Expired nitric oxide as a marker for childhood asthma

Nelson, B; Sears, Steven; Woods, Jon; Ling, Con Yee; Hunt, J.F.; Clapper, Laura M.; Gaston, Benjamin

doi:10.1016/s0022-3476(97)70204-x

Cited by 156 publications

(133 citation statements)

References 28 publications

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“…Nasally-derived NO, which may contribute to NO in exhaled air if no closure of the soft palate is achieved [38,42], could give false positive results in a patient population such as that in the present study. Since the complete closure of the soft palate requires a very high degree of compliance [42], this test cannot be performed in the vast majority of children.…”

Section: Discussionmentioning

confidence: 70%

“…A variety of observations suggest that exhaled NO in asthma is likely to be derived mainly from the inducible form of nitric oxide synthases (iNOS or type II NOS) [13, 35±37], which are rapidly induced by pro-inflammatory cytokines in a variety of cells, including macrophages and airway epithelial cells [19]. Although we do not know the pathways linking the inflammatory events that characterize asthma with NO production in the airways, it has been demonstrated that exhaled NO levels are decreased by oral corticosteroid in patients with asthma [20,38] but not in normal subjects [39].…”

Section: Discussionmentioning

confidence: 99%

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Orally exhaled nitric oxide levels are related to the degree of blood eosinophilia in atopic children with mild-intermittent asthma

et al. 1999

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Orally exhaled nitric oxide levels are related to the degree of blood eosinophilia in atopic children with mild-intermittent asthma. M. Silvestri, D. Spallarossa, V. Frangova Yourukova, E. Battistini, B. Fregonese, G.A. Rossi. #ERS Journals Ltd 1999. ABSTRACT: Increased levels of nitric oxide have been found in expired air of patients with asthma, and these are thought to be related to the airway inflammatory events that characterize this disorder. Since, in adults, bronchial inflammatory changes are present even in mild disease, the present study was designed to evaluate whether a significant proportion of children with mild-intermittent asthma could have increased exhaled air NO concentrations.Twenty-two atopic children (aged 11.1 0.8 yrs) with mild-intermittent asthma, treated only with inhaled b 2 -adrenoreceptor agonists on demand and 22 age-matched controls were studied.NO concentrations in orally exhaled air, measured by chemiluminescence, were significantly higher in asthmatics, as compared to controls (19.4 3.3 parts per billion (ppb) and 4.0 0.5 ppb, respectively; p<0.01). Interestingly, 14 out of 22 asthmatic children had NO levels >8.8 ppb (i.e. >2 standard deviations of the mean in controls). In asthmatic patients, but not in control subjects, statistically significant correlations were found between exhaled NO levels and absolute number or percentage of blood eosinophils (r=0.63 and 0.56, respectively; p<0.01, each comparison). In contrast, exhaled NO levels were not correlated with forced expiratory volume in one second (FEV1) or forced expiratory flows at 25±75% of vital capacity (FEF25±75%) or forced vital capacity (FVC), either in control subjects, or in asthmatic patients (p>0.1, each correlation).These results suggest that a significant proportion of children with mild-intermittent asthma may have airway inflammation, as shown by the presence of elevated levels of nitric oxide in the exhaled air. The clinical relevance of this observation remains to be established. Eur Respir J 1999; 13: 321±326.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Orally exhaled nitric oxide levels are related to the degree of blood eosinophilia in atopic children with mild-intermittent asthma

et al. 1999

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“…Several groups described different off-line techniques for sampling exhaled NO [7,[11][12][13][14][15][16][17][18][19]. These include tidal breathing techniques and uncontrolled or controlled single exhalations into a reservoir.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, exhalation flow cannot easily be controlled and it is difficult to prevent nasal contamination adequately, leading to increased variation in FENO values. Uncontrolled single exhalations against a resistance are easy to perform and reproducible even in young children, and there is no need for expensive or complicated equipment [7,14,16]. However, in the absence of flow control, FENO values may vary and be unsuitable to monitor individual patients.…”

Section: Discussionmentioning

confidence: 99%

Exhaled nitric oxide measurements with dynamic flow restriction in children aged 4-8 yrs

Pijnenburg

Lissenberg²,

Hofhuis³

et al. 2002

European Respiratory Journal

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Fractional exhaled nitric oxide concentration (FENO) depends on exhalation flow; however, children often are unable to perform controlled flow procedures. Therefore, a device was developed for off-line FENO sampling, with dynamic flow restriction (DFR).The authors compared off-line with on-line FENO, assessed feasibility, and obtained normal values for FENO in children aged 4-8 yrs. Subjects inhaled nitric oxide (NO)-free air and exhaled into the device, where DFR kept exhalation flow constant at 50 mL?s -1 . Dead space air was discarded. Exhaled air was collected in a 150 mL mylar balloon. On-line measurements were performed and values compared with off-line FENO in 19 adult volunteers. Seventy-nine children performed off-line sampling. All samples were analysed with a chemiluminescence NO-analyser. Normal values were obtained in 34 healthy children.There was an excellent correlation between on-and off-line values. Bland and Altman plots showed good agreement between on-and off-line FENO. Seventy-four out of 79 children were able to perform a correct off-line procedure. Geometric mean¡SEM FENO in healthy children was 4.9 ¡ 1.2 parts per billion (ppb) for male children and 7.6 ¡ 1.1 ppb for female children.It can be concluded that off-line fraction of exhaled nitric oxide measurements with dynamic flow restriction are feasible in young children and correspond to on-line values. Eur Respir J 2002; 20: 919-924.

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“…Composite symptom scores, including cough, sputum production, chest tightness, wheezing, shortness of breath, and nocturnal awakenings in the 3 months before enrollment, were significantly higher in children with severe versus mild-to-moderate asthma (15 [0-24] vs 8 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]; P = .005). However, in both groups, there were children with reported good asthma control evidenced by symptom occurrence of less than once per month (n = 6 severe; n = 10 mild-to-moderate).…”

Section: Symptomsmentioning

confidence: 99%

Features of severe asthma in school-age children: Atopy and increased exhaled nitric oxide

Fitzpatrick¹,

Gaston²,

Erzurum³

et al. 2006

Journal of Allergy and Clinical Immunology

178

160

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Expired nitric oxide as a marker for childhood asthma

Cited by 156 publications

References 28 publications

Orally exhaled nitric oxide levels are related to the degree of blood eosinophilia in atopic children with mild-intermittent asthma

Orally exhaled nitric oxide levels are related to the degree of blood eosinophilia in atopic children with mild-intermittent asthma

Exhaled nitric oxide measurements with dynamic flow restriction in children aged 4-8 yrs

Features of severe asthma in school-age children: Atopy and increased exhaled nitric oxide

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