Factors attributable to the level of exhaled nitric oxide in asthmatic children

Abstract

BackgroundAsthma is a heterogeneous disease with variable symptoms especially in children. Exhaled nitric oxide (FeNO) has proved to be a marker of inflammation in the airways and has become a substantial part of clinical management of asthmatic children due to its potential to predict possible exacerbation and adjust the dose of inhalant corticosteroids.ObjectivesWe analyzed potential factors that contribute to the variability of nitric oxide in various clinical and laboratory conditions.Materials and methodsStudy population consisted of 222 asthmatic children and 27 healthy control subjects. All children underwent a panel of tests: fractioned exhaled nitric oxide, exhaled carbon monoxide, asthma control test scoring, blood sampling, skin prick tests, and basic spirometry.ResultsFeNO and other investigated parameters widely changed according to clinical or laboratory characteristics of the tested children. Asthmatics showed increased levels of FeNO, exhaled carbon monoxide, total serum IgE, and higher eosinophilia. Boys had higher FeNO levels than girls. We found a significant positive correlation between FeNO levels and the percentage of blood eosinophils, %predicted of forced vital capacity, total serum IgE levels, and increasing age.ConclusionsVarious phenotypes of children's asthma are characterized by specific pattern of the results of clinical and laboratory tests. FeNO correlates with total serum IgE, blood eosinophilia, age, and some spirometric parameters with different strength. Therefore, the coexistence of atopy, concomitant allergic rhinitis/rhinoconjunctivitis, and some other parameters should be considered in critical evaluation of FeNO in the management of asthmatic children.

Exhaled Nitric Oxide Atopy, and Spirometry in Asthma and Rhinitis Patients in India

“…Men have consistently higher FeNO levels as compared to women [5]; even the present study reports higher FeNO levels in men. Spergel et al studied the correlation between FeNO and monthly symptom scores and documented significant correlation (r = 0.646 and r 2 = 0.417; p < 0.0001); FeNO was also able to distinguish between mild and moderate to severe persistent asthmatic patients [15]. However, the present study did not find any significant correlation of FeNO with duration of symptoms.…”

“…However, the present study did not find any significant correlation of FeNO with duration of symptoms. In a study of 222 asthmatics, and 27 HC by Banovicin et al [15], subjects with positive family history for allergic diseases (bronchial asthma, allergic rhinitis/rhino conjunctivitis, atopic eczema) showed higher FeNO (27. Atopy is a clinical definition of an IgE-antibody responder, which is a personal tendency to become sensitized and produce IgE antibodies in response to allergens.…”

“…Also, serum total IgE (S.T.IgE) correlated with FeNO levels in asthmatics [15]. However, the correlation of FeNO with spirometry variables has not been clearly defined [16,17].…”

The Interpretation of Exhaled Nitric Oxide Values in Children With Asthma Depends on the Degree of Bronchoconstriction and the Levels of Asthma Severity

“…32,33 We carefully noted that, in many of the clinical studies in adults, it is advised to perform F ENO measurements before any other lung function measurement and even before usage of short-acting ␤ 2 agonists, 34,35 and the same order of measurements and procedures is followed by most of the studies in children. 19,20,36 It does not seem justified in the context of our results in children with asthma. Therefore, our results reveal important new clinical aspects regarding the order of measurements in children with asthma.…”

Oxidative Damage and Bronchial Asthma

“…Higher concentration of hydrogen peroxide (Emelyanov et al, 2001;Horvath et al, 1998), superoxide anion radical (Jarjour & Calhoun, 1994;Sedgwick et al, 1990;Teramoto et al, 1996), nitric oxide (Ashutosh, 2000;Banovcin et al, 2009) was observed in asthmatic patients. Data about normal physiological value of ROS and oxidative damage biomarkers of DNA, proteins and lipids are missing or very rare in adults or in children population and therefore an implication of relevant conclusion can be uncertain.…”