Exhaled and nasal nitric oxide measurements: recommendations. The European Respiratory Society Task Force

Kharitonov, Sergei A.; Alving, Kjell; Barnes, Peter J.

doi:10.1183/09031936.97.10071683

Cited by 633 publications

(557 citation statements)

References 67 publications

(154 reference statements)

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“…Among non-asthmatic children, atopic subjects had higher eNO concentrations than non-atopic subjects, which contrasts with previous results showing no difference in eNO levels between atopic and nonatopic individuals either in children [7] or in adults [15,16]. This might be due to the use in these studies of a high (250 mL/s) expiratory flow rate, which has been shown to have poor sensitivity [11,12,17]. Indeed, our results were in agreement with studies using a reduced-flow rate technique for measuring eNO in both children [18] and adults [19].…”

Section: Discussioncontrasting

confidence: 86%

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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Section: Discussioncontrasting

confidence: 86%

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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“…This method has been shown to be successfully applicable both in adults and in children. NO value was measured at the plateau of the end-exhaled reading and expressed in parts per billion according to guidelines [31]. Values of NO considered in the data analysis were always measured in the last part of exhalation (plateau exhaled NO), taking the plateau of the end-exhaled carbon dioxide reading as representative of an alveolar sample [20, 30±34].…”

Section: Nitric Oxide Measurementmentioning

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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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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“…Exhaled NO was detected in all subjects: the first washout volume of expired gas, which represented the anatomical and mechanical dead space [22] and which was likely to be contaminated by nasal NO [23], generated a peak in NO values during the early part of the exhalation. This peak was followed by a plateau, associated with the last part of exhalation, which represented the NO levels derived from the lower respiratory tract [24,25].…”

Section: Detection Of No Levels In Orally Exhaled Airmentioning

confidence: 99%

Orally exhaled nitric oxide levels are related to the degree of blood eosinophilia in atopic children with mild-intermittent asthma

et al. 1999

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Orally exhaled nitric oxide levels are related to the degree of blood eosinophilia in atopic children with mild-intermittent asthma. M. Silvestri, D. Spallarossa, V. Frangova Yourukova, E. Battistini, B. Fregonese, G.A. Rossi. #ERS Journals Ltd 1999. ABSTRACT: Increased levels of nitric oxide have been found in expired air of patients with asthma, and these are thought to be related to the airway inflammatory events that characterize this disorder. Since, in adults, bronchial inflammatory changes are present even in mild disease, the present study was designed to evaluate whether a significant proportion of children with mild-intermittent asthma could have increased exhaled air NO concentrations.Twenty-two atopic children (aged 11.1 0.8 yrs) with mild-intermittent asthma, treated only with inhaled b 2 -adrenoreceptor agonists on demand and 22 age-matched controls were studied.NO concentrations in orally exhaled air, measured by chemiluminescence, were significantly higher in asthmatics, as compared to controls (19.4 3.3 parts per billion (ppb) and 4.0 0.5 ppb, respectively; p<0.01). Interestingly, 14 out of 22 asthmatic children had NO levels >8.8 ppb (i.e. >2 standard deviations of the mean in controls). In asthmatic patients, but not in control subjects, statistically significant correlations were found between exhaled NO levels and absolute number or percentage of blood eosinophils (r=0.63 and 0.56, respectively; p<0.01, each comparison). In contrast, exhaled NO levels were not correlated with forced expiratory volume in one second (FEV1) or forced expiratory flows at 25±75% of vital capacity (FEF25±75%) or forced vital capacity (FVC), either in control subjects, or in asthmatic patients (p>0.1, each correlation).These results suggest that a significant proportion of children with mild-intermittent asthma may have airway inflammation, as shown by the presence of elevated levels of nitric oxide in the exhaled air. The clinical relevance of this observation remains to be established. Eur Respir J 1999; 13: 321±326.

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Exhaled and nasal nitric oxide measurements: recommendations. The European Respiratory Society Task Force

Cited by 633 publications

References 67 publications

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

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

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

Orally exhaled nitric oxide levels are related to the degree of blood eosinophilia in atopic children with mild-intermittent asthma

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