Changes in the dose of inhaled steroid affect exhaled nitric oxide levels in asthmatic patients

Kharitonov, Sergei A.; Yates, D H; Chung, Kian Fan; Barnes, Peter J.

doi:10.1183/09031936.96.09020196

Cited by 224 publications

(150 citation statements)

References 25 publications

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“…It may be possible that in the relatively more severe subjects, for whom a regular anti-inflammatory treatment was necessary, the measurement of airway flow is less sensitive in evaluating the severity of the disease as compared to airway inflammation as evaluated by ENO. This is in agreement with the finding by KARITONOV and coworkers [19,20] who showed that significant changes of ENO levels induced by the introduction of treatment with budesonide [20] or mod-ulation of its dosage [19] were not accompanied by signi-ficant modifications in FEV1 levels.…”

Section: Resultssupporting

confidence: 93%

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Exhaled nitric oxide, serum ECP and airway responsiveness in mild asthmatic children

Piacentini

Bodini

Costella³

et al. 2000

Eur Respir J

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The purpose of the present study was to assess the possible relationships between exhaled nitric oxide (ENO), a circulating marker of eosinophil activation, serum eosinophil cationic protein (SECP), level of airway responsiveness to methacholine and lung function in asthmatic children, as well as to compare these markers between children with and without inhaled steroid therapy.In a cross-sectional study ENO, SECP and bronchial hyperresponsiveness to methacholine were evaluated in a group of 57 asthmatic children (21 without and 36 with regulator inhaled steroid therapy; aged 6±13 yrs).ENO was significantly lower in steroid treated children (p<0.01). No significant differences between steroid treated and untreated children were observed for the provocative concentration of methacholine causing a 20% faill in forced expiratory volume in one second (FEV1; PC20), SECP and FEV1. In the whole study population significant increase correlations were observed between PC20 and SECP (r=-0.329, p=0.013) and between ENO and FEV1% of predicted (r=-0.348, p<0.01). In the group not receiving inhaled steroids the inverse relationship between PC20 and SECP was more evident (r=-0.581, p<0.001). In the steroid-treated group a significant inverse relationship was observed between ENO and FEV1 (r=-0.426, p=0.0011).The level of exhaled nitric oxide and the relationships between lung function, bronchial reactivity and markers of inflammation are different between steroidtreated and untreated asthmatic children. This has implications for the monitoring of asthma in childhood. The relationship between airway inflammation and airway responsiveness has been evaluated by different groups with contrasting results. Some authors [1±6] have found a strong relationship between inflammatory cells in the airway and the level of bronchial responsiveness while others failed to find such a correlation [7±11].Similarly, contrasting results have been found between serum markers of eosinophil activation, in particular serum eosinophil cationic protein (SECP), and the degree of bronchial responsiveness in asthmatic patients [12±15].Recently, the measurement of exhaled nitric oxide (ENO) has been proposed as a noninvasive means for assessing the degree of airway inflammation [16±18]. Some studies have evaluated the effect of treatment with inhaled steroids on the levels of ENO in asthmatic adults [19,20] and one study in children with acute asthma [21]. Furthermore, a few studies have evaluated the relationship of this parameter with the level of airway hyperresponsiveness with contrasting results [22±25].The purpose of the present study was to assess the possible relationship between ENO, a circulating marker of eosinophil activation SECP, level of bronchial hyperresponsiveness (BHR) to methacholine and lung function in asthmatic children, as well as to compare these markers between patients with and without inhaled steroid treatment. Material and methods Subjects and study designFifty-seven children with mild to moderate asthma, clinically st...

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Section: Resultssupporting

confidence: 93%

“…Some studies have evaluated the effect of treatment with inhaled steroids on the levels of ENO in asthmatic adults [19,20] and one study in children with acute asthma [21]. Furthermore, a few studies have evaluated the relationship of this parameter with the level of airway hyperresponsiveness with contrasting results [22±25].…”

mentioning

confidence: 99%

Exhaled nitric oxide, serum ECP and airway responsiveness in mild asthmatic children

Piacentini

Bodini

Costella³

et al. 2000

Eur Respir J

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“…Furthermore, inhaled corticosteroids decrease exhaled NO (eNO) [4,5]. These results support the argument that eNO level is a marker of airway inflammation and suggest that measurement of eNO may be important in the management of asthma [6].…”

Section: Introductionsupporting

confidence: 58%

Interrelationships among asthma, atopy, rhinitis and exhaled nitric oxide in a population‐based sample of children

Jouaville¹,

Annesi‐Maesano

Nguyễn³

et al. 2003

Clin Experimental Allergy

116

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SummaryBackground Exhaled nitric oxide (eNO) has attracted increasing interest as a non-invasive marker of airway inflammation in asthma. However, little evidence exists on the influences exerted on eNO by the interrelations among atopic status, asthma and rhinitis. Methods Among the 1156 children who participated in a large-scale epidemiological survey on asthma and allergies (ISAAC II: International Study of Asthma and Allergies in Childhood Phase II) in the city of Clermont-Ferrand, 53 asthmatics without corticosteroid treatment and 96 nonasthmatics were invited to perform eNO and skin prick tests (SPTs) to 12 common allergens. Results Atopic asthmatic children had higher eNO than non-atopic asthmatic children (28.979.1 vs. 17.1713.1 p.p.b.; P 5 0.0004) with a significant increase when one SPT or more are positive (26.577.8 vs. 17.1713.1 p.p.b.; P 5 0.03). Similarly, non-asthmatic, atopic subjects had higher eNO than non-atopic subjects with a significant increase when two SPTs or more are positive (19.479.8 vs. 11.7 76.7 p.p.b.; P 5 0.003). In the case of equal levels of positive SPTs (0, 1, X2), asthmatic children always had higher eNO than non-asthmatic ones. Furthermore, among non-asthmatic children, the eNO level increased only in atopics who had rhinitis (20.7713 vs. 12.576.4 p.p.b. in atopic controls (subjects without rhinitis and asthma) and 12.376.6 p.p.b. in non-atopic controls; P 5 0.001), whereas among asthmatic children, eNO level increased in atopics independently of rhinitis (28.279.5 p.p.b. in those with rhinitis and 30.978.1 p.p.b. in those without) as well as in nonatopics with rhinitis (22.5717.2 p.p.b.). Conclusions Our data suggest that besides atopy and asthma, allergic rhinitis should also be taken into account in the assessment of eNO.

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“…The forced expiratory volume in one second (FEV1) and forced mid-expiratory flow (FEF25±75) were considered in the analysis of results. The FE,NO was measured using a chemiluminescence analyser (Logan LR 2149; Logan, Rochester, UK) before performing spirometry [14,15].…”

Section: Lung Function and Nitric Oxide Measurementmentioning

confidence: 99%

“…Recent studies have shown that inhaled corticosteroids are capable of decreasing the FE,NO in asthmatic patients in a dose-dependent fashion [14,15].…”

mentioning

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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Changes in the dose of inhaled steroid affect exhaled nitric oxide levels in asthmatic patients

Cited by 224 publications

References 25 publications

Exhaled nitric oxide, serum ECP and airway responsiveness in mild asthmatic children

Exhaled nitric oxide, serum ECP and airway responsiveness in mild asthmatic children

Interrelationships among asthma, atopy, rhinitis and exhaled nitric oxide in a population‐based sample of children

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

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