Nitric oxide in exhaled air

Lundberg, Jon O.; Weitzberg, Eddie; Lundberg, Jan M.; Alving, Kjell

doi:10.1183/09031936.96.09122671

Cited by 137 publications

(120 citation statements)

References 66 publications

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“…Standardization is necessary for the collection of acceptable and comparable data both within one center and between several centers. For eNOsb measurements, standardization primarily involves the expiratory target flow of 50 ml/s, as eNO is inversely related to flow (9)(10)(11)(12)(13). Furthermore, standardization requires the following criteria: inhalation to total lung capacity during the inspiratory maneuver, inspired NO concentration of <5 parts per billion (ppb), exhalation time of ≥4 s for children <12 y and ≥6 s if older, duration of expiratory plateau at target flow of ≥2 s, expiratory pressure level of 5-20 cm H 2 O for velum closure, calibration, hardware, and measurement techniques (9).…”

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confidence: 99%

Comparison of online single-breath vs. online multiple-breath exhaled nitric oxide in school-age children

et al. 2012

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IntroductIon: standards for online multiple-breath (mb) exhaled nitric oxide (eNO) measurements and studies comparing them with online single-breath (sb) eNO measurements are lacking, although eNOmb requires less cooperation in children at school age or younger. Methods: Online eNOmb and eNOsb were measured in 99 healthy children and (in order to observe higher values) in 21 children with suspected asthma at a median age of 6.1 and 11.7 y, respectively. For eNOmb, we aimed for 20 tidal breathing maneuvers; eNOsb was measured according to standards. The two techniques were compared by standard methods after computing NO output or extrapolating eNOmb to the standard flow of 50 ml/s (eNOmb 50 ). results: Measurements were acceptable in 82 (eNOmb) and 81 (eNOsb) children. Paired data were available for 65 children. On a log-log scale, eNOmb 50 (geometric mean ± sD 13.1 ± 15.5 parts per billion, ppb) was correlated with eNOsb (12.5 ± 15.8 ppb), with r 2 = 0.87. The mean difference between eNOsb and eNOmb 50 was −0.7 ppb, with limits of agreement (LOas) of 4.0 and −5.3 ppb. dIscussIon: Despite its correlation with eNOsb, the LOa range hampers eNOmb use in research, where exact values across the whole range are warranted. however, eNOmb might be an alternative tool especially at preschool age, when cooperation during measurements is crucial.

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confidence: 99%

Comparison of online single-breath vs. online multiple-breath exhaled nitric oxide in school-age children

et al. 2012

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“…For this reason, it was recently suggested that the monitoring of lung function and symptoms are not sensitive enough to reflect the extent of airway inflammation [25]. The measurement of FE,NO has been proposed as a simple noninvasive means of monitoring the level of airway inflammation [11±13, 16,26]. It has also been demonstrated that FE,NO is increased after allergen-induced asthmatic reactions [27,28], whereas it is reduced after treatment with inhaled steroids [15] in a dose-related fashion [14].…”

Section: Discussionmentioning

confidence: 99%

“…This method has been shown to be successfully applicable in both adults and children. The FE,NO was measured at the plateau of the end-expiratory reading and expressed in parts per billion (ppb) according to guidelines [16]. The FE,NO considered in the data analysis were always measured at the plateau FE,NO, taking the plateau of the endexpiratory carbon dioxide reading as representative of an alveolar sample [13,17].…”

Section: Lung Function and Nitric Oxide Measurementmentioning

confidence: 99%

Exhaled nitric oxide in asthmatic children exposed to relevant allergens: effect of flunisolide

Piacentini

Bodini

Costella³

et al. 2000

Eur Respir J

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Inhaled corticosteroids are capable of reducing the level of exhaled nitric oxide (expiratory nitric oxide fraction (FE,NO)) in asthmatic patients in a dosedependent fashion. The aim of this study was to evaluate whether or not treatment with an inhaled steroid can prevent changes in FE,NO after the exposure to relevant allergens, following avoidance, in asthmatic children allergic to house dust mite.Thirty-two house dust mite-allergy asthmatic children were randomly allocated to treatment with inhaled flunisolide (500 mg b.i.d.) or placebo and evaluated before and 2 weeks after a period of natural exposure to mite antigens. Lung function and FE,NO were evaluated.FE,NO was increased in the placebo-treated group after antigen exposure. Treatment with inhaled flunisolide prevented such increase in FE, NO (p<0.001). No change was observed in lung function parameters.Inhaled flunisolide is effective in preventing the increase in airway inflammation observed in allergic asthmatic children re-exposed to allergens. It is well recognized that asthma is an inflammatory disease and that indoor allergens, in particular house dust mite, represent a relevant factor in the aetiology of the disease [1]. It has been demonstrated that the development or worsening of asthma symptoms in children may be alleviated by allergen avoidance [2,3] or by suppressing the bronchial response to allergen challenge [4±9].In recent years, different markers have been proposed for the evaluation of level of airway inflammation [10]. Among these, the measurement of exhaled nitric oxide levels (expiratory nitric oxide fraction (FE,NO)) is considered a noninvasive means of assessing the degree of airway inflammation in asthmatics [11±13].Recent studies have shown that inhaled corticosteroids are capable of decreasing the FE,NO in asthmatic patients in a dose-dependent fashion [14,15].In this study, whether treatment with an inhaled steroid can prevent changes in FE,NO after a brief period of exposure to relevant allergens was evaluated in a group of asthmatic children allergic to house dust mite. Material and methods SubjectsThirty-two children (26 males and six females), ranging in age 6±15 yrs and with a history of bronchial asthma and a positive skin-prick test to house dust mite, were evaluated at the "Istituto Pio XII" long-stay hospital (Misurina, Belluno, Italy), situated at an altitude of 1,756 m in the Italian Alps. None of the patients had had respiratory infections for $2 months before the beginning of the study and none of them were allergic to furry pets.None of the children had received oral corticosteroids for $2 months or inhaled corticosteroids for $1 month before the study since they were staying in a house dust mite-free environment.The study was approved by the Istituto Pio XII Ethics Committee and both children and their parents gave informed consent. Study designThe study was performed between December 1997 and January 1998. The children admitted to the study had been living at the Istituto Pio XII, an environment fre...

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“…Of chemokines eotaxin, IL-8, regulated on activation, normal T-cell expressed and secreted (RANTES) and others are of interest, but with the exception of IL-8, for which good assays are available (35,36), the measurements of chemokines have limited clinical interest. Another inflammation marker, which is produced by many cells and is increasingly used as a tool to reflect inflammation in the airways is nitric oxide (NO) in exhaled air (37)(38)(39)(40). Its position in the clinical routine is still uncertain mostly because of methodological problems and difficulties in the interpretation of the results (40-42).…”

Section: Monitoring Of Inflammationmentioning

confidence: 99%

Monitoring the allergic inflammation

Venge

2003

Allergy

127

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Individual symptoms of allergy such as asthma, dermatitis, rhinitis have many different underlying mechanisms. The detailed characterization of the inflammatory mechanisms underlying symptom development in the individual patient is important in order to optimally control treatment. Measurement of eosinophil cationic protein (ECP) in sputum or blood and eosinophil protein X/eosinophil derived neurotoxin (EPX/EDN) in urine may be used to read the involvement of the eosinophil granulocyte in the process. An important information as eosinophil dominated processes seem to be particularly sensitive to corticosteroid treatment. The possibilities to measure the involvement of other inflammatory cells exist today, but are only used to a small extent. The dream would be that every patient with an inflammatory disease is characterized with respect to the profile of involving cells and mediators. Such information would provide us with a unique understanding of the underlying mechanisms of the development of disease symptoms and the possibilities of treating these.

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Nitric oxide in exhaled air

Cited by 137 publications

References 66 publications

Comparison of online single-breath vs. online multiple-breath exhaled nitric oxide in school-age children

Comparison of online single-breath vs. online multiple-breath exhaled nitric oxide in school-age children

Exhaled nitric oxide in asthmatic children exposed to relevant allergens: effect of flunisolide

Monitoring the allergic inflammation

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