Fractional Exhaled Nitric Oxide and Impulse Oscillometry in Children With Allergic Rhinitis

Abstract

PurposeAirway inflammation, bronchial hyper-responsiveness (BHR), and bronchodilator response (BDR) are representative characteristics of asthma. Because allergic rhinitis (AR) is a risk factor for asthma development, we evaluated these 3 characteristics in AR using measurement of fractional exhaled nitric oxide (FeNO), a methacholine challenge test (MCT), and impulse oscillometry (IOS).MethodsThis study included 112 children with asthma (asthma group), 196 children with AR (AR group), and 32 control subjects (control group). We compared pulmonary function parameters and FeNO levels among the 3 groups. The AR group was subdivided into 2 categories: the AR group with BHR and the AR group without, and again pulmonary function and FeNO levels were compared between the 2 subgroups.ResultsFeNO levels were more increased in the AR and asthma groups than in the control group; within the AR group, FeNO was higher in the AR group with BHR than in the AR group without. The BDR was more increased in the AR group than in the control group when percent changes in reactance at 5 Hz (Δ X5) and reactance area (Δ AX) were compared. In the AR group, however, there was no difference in Δ X5 and Δ AX between the AR group with BHR and the AR group without.ConclusionsReversible airway obstruction on IOS and elevated FeNO levels were observed in children with AR. Because elevated FeNO levels can indicate airway inflammation and because chronic inflammation may lead to BHR, FeNO levels may be associated with BHR in AR. IOS can be a useful tool for detecting lower airway involvement of AR independent of BHR assessed in the MCT.

Sputum pentraxin 3 as a candidate to assess airway inflammation and remodeling in childhood asthma

“…A specific IgE was measured for 6 common allergens in Korea: Dermatophagoides pteronyssinus , Dermatophagoides farina , egg whites, cow milk, German cockroach, and Alternaria alternata . [16] This study was approved by the Institutional Review Board of Severance Hospital (protocol no. 4-2004-0036).…”

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

“…Although the literature on FeNO measurement in children with AR is less extensive, FeNO is increased in children with AR. 57,58 A considerable body of evidence suggests that rhinitis and asthma represent the manifestations of one airway disease of common pathogenic pathway with a wide spectrum of severity. 59 Increased FeNO in patients with AR probably reflects the extension of inflammation throughout the airways, a feature in the well-known concept of the 'united airway. '…”

Subclinical lower airways correlates of chronic allergic and non‐allergic rhinitis

“…Increased FeNO was observed in AR with and without BHR . Children with AR and BHR had slightly higher FeNO values than patients without BHR.…”

“…Kim et al . observed that the bronchodilator response in reactance at 5 Hz (Δ ×5) and the reactance area (Δ AX) increased more in the asthma and AR groups than in the controls.…”