Exhaled nitric oxide is associated with severity of pediatric acute asthma exacerbations

Fractional exhaled nitric oxide change in pediatric patients after emergency department care of asthma exacerbations

“…We previously reported that FeNO levels were associated with acute asthma exacerbation severity measured by the percentage of predicted forced expiratory volume in 1 second. 1 In addition, FeNO was higher in African-American participants in this population compared with white participants.…”

“…1,5 We excluded participants who received systemic corticosteroids within the preceding 4 weeks or who had signs or symptoms of a viral respiratory infection because these events could significantly decrease or increase FeNO. 6 Recruitment of the cohort of 80 participants required using the entire pool of eligible parent-study participants.…”

Usefulness of determining exhaled nitric oxide levels for the assessment of asthma severity in children

“…The utility of FeNO measurement in different respiratory diseases, including asthma, has been confirmed in a number of studies (4,11,29) . Langley et al showed a positive correlation between FeNO and the predicted FEV1 in their study in children with asthma exacerbation requiring the use of inhaled bronchodilators and systemic corticosteroids (30) . Ratnawati and Thomas have shown that a decrease in FeNO preceded the improvement in FEV1 parameter following oral corticosteroid administration (31) .…”

“…It should be noted that asthma cannot be excluded in children based on low FeNO levels (3) . The American Thoracic Society recommends the following: • the use of FeNO in the diagnosis of eosinophilic airway inflammation; • the use of FeNO in determining the likelihood of steroid responsiveness in individuals with chronic respiratory symptoms; • the use of FeNO in monitoring airway inflammation in patients with asthma; • that FeNO less than 25 ppb in adults (<20 ppb in children) be used to indicate that eosinophilic inflammation and responsiveness to corticosteroids are less likely; • that FeNO greater than 50 ppb in adults (>35 ppb in children) be used to indicate that eosinophilic inflammation and, in symptomatic patients, responsiveness to corticosteroids are likely; • that FeNO values between 25 ppb and 50 ppb in adults (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) ppb in children) should be interpreted with reference to the clinical context (23,24) . The change in the FeNO value, which should be considered significant, is currently being discussed.…”

“…Wiele badań potwierdza przydatność pomiaru FeNO w różnych schorzeniach układu oddechowego, w tym w astmie (4,11,29) . W badaniu Langley i wsp., przeprowadzonym na grupie dzieci z zaostrzeniem astmy wymagającym leczenia lekami wziewnymi rozszerzającymi oskrzela i systemowo podawanymi glikokortykosteroidami, udowodniono dodatnią korelację między FeNO a przewidywanym FEV1 (30) . Z kolei Ratnawati i Thomas dowodzą, iż obniżenie FeNO poprzedzało poprawę parametru FEV1 po doustnym leczeniu glikokortykosteroidami (31) .…”