Section: N 1987 Ignarro and Palmer And Their Coworkersmentioning

confidence: 99%

Exhaled nitric oxide in the diagnosis and management of bronchial asthma: From bench to bedside?

Abba

Adeiza

2011

Ann Nigerian Med

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A B S T R A C TThe identifi cation of nitric oxide in exhaled breath and its role as a surrogate marker of eosinophilic infl ammation of the airways led to rapid development in the area of its measurement. Standardized measurement techniques have been developed as well as simple, cheap, and reliable equipments. Although a number of factors have been identifi ed as affecting its assay, fractional exhaled nitric oxide (FENO) can reliably be used to distinguish eosinophilic from non-eosinophilic airway infl ammation. Unlike the other indirect measures of airway infl ammation such as FEV1 reversibility and bronchoprovocative tests, FENO is noninvasive and gives a direct measure of infl ammation. There are suffi cient data supporting its role in the diagnosis of asthma, monitoring of disease, prediction of relapse, and level of compliance. Measurement of FENO has therefore made the transition from the bench to the bedside. Of recent, there are attempts at devising interpretative strategies for its use in day to day clinical practice.

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Exhaled nitric oxide in diagnosis and management of respiratory diseases

Cited by 54 publications

References 96 publications

Bronchiolitis obliterans after allogeneic hematopoietic SCT: further insight—new perspectives?

Bronchiolitis obliterans after allogeneic hematopoietic SCT: further insight—new perspectives?

Effects of atopy and rhinitis on exhaled nitric oxide values ‐ a systematic review

Exhaled nitric oxide in the diagnosis and management of bronchial asthma: From bench to bedside?

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