Increase in Alveolar Nitric Oxide in the Presence of Symptoms in Childhood Asthma

Mahut, Bruno; Delacourt, Christophe; Zerah-Lancner, Françoise; Blic, J. de; Harf, Alain; Delclaux, Christophe

doi:10.1378/chest.125.3.1012

Cited by 100 publications

(81 citation statements)

References 28 publications

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“…As compared with other investigators who measured alveolar NO in adults with mildto-moderate persistent asthma [21], severe asthma [11], and in children with mild [22] and refractory asthma [10], the present authors obtained alveolar NO levels in a lower range (3-4-fold lower). This could be due to differences between patient characteristics and/or differences in the technical aspects of the measurements, such as the use of higher flow rates to calculate alveolar NO in the present study.…”

Section: Discussionsupporting

confidence: 53%

“…Comparison of alveolar NO levels between patients with mildto-moderate and severe asthma revealed no significant differences after initial analysis, which was surprising. In studies by other groups, higher levels of alveolar NO were found in symptomatic children versus asymptomatic children with asthma [22], in patients with nocturnal asthma compared with non-nocturnal asthma [23], and in patients with severe versus mild-to-moderate asthma [11]. An explanation for the lack of a significant difference in alveolar NO levels between patients with mild-to-moderate and severe asthma in the present study could be the large variability of alveolar NO levels amongst the patients with severe asthma.…”

Section: Discussionmentioning

confidence: 79%

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Alveolar nitric oxideversusmeasures of peripheral airway dysfunction in severe asthma

Veen¹,

Sterk²,

Schot³

et al. 2006

Eur Respir J

129

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Alveolar nitric oxide (NO) is a measure of peripheral airway inflammation in asthma, potentially associated with disease severity. The relationship between alveolar NO and physiological tests of peripheral airway (dys)function has not been investigated. The present authors hypothesised that peripheral airway inflammation and dysfunction are inter-related and associated with asthma severity.Alveolar NO was compared between 17 patients with mild-to-moderate asthma and 14 patients with severe asthma and related to total lung capacity (TLC), residual volume (RV)/TLC, thoracic gas volume (FRC), slope of the single breath nitrogen washout curve (dN 2 ), closing capacity (CC)/ TLC and fall in forced vital capacity at the provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second. In patients with severe asthma, strong correlations were found between alveolar NO and RV/TLC % pred, FRC % pred, dN 2 , and CC/TLC. Patients with oral steroid-dependent asthma had higher alveolar NO levels (2.7 ppb) compared with the other patients with severe (0.6 ppb) and mild-to-moderate asthma (0.3 ppb).The present authors conclude that alveolar nitric oxide is closely related to parameters of peripheral airway dysfunction in patients with severe asthma, and that oral steroid-dependent asthmatics have more peripheral airway disease than nonsteroid-dependent asthmatics. This suggests that patients on chronic oral steroid treatment have more extensive disease and require additional anti-inflammatory treatment to better target the peripheral airways.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 79%

Alveolar nitric oxideversusmeasures of peripheral airway dysfunction in severe asthma

Veen¹,

Sterk²,

Schot³

et al. 2006

Eur Respir J

129

View full text Add to dashboard Cite

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“…More elaborate methods that account for the complexity upstream to what we measure as eNO have been published (10). As eNO is flow dependent in a nonlinear fashion, these models aim at modeling NO production in the lung and shedding light on factors influencing NO production dependent and independent of flow (10,13,28). However, they lack the simplicity and ease of use of the multiple-breath method with uncontrolled flow rate, especially for young children.…”

Section: N = 55mentioning

confidence: 99%

Comparison of online single-breath vs. online multiple-breath exhaled nitric oxide in school-age children

et al. 2012

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IntroductIon: standards for online multiple-breath (mb) exhaled nitric oxide (eNO) measurements and studies comparing them with online single-breath (sb) eNO measurements are lacking, although eNOmb requires less cooperation in children at school age or younger. Methods: Online eNOmb and eNOsb were measured in 99 healthy children and (in order to observe higher values) in 21 children with suspected asthma at a median age of 6.1 and 11.7 y, respectively. For eNOmb, we aimed for 20 tidal breathing maneuvers; eNOsb was measured according to standards. The two techniques were compared by standard methods after computing NO output or extrapolating eNOmb to the standard flow of 50 ml/s (eNOmb 50 ). results: Measurements were acceptable in 82 (eNOmb) and 81 (eNOsb) children. Paired data were available for 65 children. On a log-log scale, eNOmb 50 (geometric mean ± sD 13.1 ± 15.5 parts per billion, ppb) was correlated with eNOsb (12.5 ± 15.8 ppb), with r 2 = 0.87. The mean difference between eNOsb and eNOmb 50 was −0.7 ppb, with limits of agreement (LOas) of 4.0 and −5.3 ppb. dIscussIon: Despite its correlation with eNOsb, the LOa range hampers eNOmb use in research, where exact values across the whole range are warranted. however, eNOmb might be an alternative tool especially at preschool age, when cooperation during measurements is crucial.

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“…In the present study, no statistically significant difference was observed between the groups; however, some authors have described such significance. 18,19 The present study revealed that, even though asthma The authors concluded that the control group received a higher dose of inhaled corticosteroids than necessary and suggested that exhaled nitric oxide is a logical alternative to the adjustment of inhaled corticosteroid therapy.…”

Section: Discussionmentioning

confidence: 63%

Óxido nítrico em criança com asma persistente

Jentzsch¹,

Bourgeois²,

Blic³

et al. 2006

J. Pediatr. (Rio J.)

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Objective: To assess the difference in exhaled nitric oxide levels in atopic and nonatopic asthmatic patients treated with anti-inflammatory drugs, and to compare exhaled nitric oxide measurement with lung function tests.Methods: Cross-sectional study with 45 consecutively selected patients with moderate and severe persistent asthma, aged between 6 and 17 years, and treated with anti-inflammatory drugs for at least 1 year. The patients were split into two groups: atopic ones (with positive skin tests) and nonatopic ones. The clinical and functional assessments and the measurement of exhaled nitric oxide were carried out concomitantly.Results: There was a male predominance (62.5%), with an age range between 6 and 13 years (mean of 10.4 years) in 85% of the patients. Neither the symptoms associated with asthma (p = 0.07), allergic rhinitis (p = 0.17), food allergy (p = 0.09), necessity of systemic corticosteroids (p = 0.10), antileukotrienes (p = 0.20) and antihistamines (p = 0.70), nor the three parameters used to assess lung function (FEV 1 , FEV 1 /FVC and FEF 25-75% , p > 0.14) were statistically significant. The frequency of eczema (p < 0.005) and exhaled nitric oxide levels (p < 0.001) were higher among atopic patients. Conclusion:Results suggest that clinical and functional stability of asthma among atopic patients does not necessarily reflect an efficient control over the inflammatory process and a higher probability for recurrence after discontinuation of anti-inflammatory therapy.

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Increase in Alveolar Nitric Oxide in the Presence of Symptoms in Childhood Asthma

Cited by 100 publications

References 28 publications

Alveolar nitric oxideversusmeasures of peripheral airway dysfunction in severe asthma

Alveolar nitric oxideversusmeasures of peripheral airway dysfunction in severe asthma

Comparison of online single-breath vs. online multiple-breath exhaled nitric oxide in school-age children

Óxido nítrico em criança com asma persistente

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