Determinants of Exhaled Nitric Oxide Levels (FeNO) in Childhood Atopic Asthma: Evidence for Neonatal Respiratory Distress as a Factor Associated With Low FeNO Levels

Ricciardolo, Fabio Luigi Massimo; Silvestri, Michela; Pistorio, Angela; Strozzi, Maria Chiara; Tosca, Maria Angela; Bellodi, Simona; Battistini, Elena; Gardella, Chiara; Rossi, Giovanni A.

doi:10.3109/02770903.2010.489245

Cited by 12 publications

(12 citation statements)

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“…One study of 52 children aged 5–36 months demonstrated significantly higher FeNO levels in children with a positive asthma predictive index (API) compared to those with a negative API, although the median levels in both groups were low at 12.5 and 5.6 ppb, respectively [34]. FeNO levels have been described to be higher in allergic or atopic asthma compared to nonallergic asthma [45], but are also elevated in children who have allergic sensitization as demonstrated by positive skin-prick testing or aeroallergen-specific IgE [32,35,43]. FeNO levels have been shown to be higher in children with allergic sensitization or atopy and no asthma compared to nonallergic asthma [32,35,45], and have been found to be higher in children both with treated and untreated asthma than in healthy nonatopic children [54].…”

Section: Feno and Diagnosis Of Asthmamentioning

confidence: 99%

“…A history of neonatal respiratory distress in preterm infants without bronchopulmonary dysplasia (BPD) may lead to lower FeNO levels in children with atopic asthma, as described in a study by Ricciardolo et al [43]. A similar finding of lower FeNO levels was previously reported in school-aged children with BPD compared to controls [55], while Filippone et al found that FeNO levels were similar and normal among former preterm (defined as ≤32 weeks gestation) adolescents with BPD, former preterm adolescents without BPD and healthy adolescents born at term, a finding that held true even in the presence of atopy [56].…”

Section: Feno and Diagnosis Of Asthmamentioning

confidence: 99%

“…One study found a significant but weak correlation between FeNO and FEV 1 [60], while Ricciardolo et al found an FEV1 of ≤86% predicted was associated with FeNO levels between 20 and 40 ppb in children with mild–moderate asthma [43]. …”

Section: Feno and Lung Functionmentioning

confidence: 99%

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An Overview of Fractional Exhaled Nitric Oxide and Children with Asthma

Rao

Phipatanakul

2016

Expert Review of Clinical Immunology

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SUMMARY Asthma is the most common pediatric chronic disease and is characterized by lung inflammation. Fractional exhaled nitric oxide (FeNO) is thought to reflect the presence of eosinophilic airway inflammation, and is an easy, non-invasive test that has held promise in providing additional objective data. However, not all studies have shown a clinical benefit in the use of FeNO to guide management of asthma in children. This review will describe the results of the most recent studies examining the use of FeNO in the diagnosis and treatment of asthma in infants, pre-school-aged children and in school-aged children. It will aid the clinician in providing a clinical context in which FeNO may be most useful in treating pediatric asthma.

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Section: Feno and Diagnosis Of Asthmamentioning

confidence: 99%

Section: Feno and Diagnosis Of Asthmamentioning

confidence: 99%

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An Overview of Fractional Exhaled Nitric Oxide and Children with Asthma

Rao

Phipatanakul

2016

Expert Review of Clinical Immunology

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“…Filiponne et al [16] have shown that children born prematurely with and without BPD have increase oxidative stress compared to children born at term despite normal eNO levels, pointing to other inflammatory pathways that cannot be picked up by eNO measurements. Ricciardlo et al [33] investigated determinants of eNO in childhood atopic asthma. They found that neonatal respiratory distress has been associated with low eNO in children with atopic asthma [33].…”

Section: Discussionmentioning

confidence: 99%

“…Ricciardlo et al [33] investigated determinants of eNO in childhood atopic asthma. They found that neonatal respiratory distress has been associated with low eNO in children with atopic asthma [33]. The higher eNO and V’ NO in long-term (≥7 days) than in short-term (<7 days) ventilated infants may have been caused by established ongoing inflammation secondary to prolonged intubation and mechanical ventilation as well as exposure to supplemental oxygen [34].…”

Section: Discussionmentioning

confidence: 99%

Effect of intubation and mechanical ventilation on exhaled nitric oxide in preterm infants with and without bronchopulmonary dysplasia measured at a median postmenstrual age of 49 weeks

et al. 2014

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BackgroundExhaled nitric oxide (eNO) is a marker of established airway inflammation in adults and children, but conflicting results have been reported in preterm infants when postnatal eNO is measured during tidal breathing. This study investigated the extent to which intubation and mechanical ventilation (MV) affect eNO and NO production (V’NO) in preterm infants with and without bronchopulmonary dysplasia (BPD).Patients and methodsA total of 176 very low birth weight (VLBW) infants (birth weight <1500 g), including 74 (42%) with and 102 (58%) without BPD, were examined at a median postmenstrual age of 49 weeks. Of the 176 infants, 84 (48%) did not require MV, 47 (27%) required MV for <7 days and 45 (26%) required MV for ≥7 days. Exhaled NO and tidal breathing parameters were measured in sleeping infants during tidal breathing, respiratory mechanics were assessed by occlusion tests, and arterialized capillary blood gas was analyzed.ResultseNO was significantly correlated with tidal breathing parameters, while V’NO was correlated with growth parameters, including age and body length (p < 0.001 each). Infants who were intubated and received MV for <7 days had significantly lower eNO (p < 0.01) and V’NO (p < 0.01) than non-ventilated infants. In contrast, eNO and V’NO did not differ significantly in non-ventilated infants and those receiving MV for ≥7 days. Multivariate analysis showed that independent on the duration of MV eNO (p = 0.003) and V’NO (p = 0.018) were significantly increased in BPD infants comparable with the effects of intubation and MV on eNO (p = 0.002) and V’NO (p = 0.017).ConclusionsPreterm infants with BPD show only weak postnatal increases in eNO and V’NO, but these changes may be obscured by the distinct influences of breathing pattern and invasive respiratory support. This limits the diagnostic value of postnatal eNO measurements in the follow-up of BPD infants.

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Neonatal FeNO, risk factors, and respiratory morbidity in infants: A cohort study

Goth

Schmidt

Green

et al. 2021

Pediatric Pulmonology

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Background Respiratory symptoms in infancy are more common in premature infants. Nitric oxide (NO) is involved in prenatal and neonatal lung development. Measurement of exhaled NO is easy and well‐tolerated by neonates. We investigated whether neonatal exhaled NO can be used to predict subsequent respiratory symptoms. Furthermore, we sought to determine prenatal and postnatal factors associated with increased respiratory symptom risk during the first year of life in premature and mature infants. Methods Tidal fractional exhaled NO (FeNO) was measured in a birth cohort (n = 135) of premature and mature infants, up to six times during the first month of life. Primary outcomes were troublesome respiratory symptoms (TRS) and doctor‐diagnosed asthmatic bronchitis (AB) at 1 year of age. Findings The correlation between FeNO and TRS changed significantly in an age‐dependent pattern in moderately premature infants (p = .02). Moderately premature infants with a low FeNO of 2 ppb on postnatal Day 3 had a 48% (95% confidence interval [CI]: 17%–80%) probability of TRS, compared with a probability of 12% (95% CI: 1%–64%) for otherwise similar infants with a FeNO of 11 ppb. Respiratory syncytial virus infection and parental smoking significantly increased the TRS risk in premature infants. Parental asthma and maternal antibiotic use during pregnancy significantly increased the TRS risk in mature infants. Interpretation An age‐specific association between neonatal FeNO and respiratory symptoms was seen in moderately premature infants. TRS risk was associated with postnatal factors in premature and prenatal factors in mature infants.

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Determinants of Exhaled Nitric Oxide Levels (FeNO) in Childhood Atopic Asthma: Evidence for Neonatal Respiratory Distress as a Factor Associated With Low FeNO Levels

Abstract: Besides confirming the well-known tight association between blood eosinophilia and/or allergic sensitization and FeNO, these data provide new evidence for neonatal respiratory distress as potential factor associated with low FeNO levels in childhood atopic asthma.

Cited by 12 publications

References 44 publications

An Overview of Fractional Exhaled Nitric Oxide and Children with Asthma

An Overview of Fractional Exhaled Nitric Oxide and Children with Asthma

Effect of intubation and mechanical ventilation on exhaled nitric oxide in preterm infants with and without bronchopulmonary dysplasia measured at a median postmenstrual age of 49 weeks

Neonatal FeNO, risk factors, and respiratory morbidity in infants: A cohort study

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