Asthma and lower airway diseaseExhaled nitric oxide, lung function, and exacerbations in wheezy infants and toddlers
Section snippets
Subjects
Children 6 to 24 months of age with 3 or more episodes of physician-diagnosed wheezing treated with bronchodilators or corticosteroids were recruited for a single-center longitudinal study. Subjects with birth at less than 36 weeks' gestation, congenital heart disease, dysphagia, severe gastroesophageal reflux, or upper airway obstruction were excluded. Systemic or inhaled corticosteroid treatment was not permitted for 3 weeks before baseline lung function and FENO measurement. Thereafter,
Results
Forty-seven infants and toddlers were recruited with a mean age of 15.6 months (SD, ±5.2 months) at enrollment. Technically acceptable RVRTC flow-volume curves were obtained from 44 subjects at enrollment. Baseline characteristics of the cohort are presented in Table I. The mean FEV0.5, FEF25-75, and FEF75z scores for the cohort at enrollment were significantly less than zero (a z score equal to zero represents the mean value of published normative data). Four subjects were lost to follow-up,
Discussion
In a cohort of infants and toddlers with a history of recurrent episodes of wheezing, we found that enrollment SB-eNO levels were not associated with baseline forced expiratory volumes or flows. However, enrollment SB-eNO levels were significantly higher in subjects with a subsequent decrease in lung function than in subjects with an increase in lung function over 6 months of follow-up. SB-eNO levels were significantly higher in subjects with bronchodilator responsiveness. A higher enrollment
References (45)
- et al.
Prospective evaluation of the validity of exhaled nitric oxide for the diagnosis of asthma
Chest
(2003) - et al.
The use of exhaled nitric oxide in the diagnosis of asthma in school children
J Pediatr
(2009) - et al.
Relations between exhaled nitric oxide and measures of disease activity among children with mild-to-moderate asthma
J Pediatr
(2003) - et al.
Effect of elevated exhaled nitric oxide levels on the risk of respiratory tract illness in preschool-aged children with moderate-to-severe intermittent wheezing
Ann Allergy Asthma Immunol
(2009) - et al.
The Melbourne Asthma Study: 1964-1999
J Allergy Clin Immunol
(2002) - et al.
Natural course of sensitization to food and inhalant allergens during the first 6 years of life
J Allergy Clin Immunol
(1999) - et al.
Measurements of exhaled nitric oxide in healthy subjects age 4 to 17 years
J Allergy Clin Immunol
(2005) Development of wheezing disorders and asthma in preschool children
Pediatrics
(2002)- et al.
Asthma and wheezing in the first six years of life. The Group Health Medical Associates
N Engl J Med
(1995) - Expert Panel Report 3 (EPR3): guidelines for the diagnosis and management of asthma. Available at:...
Exhaled markers of pulmonary disease
Am J Respir Crit Care Med
Exhaled nitric oxide measurements: clinical application and interpretation
Thorax
Correlation between exhaled nitric oxide, sputum eosinophils, and methacholine responsiveness in patients with mild asthma
Thorax
Changes in the dose of inhaled steroid affect exhaled nitric oxide levels in asthmatic patients
Eur Respir J
Effect of inhaled budesonide on lung function and airway inflammation
Am J Respir Crit Care Med
Effect of differing doses of inhaled budesonide on markers of airway inflammation in patients with mild asthma
Thorax
Noninvasive assessment of airway inflammation in children: induced sputum, exhaled nitric oxide, and breath condensate
Eur Respir J
Exhaled nitric oxide correlates with airway hyper-responsiveness in steroid-naïve patients with mild asthma
Am J Respir Crit Care Med
Exhaled nitric oxide correlates with airway eosinophils in childhood asthma
Thorax
Comparison of inflammatory cell counts in asthma: induced sputum vs bronchoalveolar lavage and bronchial biopsies
Clin Exp Allergy
Expired nitric oxide levels during treatment of acute asthma
Am J Respir Crit Care Med
Effect of a nitric oxide synthase inhibitor and a glucocorticosteroid on exhaled nitric oxide
Am J Respir Crit Care Med
Cited by (0)
Supported by National Heart, Lung, and Blood InstituteK23HL077626; CTSA grant no. I ULI RR025014-01; and Seattle Children's Hospital.
Disclosure of potential conflict of interest: J. S. Debley has received research support from the National Institutes of Health/National Heart, Lung, and Blood Institute, American Lung Association, and Merck & Co. The rest of the authors have declared they have no conflict of interest.