Exhaled nitric oxide levels during treatment in patients hospitalized with asthma

Abstract

The time required for fractional excretion of nitric oxide (FE(NO)) measurements to acutely change after systemic corticosteroids is unknown, limiting the usefulness of this biomarker in hospital treatment and discharge decisions. The purpose of this study was to follow FE(NO) measurements of hospitalized adult patients with asthma receiving therapy and to correlate FE(NO) with forced expiratory volume in 1 second percent predicted (FEV(1)%). Ten acute asthmatic patients who required hospitalization were recruited and treated with standard therapy. FE(NO) measurements were performed at presentation to the emergency department (baseline), as well as 1, 4, 6, 8, 12, and 24 hours after the initiation of therapy. FEV(1)% was measured at baseline, 1, 6, 12, and 24 hours. Subjects also were called 3 days after discharge to assess if symptoms had improved. The baseline FE(NO) was 57.5 parts per billion (ppb). There was no significant change over the first 8 hours. At 12 hours, there was an increase to 96.5 ppb (p = 0.01). Compared with baseline, all 10 subjects showed an increase at the 12-hour time point, with an average increase of 52%. The correlation between change in FE(NO) and change in FEV(1)% approached significance (p = 0.089). Subjects who improved after discharge had a greater percent increase in FE(NO) than those who did not (p = 0.043). FE(NO) measurements increase in hospitalized asthmatic patients receiving therapy. This augmentation appears to be associated with improvements in FEV(1). Asthmatic patients who show a greater increase in FE(NO) may have better outcomes after discharge.

Lung function and biomarkers of airway inflammation during and after hospitalization for acute exacerbations of childhood asthma associated with viral respiratory symptoms

“…15 There is also a paucity of data reporting measurements of FENO and lung function in children during hospitalization for acute asthma. 16–18 Our finding of no correlation between enrollment lung function and enrollment FENO is consistent with data reported by Baptist et al 16 The mean FENO concentrations in their patients before discharge from the hospital were slightly higher than those in our patients (38.4 vs. 31.5ppb), and the average enrollment FEV1 in their patients was also lower (64.4% vs. 76.9% predicted). These differences could be explained by their cohort having either more severe asthma or being more acutely ill at the time of enrollment lung function measurements.…”

An Umbrella Review: Corticosteroid Therapy for Adults with Acute Asthma

“…While potentially appealing, given the cost and availability of these tests, further research is needed to evaluate the clinical benefit of incorporating biomarkers of eosinophilic airway inflammation in the acute care setting 58,59…”

Airway calibre variation is a major determinant of exhaled nitric oxide's ability to capture asthma control

“…Should the asthma worsen, such a relatively large ACQ score increase could potentially be classified as a moderate exacerbation according to ATS/ERS recommendations [24]. Previous studies have already reported a paradoxical parallel increase in FEV1 and FENO during the recovery phase of an acute severe exacerbation [25,26]. Opposite FENO-FEV1 moves were not reported in those studies that involved relatively small numbers of patients, who experienced severe rather than moderate exacerbation.…”