Multicentre trial evaluating alveolar NO fraction as a marker of asthma control and severity

Mahut, Bruno; Trinquart, Ludovic; Bourgeois, M. Le; Becquemin, M.H.; Beydon, Nicole; Aubourg, F.; Jala, M.; Bidaud-Chevalier, Brigitte; Dinh-Xuan, A. T.; Randrianarivelo, Odile; Denjean, A.; Blic, J. de; Delclaux, Christophe

doi:10.1111/j.1398-9995.2009.02221.x

Cited by 52 publications

(64 citation statements)

References 32 publications

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“…In this study, J’awNO showed a trend toward increased values in patients with more severe asthma than those with milder disease. However, when CANO(TMAD) was determined using a trumpet model with axial diffusion that estimated NO concentrations exiting the respiratory bronchioles and alveolar region, CANO(TMAD) was not correlated with disease severity, which is consistent with a recent finding by Mahut et al [26]. Given that CANO is not adjusted for NO axial diffusion from conducting airways and could be more contaminated by small-airway NO diffusion than CANO(TMAD), this discrepancy between previous findings with CANO and those with CANO(TMAD) in this study may indicate that small-airway inflammation influences asthma severity to a greater extent than the actual alveolar inflammation.…”

Section: Discussionsupporting

confidence: 81%

Association of Alveolar Nitric Oxide Levels with Pulmonary Function and Its Reversibility in Stable Asthma

Matsumoto¹,

Niimi²,

Jinnai³

et al. 2010

Respiration

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Background: Inflammation of peripheral airways is implicated in the pathophysiology of severe asthma. However, contributions of peripheral airway inflammation to airway caliber/function in patients with stable asthma, including those with mild to moderate disease, remain to be confirmed. Objectives: To determine whether peripheral airway inflammation affects airway function in patients with asthma. Methods: In 70 patients with mild to severe asthma, alveolar nitric oxide [CANO(TMAD)] levels were examined as a noninvasive biomarker of peripheral airway/alveolar inflammation. CANO(TMAD) and maximal nitric oxide (NO) flux in the airway compartment, J’awNO, were estimated with a model that incorporated trumpet-shaped airways and axial diffusion using exhaled NO output at different flow rates. Measures of pulmonary function were then assessed by spirometry and an impulse oscillometry system, and their bronchodilator reversibility was examined. Results: CANO(TMAD) levels were not correlated with pre- or postbronchodilator spirometric values, but were significantly associated with prebronchodilator reactance at low frequency (Xrs5) (rho = –0.31, p = 0.011), integrated area of low-frequency Xrs (AX) (rho = 0.35, p = 0.003) and negative frequency dependence of resistance (Rrs5-Rrs20) (rho = 0.35, p = 0.004). Furthermore, CANO(TMAD) levels were associated with bronchodilator reversibility of FEV₁, FEF_25–75%, Xrs5 and AX (rho = 0.35, 0.31, –0.24 and –0.31, respectively; p ≤ 0.05 for all). No variables were related to J’awNO. Conclusions: Elevated CANO(TMAD), but not J’awNO, partly reflects reversible airway obstruction originating in the peripheral airway. These findings indicate the involvement of peripheral airway inflammation in physiological abnormalities in asthma.

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Section: Discussionsupporting

confidence: 81%

Association of Alveolar Nitric Oxide Levels with Pulmonary Function and Its Reversibility in Stable Asthma

Matsumoto¹,

Niimi²,

Jinnai³

et al. 2010

Respiration

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“…The lack of correlation between FENO and asthma control has been previously reported both in adults and children [20][21][22]. A weak correlation between asthma control, evaluated with ACT, and FENO was described by Japanese authors in a cohort of 105 patients with a high prevalence of uncontrolled asthma (60%) [23].…”

Section: Discussionmentioning

confidence: 88%

Nasal nitric oxide is a marker of poor asthma control

Heffler¹,

Pizzimenti²,

Badiu³

et al. 2013

J. Breath Res.

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Asthma control, evaluated by symptoms, exacerbations rate and lung function may be greatly influenced by comorbidities, particularly chronic rhinosinusitis (CRS). Measurement of nasal nitric oxide (nNO) is a simple way to assess the severity of CRS. We aimed to analyze the relationship between asthma control and nasal NO. All patients with moderate-to-severe asthma on regular follow-up at our Outpatients' Clinic between November 2009 and April 2010 were included into the study. All patients were evaluated for asthma control by asthma control questionnaire (ACQ) and comorbidities (rhinitis, chronic rhinosinusitis with (CRSwNP) or without nasal polyps, obesity). Exhaled nitric oxide and nNO were obtained in all patients. Eighty-two patients were enrolled (mean age: 48 years, range: 21-80; 42 females). According to ACQ, 53 patients (64.6%) reported controlled asthma. Patients with uncontrolled asthma had lower nNO and higher prevalence of CRSwNP, with a significant correlation between nNO and ACQ. nNO is a biomarker negatively related to asthma control. As low nNO values were associated to CRSwNP, our results indicate that asthma control is highly influenced by this comorbidity.

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“…38 Two studies demonstrated no association between alveolar NO values and ACQ scores. 28,29 The studies of Oosterhoff et al 42 ACT, Asthma Control Test; BDI, Baseline Dyspnea Index; CC, closing capacity; CT, computed tomography; CV, closing volume; dN2, slope of phase III of SBNT; FOT, forced oscillation technique; FRC, functional residual capacity; FVC, forced vital capacity; IC, inspiratory capacity; R5, resistance of the respiratory system at 5 Hz; R20, resistance of the respiratory system at 20 Hz; R5-R20, difference of R5 and R20; Rp, peripheral lung resistance; SF6, sulfur hexafluoride; VC, vital capacity; X5, reactance of the respiratory system at 5 Hz.…”

Section: Discussionmentioning

confidence: 97%

Small-airways dysfunction associates with respiratory symptoms and clinical features of asthma: A systematic review

Wiel

Hacken

Postma

et al. 2013

Journal of Allergy and Clinical Immunology

159

100

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Multicentre trial evaluating alveolar NO fraction as a marker of asthma control and severity

Abstract: Alveolar and exhaled NO fractions are not indexes of control or severity in asthmatic children and adults under treatment.

Cited by 52 publications

References 32 publications

Association of Alveolar Nitric Oxide Levels with Pulmonary Function and Its Reversibility in Stable Asthma

Association of Alveolar Nitric Oxide Levels with Pulmonary Function and Its Reversibility in Stable Asthma

Nasal nitric oxide is a marker of poor asthma control

Small-airways dysfunction associates with respiratory symptoms and clinical features of asthma: A systematic review

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