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

Kim, Hyo-Bin; Eckel, Sandrah P.; Kim, Jeong Hee; Gilliland, Frank D.

doi:10.4168/aair.2015.8.1.12

Cited by 5 publications

(5 citation statements)

References 70 publications

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“…Determinants of exhaled NO includes age, sex, body height, atopy and smoking status, but in our study exhaled NO correlates only with age, and in spite of a significant correlation, it is weak and was not possible to derive any equation of reference values (results not shown). In developing individuals, exhaled NO increases until 14 years in females and 16 in males, and similar development is observed for anatomic dead space volume .…”

Section: Discussioncontrasting

confidence: 59%

“…First, the large number of asthmatic children in our study being treated with inhaled corticosteroids, a well‐known modifier of exhaled NO levels and a high prevalence of allergic rhinitis, which is usually correlated with exhaled NO levels. Secondly, our evaluations were conducted during pollen season, contributing to high exhaled NO levels, even when asthma was not present, in pollen allergic patients . Thirdly, the use of respiratory symptoms with high levels of exhaled NO as a definition of uncontrolled asthma, and the subsequent evaluation of an association with exhaled NO ratio may lead to a risk of circular reasoning.…”

Section: Discussionmentioning

confidence: 99%

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Spirometry‐adjusted fraction of exhaled nitric oxide increases accuracy for assessment of asthma control in children

Martins

Silva

Severo

et al. 2017

Pediatric Allergy Immunology

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Spirometry and exhaled nitric oxide are two important complimentary tools to identify and assess asthma control in children. We aimed to determine the ability of a new suggested spirometry-adjusted fraction of exhaled nitric oxide (NO) index in doing that. A random sample of 1602 schoolchildren were screened by a health questionnaire, skin prick tests, spirometry with bronchodilation and exhaled NO. A total of 662 children were included with median (IQR) exhaled NO 11(14) ppb. Receiver operating characteristic (ROC) curves using exhaled NO equations from Malmberg, Kovesi and Buchvald, and spirometry-adjusted fraction of exhaled NO values were applied to identify asthmatic children and uncontrolled asthma. Receiver operating characteristic (ROC) curves failed to identify asthmatic children (all AUC < 0.700). Spirometry-adjusted fraction of exhaled NO/FEV (AUC = 0.712; P = .010) and NO/FEF (AUC = 0.735 P = .004) had a fair and increased ability to identify uncontrolled disease compared with exhaled NO (AUC = 0.707; P = .011) or the Malmberg equation (AUC = 0.701; P = .014). Sensitivity and specificity identifying non-controlled asthma were 59% and 81%, respectively, for the cut-off value of 9.7 ppb/L for exhaled NO/FEV , and 40% and 100% for 15.7 ppb/L/s for exhaled NO/FEF . Exhaled NO did not allow to identify childhood asthma. Spirometry-adjusted fraction of exhaled NO performed better-assessing asthma control in children. Thus, although more validation studies are needed, we suggest its use in epidemiological studies to assess asthma control.

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Section: Discussioncontrasting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Spirometry‐adjusted fraction of exhaled nitric oxide increases accuracy for assessment of asthma control in children

Martins

Silva

Severo

et al. 2017

Pediatric Allergy Immunology

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“…It was reported that diffusing capacity of NO in the bronchial wall of patients with AR was high, suggesting subclinical change of bronchial mucosa in AR [17]. The nasal nitric oxide levels were found to decrease in children with AR after topical corticosteroids were administered [18].…”

Section: Discussionmentioning

confidence: 91%

Exhaled Nitric Oxide and Symptom Severity in Children with Allergic Rhinitis

Kim¹,

Park²,

Moon³

et al. 2017

J Allergy Ther

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Objective: There have been few reliable biomarkers to evaluate allergic rhinitis (AR) severity in children. This study aimed to investigate a biomarker for assessing AR severity in children. Methods:A total of 107 children with AR (80) and non-allergic rhinitis (NAR, 27) were included in this study. The fraction of exhaled nitric oxide (FeNO) was measured and AR severity and duration was graded in patients with AR. We assessed the association between FeNO and the Allergic Rhinitis and its Impact on Asthma (ARIA) classes.Results: FeNO levels in the AR and NAR groups were 34.7 ± 22.1 and 17.0 ± 13.1 ppb, respectively (p=0.001). FeNO levels were significantly different (p<0.05) in the four ARIA classes: 14.3 ± 3.7 ppb in the mild intermittent group, 22.7 ± 4.8 ppb in the mild persistent group, 32.1 ± 16.1 ppb in the moderate-to-severe intermittent group, and 48.2 ± 25.2 ppb in the moderate-to-severe persistent group. We collapsed the 4 ARIA classes into 2 groups based on severity or duration. FeNO levels of the mild symptom group and moderate-to-severe symptom group were 18.7 ± 6.0 and 41.1 ± 23.0 ppb, respectively, which were significantly different (p=0.001). FeNO levels of the intermittent duration group (n=36) and persistent duration group (n=44) were 26.6 ± 15.9 and 41.2 ± 24.4 ppb, respectively, which were significantly different (p=0.001). Conclusion:FeNO levels were higher in children with increased severity and duration of AR. FeNO could be an indicator for classifying severity and evaluating treatment efficacy in children with AR.

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“…17,18 Furthermore, a previous study found that perennial allergic rhinitis was associated with high FeNO levels and more severe asthma. Those patients in the FeNO high group reported that their symptoms were more likely to be induced by allergen exposure.…”

Section: Discussionmentioning

confidence: 99%

Clinical features in patients of cough variant asthma with normal and high level of exhaled fractional nitric oxide

Tang

Zhou

Miao

et al. 2016

Clinical Respiratory J

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

Cited by 5 publications

References 70 publications

Spirometry‐adjusted fraction of exhaled nitric oxide increases accuracy for assessment of asthma control in children

Spirometry‐adjusted fraction of exhaled nitric oxide increases accuracy for assessment of asthma control in children

Exhaled Nitric Oxide and Symptom Severity in Children with Allergic Rhinitis

Clinical features in patients of cough variant asthma with normal and high level of exhaled fractional nitric oxide

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