Relationship of exhaled nitric oxide to clinical and inflammatory markers of persistent asthma in children

Strunk, Robert C.; Szefler, Stanley J.; Phillips, Brenda R.; Zeiger, Robert S.; Chinchilli, Vernon M.; Larsen, Gary L.; Hodgdon, Kevin; Morgan, Wayne J.; Sorkness, Christine A.; Lemanske, Robert F.

doi:10.1016/j.jaci.2003.08.014

Cited by 287 publications

(231 citation statements)

References 43 publications

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“…One possible explanation for the current findings regarding the lack of a difference in FeNO levels in young smokers compared with nonsmokers is related to the known association of increasing age in children (but not adults) with increasing FeNO [40][41][42]. As such, continued increases in FeNO in adults ,21 yrs of age may have counteracted smoking-related declines in FeNO in this age group and accounted for the findings regarding the lack of a difference in FeNO levels in young smokers compared with nonsmokers.…”

Section: Discussionmentioning

confidence: 61%

“…As there was an uneven distribution of subjects in each age group with regard to the variables listed in table 2, the present authors also tested whether smoking status was significantly associated with FeNO levels in multiple linear regression models when subjects were stratified on the basis of age and while controlling for other variables (sex and total IgE levels; cotinine was not included because it is absent in most nonsmokers) associated with FeNO levels [31,40]. This analysis confirmed that smoking status was significantly associated with FeNO levels in older subjects (aged 21-40 yrs, p,0.0001; table 3) but not younger subjects (aged 18-20 yrs, p50.16; table 4).…”

Section: Age-related Declines In Feno Levels In Smokersmentioning

confidence: 99%

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Smoking is associated with an age-related decline in exhaled nitric oxide

Sundy

Hauswirth²,

Mervin-Blake³

et al. 2007

Eur Respir J

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Age-related declines in forced expiratory volume in one second are accelerated in smokers. Smoking is associated with decreased exhaled nitric oxide fraction (FeNO). The aim of the present study was to determine the impact of age on FeNO in otherwise healthy smokers and nonsmokers.FeNO and serum cotinine levels were measured in 994 healthy subjects aged 18-40 yrs. American Thoracic Society questionnaire data on smoking habits was used to validate serum cotinine levels as a surrogate marker for categorisation of smokers and nonsmokers in the cohort.Serum cotinine levels were a good discriminator of smokers (n599) and nonsmokers (n5895). FeNO levels were significantly lower in otherwise healthy smokers compared with nonsmokers. There was an inverse correlation of serum cotinine levels with FeNO. No correlation of age with FeNO was found in nonsmokers but an inverse correlation of FeNO with age in smokers was found. FeNO was significantly lower in smokers aged 21-40 yrs compared with nonsmokers aged 21-40 yrs, but was not lower in smokers aged 18-20 yrs compared with nonsmokers of the same age.Smoking was associated with decreased exhaled nitric oxide. The greatest smoking-related declines in exhaled nitric oxide occurred in older subjects. This suggests that smoking is associated with age-related declines in exhaled nitric oxide and justifies future mechanistic studies that address the impact of exhaled nitric oxide decline on lung function.

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Section: Discussionmentioning

confidence: 61%

Section: Age-related Declines In Feno Levels In Smokersmentioning

confidence: 99%

Smoking is associated with an age-related decline in exhaled nitric oxide

Sundy

Hauswirth²,

Mervin-Blake³

et al. 2007

Eur Respir J

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“…Exhaled nitric oxide (eNO) serves as a surrogate measure of allergic airway inflammation. It is correlated with the expression of inducible NO synthase in airways of atopics, especially individuals with atopic asthma (4,5). In both the clinical and the research settings, eNO aids in discriminating different asthma phenotypes, particularly the atopic vs. the nonatopic form (6,7).…”

mentioning

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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“…Also, the association between the degree of atopy and FeNO levels has been reported [12,31,32], with the conclusion that, as the number of positive responses to skin prick test increases, the FeNO levels also increase [6,12,33]. This finding has been attributed to the difference in inflammatory cell recruitment in atopic (eosinophilic) and non-atopic asthmatics (neutrophilic), as well as to cell activity of NO-producing cells [28].…”

Section: Discussionmentioning

confidence: 99%

Exhaled Nitric Oxide Atopy, and Spirometry in Asthma and Rhinitis Patients in India

Kumar

Gupta

2017

Advances in Respiratory Medicine

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Introduction: Asthma is a chronic airway inflammatory disorder. Nitric oxide (NO) is non-invasively measured in exhaled breath (FeNO). The aim of the study was to investigate the anthropometric and physiologic factors that influence FeNO measurements. Also, to evaluate FeNO correlation with spirometry and inflammatory markers in asthma and rhinitis. Material and methods: The study was a prospective analysis of asthma (BA) and rhinitis (AR) in patients enrolled from outpatient clinics between 2011 and 2015. Healthy controls (HC) were enrolled from the community. All subjects underwent baseline spirometry with reversibility, FeNO measurements, skin prick tests, and blood sampling for absolute eosinophil counts and serum total IgE levels. Results: Of 528 enrolled participants, 215 were BA, 248 were BA-AR and 65 were HC. The mean FeNO was higher in atopic versus nonatopic subjects (34.14 vs. 25.99; p < 0.001); asthmatics versus non-asthmatics (30.46 vs. 12.91; p < 0.001), and in participants with BA-AR, compared to those without BA-AR (32.56 vs. 30.46; p < 0.001). The odds ratio for FeNO in the study population showed a significant positive association with male gender, absolute eosinophil count (AEC), breathlessness, duration of symptoms, family history and atopy. In examining the diagnostic accuracy of FeNO for asthma, the AUC for FeNO value is 0.833 (95% confidence interval [CI], 0.717-0.901), with cut-off levels to screen for asthma being 19.45 at 71.2% sensitivity and 81.8% specificity (p < 0.001). The Positive Predictive Value 96.84% (95% CI: 94.43-98.23) and Negative Predictive Value 30% (95% CI: 23.78-37.05) for asthma prediction with FeNO. Conclusion:The study highlights the importance of estimation of anthropometric parameters and dyspnea assessment in the evaluation of FeNO levels. Also, the presence of atopy may influence the results in the interpretation of FeNO readings. Moreover, the study have demonstrated that spirometry and FeNO have no significant correlation, which further lays emphasis on them as being different physiological parameters of asthma.

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Relationship of exhaled nitric oxide to clinical and inflammatory markers of persistent asthma in children

Cited by 287 publications

References 43 publications

Smoking is associated with an age-related decline in exhaled nitric oxide

Smoking is associated with an age-related decline in exhaled nitric oxide

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

Exhaled Nitric Oxide Atopy, and Spirometry in Asthma and Rhinitis Patients in India

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