Exhaled Nitric Oxide Decreases in Association with Attendance at an Asthma Summer Camp

Abstract

Attendance at a summer asthma camp has been associated with improved outcomes in children with asthma. We hypothesized that one mechanism involved in improved asthma outcomes is reduction in airway inflammation. To investigate this, we measured the fractional concentration of exhaled nitric oxide (FeNO), lung function (forced expiratory volume in 1 sec, FEV(1)) and asthma control (Juniper Asthma Control Questionnaire, ACQ) from children at the beginning and end of a 1-week asthma summer camp. We also obtained a symptoms-only ACQ at 1 and 6 months after the end of camp. We enrolled 10 girls, 17 boys, mean (+/- SD) age = 9.6 +/- 1.3 years. At baseline, FeNO (ppb), median (25-75 IQR) = 11.4 (7.2-21.3); ACQ = 0.86 (0.43-1.21); FEV(1) (%pred, mean +/- SD) = 87 +/- 10. At the end of camp, FeNO = 6.2 (4.4-8.4), a change of -45%, p < 0.0001; ACQ = 0.71 (0.43-1.14), a fall of 14%, p = 0.72; and mean FEV(1)% predicted remained unchanged. There were no significant changes in the follow-up symptoms-only ACQ at 1 and 6 months. We conclude that airway inflammation, as measured by FeNO, improved during 1 week of asthma camp, but there were no significant changes in lung function or asthma control. Since no child had a change in anti-inflammatory therapy during camp, these findings suggest that airway inflammation was reduced because of improved adherence to therapy and/or reduced exposure to pro-inflammatory stimuli in the home environment. The finding of reduced inflammation following attendance at an asthma summer camp should motivate the child, the parents and the clinician to focus their efforts on improving adherence to therapy and reducing exposures at home.

Rehabilitation of Allergic Diseases in Children — Climatothalassotherapy as a Power Tool in Achieving Optimal Disease Control

“…With statistically relevant significance it can be established that climate has a positive effect on reducing the values in FeNO as a biomarker of inflammation and thus favorably affect on asthma control. Kaminski et al in their study had similar observations [10]. Of course, it should be taken into account that specific micro factors like air pollution as well as the number and proximity of roads and clean air and seawater [11,12].…”

Urinary Bromotyrosine Measures Asthma Control and Predicts Asthma Exacerbations in Children

“…15,16 Six weeks after the initial study encounter, participants (with parent/guardians) were readministered the ACQ6 by telephone and asked about any asthma exacerbations since the initial study encounter, defined a priori as an acute de-compensation of asthma control resulting in a visit to the emergency department, unexpected doctor’s appointment or phone call, oral or parenteral corticosteroid burst, or an acute onset of asthma-related respiratory symptoms per self-report. All clinicians involved with the care of study participants were blinded to ACQ6 results, urinary BrTyr levels, and exhaled NO measurements.…”

What is a clinically meaningful change in exhaled nitric oxide for children with asthma?

“…Considerable variation in F E NO values over time has also been reported in “natural experiments” in children. For example Huss‐Marp et al observed that F E NO values in children with mild intermittent asthma with initial F E NO > 17 ppb and attending a summer camp at altitude fell by 50% over four to 6 weeks independent of symptoms, and Kaminsky et al found F E NO values fell from 11 to 6 ppb (a 45% reduction) independent of asthma control among 27 children attending a 1‐week summer camp. Two studies of children with asthma who were sensitized to grass found the F E NO values rose by approximately 50% during the pollen season but asthma symptoms also rose during this time.…”