Basic aspects of exhaled nitric oxide

Alving, Kjell; Malinovschi, Andreï

doi:10.1183/1025448x.00028509

Cited by 106 publications

(151 citation statements)

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“…However, only moderate correlations have been reported between the 2 components, 8 and this view is now being challenged by a model in which systemic inflammation plays an independent role in patients with asthma and other respiratory diseases. 3,9,10 This new hypothesis is supported by data from studies showing that systemic inflammation is not always reduced by inhaled corticosteroids 11,12 and that systemic therapies, such as leukotriene receptor antagonists, might be more effective in reducing systemic inflammatory markers. 13,14 Furthermore, biological treatments directed at blocking IL-5 effectively decrease the signs of systemic inflammation, as measured by B-Eos values, but does not change FENO values, 15 whereas anti-IL-13 treatment reduces FENO values without decreasing B-Eos values.…”

supporting

confidence: 56%

“…27 FENO signals local IL-4/IL-13-mediated mechanisms in the bronchial mucosa that are primarily triggered by aeroallergen exposure. 3 An increase in FENO values seems to precede moderate, but not severe, asthma exacerbations. 28 We have recently reported that guiding anti-inflammatory treatment in asthma based on FENO measurement resulted in a reduction of moderate, but not severe, exacerbations.…”

Section: Discussionmentioning

confidence: 99%

“…2 The fraction of exhaled nitric oxide (FENO) is a local marker of airways inflammation, primarily that triggered by IL-4 and IL-13. 3 Measurement of FENO is increasingly used in clinical practice, and clinical guidelines on the use of FENO have recently been published by the American Thoracic Society (ATS). 4 Systemic eosinophilic inflammation, which is measured as blood eosinophil count (B-Eos) or serum eosinophil cationic protein (ECP) values, is also seen in asthmatic patients.…”

mentioning

confidence: 99%

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Exhaled nitric oxide levels and blood eosinophil counts independently associate with wheeze and asthma events in National Health and Nutrition Examination Survey subjects

Malinovschi¹,

Fonseca²,

Jacinto³

et al. 2013

Journal of Allergy and Clinical Immunology

230

158

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Background: Fraction of exhaled nitric oxide (FENO) and blood eosinophil count (B-Eos) values, markers of local and systemic eosinophilic inflammation, respectively, are increased in asthmatic patients. Little is known about the relation of these markers to reported wheeze and asthma events in a random population sample. Objectives: We sought to determine the individual and independent values of B-Eos and FENO in relation to wheeze, asthma diagnosis, and asthma events in a cross-sectional study. 3 ) values rendered an adjusted odds ratio of 4.5 of having wheeze, 5.1 of having asthma, 5.4 for asthma attacks, and 2.9 for asthma-related ED visits compared with normal FENO (<25 ppb) and B-Eos (<300 cells/mm

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supporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Exhaled nitric oxide levels and blood eosinophil counts independently associate with wheeze and asthma events in National Health and Nutrition Examination Survey subjects

Malinovschi¹,

Fonseca²,

Jacinto³

et al. 2013

Journal of Allergy and Clinical Immunology

230

158

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“…Although the mechanism for the age dependence of FeNO is largely unknown, having the same fixed expiratory flow in all ages is a possible reason [4]. With increasing height accompanying ageing, the total airway mucosal surface area available for NO diffusion will increase, which will lead to higher FeNO levels using the same exhalation flow rate [27,28]. The age-dependence of FeNO has been suggested in previous smaller studies in children [7,[29][30][31]. )…”

Section: Exhaled Biomarkers T-c Yao Et Almentioning

confidence: 93%

Reference values of exhaled nitric oxide in healthy Asian children aged 5 to 18 years

Yao

Wi²,

Ls³

et al. 2011

Eur Respir J

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This study was undertaken to establish reference values of exhaled nitric oxide fraction (FeNO) and its determinants in healthy Asian children.693 healthy Asian children aged 5-18 yrs were assessed using a single-breath online FeNO measurement (exhaled flow 50 mL?s -1 ), questionnaires, anthropometric measurements, spirometry and total and specific immunoglobulin (Ig) E.Geometric mean FeNO and the upper 95% CI were 13.7 ppb and 49.7 ppb, respectively, for healthy children, and 11.2 ppb and 30.2 ppb, respectively, for those without allergic sensitisation. FeNO was positively associated with age, allergic sensitisation, total IgE, ambient nitric oxide, measurement in the afternoon, and drinking water within 1 h before testing, and was negatively associated with weight. In healthy children without allergic sensitisation, age was the single best explanatory variable. The FeNO predicted values were 1-2 ppb higher in Asian than in Caucasian children in earlier studies, while the upper 95% CI were 9-10 ppb higher.In conclusion, the upper limits of normal FeNO in Asian children depend on age, from 21 ppb in young children to 39 ppb in adolescents. Ethnicity, age, allergic sensitisation, total IgE, ambient nitric oxide, time of testing, drinking water and weight are important determinants.

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“…Estes resultados são consonantes com o que foi referido em The European Respiratory Monograph por Alving e Malinovschi. 57 Relativamente à Fig. 3, uma possível justificação para algumas crianças classificadas pela GINA como parcialmente controlada ou não controlada e que, com base na classificação do FENO, se encontram no nível normal, será devido ao facto do FENO não apresentar uma boa correlação com a inflamação mediada por neutrófilos.…”

Section: Discussionunclassified

Fração Exalada de Óxido Nítrico no Controlo e Abordagem Terapêutica da Asma

et al. 2014

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(1) = 8,71; OR = 2,33; p = 0,003) sobre a probabilidade de mudar de nível de controlo da asma. Por cada nível de fração exalada de óxido nítrico incrementado o odds de passar a não controlada é 2,33 vezes superior. Discussão: A probabilidade de uma criança asmática mudar o seu nível de controlo da asma, de 'controlada' para 'parcialmente controlada/não controlada', tendo em consideração uma alteração no seu nível da fração exalada de óxido nítrico, aumenta 133%. Palavras-chave: Criança; Asma; Expiração; Óxido Nítrico; Portugal. AbSTRACTIntroduction: Asthma is a chronic respiratory disease characterized by hyper-responsiveness and bronchial inflammation. The bronchial inflammation in these patients can be monitored by measuring the fractional exhaled nitric oxide. This study aims to determine fractional exhaled nitric oxide association with peak expiratory flow and with asthma control inferred by the Global Initiative for Asthma. Material and Methods:Observational, analytical and cross-sectional study of children with asthma, 6-12 years-old, followed in the Outpatient Respiratory Pathology of Braga Hospital. Sociodemographic and clinical information were collected through a questionnaire. fractional exhaled nitric oxide and peak expiratory flow were determined by portable analyzer Niox Mino ® and flow meter, respectively. Results: The sample is constituted by 101 asthmatic children, 63 (62.4%) of males and 38 (37.6%) females. The mean age of participants in the sample is 9.18 (1.99) years. The logistic regression performed with the cutoff value obtained by ROC curve, revealed that fractional exhaled nitric oxide (b FENO classes = 0.85; χ 2 Wald (1) = 8.71; OR = 2.33; p = 0.003) has a statistical significant effect on the probability of changing level of asthma control. The odds ratio of going from "controlled" to "partly controlled/uncontrolled" is 2.33 per each level of fractional exhaled nitric oxide. Discussion: The probability of an asthmatic children change their level of asthma control, from 'controlled' to 'partly controlled/uncontrolled', taking into account a change in their fractional exhaled nitric oxide level, increases 133%.

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Basic aspects of exhaled nitric oxide

Cited by 106 publications

References 0 publications

Exhaled nitric oxide levels and blood eosinophil counts independently associate with wheeze and asthma events in National Health and Nutrition Examination Survey subjects

Exhaled nitric oxide levels and blood eosinophil counts independently associate with wheeze and asthma events in National Health and Nutrition Examination Survey subjects

Reference values of exhaled nitric oxide in healthy Asian children aged 5 to 18 years

Fração Exalada de Óxido Nítrico no Controlo e Abordagem Terapêutica da Asma

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