Login Register Cart 0
Generic placeholder image

Current Respiratory Medicine Reviews

Editor-in-Chief

ISSN (Print): 1573-398X
ISSN (Online): 1875-6387

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Studying the Role of Alveolar Exhaled Nitric Oxide in Combination with Bronchial Nitric Oxide to Predict Asthma Control in Children with Asthma: A Real-Life Prospective Study

Author(s): Thuy Nguyen-Thi-Dieu, Hanh Do-Thi, Huong Nguyen-Thi-Quynh, Huong Le-Thi-Minh and Sy Duong-Quy*

Volume 19, Issue 1, 2023

Published on: 28 October, 2022

Page: [66 - 76] Pages: 11

DOI: 10.2174/1573398X18666221010112508

Price: $65

Abstract

Background: Fractional Exhaled Nitric Oxide (FENO) is currently used as a biomarker of airway inflammation in patients with asthma. However, the role of alveolar nitric oxide (CANO) in asthmatic children has not been clearly demonstrated.

Methods: It was a prospective and descriptive study. The measurement of FENO and CANO, spirometry, blood eosinophil counts (BEC), and total IgE levels were performed for each study subject.

Results: This study included 109 uncontrolled asthmatic children without inhaled corticosteroid (ICS) treatment. The exhaled NO level in asthmatic patients was significantly higher than in control subjects: FENO: 22.5 vs. 8.4 ppb; CANO: 5.9 vs. 2.8 ppb; J’awNO (maximum airway nitric oxide flux): 56.9 vs. 18.7 ppb; respectively. The sensitivities and specificities for asthma diagnosis with the cut-off of CANO at 3.5 ppb and 5.0 ppb were 74.3% and 73.3%, and 46.0% and 83.3%, respectively. There were the moderate and the weak correlations between CANO with FENO and CANO with IgE in asthmatic patients (r = 0.465, 95%CI (0.133-0.659), P=0.001; r=0.133, 95%CI (0.068- 0.497), P=0.184; respectively). The percentage of controlled asthma in patients with CANO ≥5 ppb at inclusion was higher than that in CANO <5 ppb group.

Conclusion: Exhaled NO is a relevant biomarker of allergic asthma. The level of FENO and CANO might be used to predict asthma control in children.

Keywords: Asthmatic children, allergic asthma, FENO, CANO, asthma control, inhaled corticosteroid.

« Previous Next »
Graphical Abstract

[1]
Global Strategy for Asthma Management and Prevention (GINA) 2019. Available from: www.ginasthma.org (Accessed on: November 8th 2019).
[2]
Kurukulaaratchy RJ, Raza A, Scott M, et al. Characterisation of asthma that develops during adolescence; findings from the Isle of Wight Birth Cohort. Respir Med 2012; 106(3): 329-37.
[http://dx.doi.org/10.1016/j.rmed.2011.12.006] [PMID: 22212639]
[3]
Andersson M, Hedman L, Bjerg A, Forsberg B, Lundbäck B, Rönmark E. Remission and persistence of asthma followed from 7 to 19 years of age. Pediatrics 2013; 132(2): e435-42.
[http://dx.doi.org/10.1542/peds.2013-0741] [PMID: 23897917]
[4]
John Henderson A. Childhood asthma phenotypes in the twenty-first century. Breathe (Sheff) 2014; 10(2): 100-8.
[http://dx.doi.org/10.1183/20734735.014613]
[5]
Wenzel SE. Asthma phenotypes: The evolution from clinical to molecular approaches. Nat Med 2012; 18(5): 716-25.
[http://dx.doi.org/10.1038/nm.2678] [PMID: 22561835]
[6]
Shaaban R, Zureik M, Soussan D, et al. Rhinitis and onset of asthma: A longitudinal population-based study. Lancet 2008; 372(9643): 1049-57.
[http://dx.doi.org/10.1016/S0140-6736(08)61446-4] [PMID: 18805333]
[7]
Petsky HL, Cates CJ, Lasserson TJ, et al. A systematic review and meta-analysis: Tailoring asthma treatment on eosinophilic markers (exhaled nitric oxide or sputum eosinophils). Thorax 2012; 67(3): 199-208.
[http://dx.doi.org/10.1136/thx.2010.135574] [PMID: 20937641]
[8]
Global Strategy for Asthma Management and Prevention (GINA) 2022. Available from: www.ginasthma.org (Accessed on: August 5th 2022).
[9]
Poddighe D, Brambilla I, Licari A, Marseglia GL. Omalizumab in the therapy of pediatric asthma. Recent Pat Inflamm Allergy Drug Discov 2018; 12(2): 103-9.
[http://dx.doi.org/10.2174/1872213X12666180430161351] [PMID: 29714140]
[10]
van de Kant KDG, Klaassen EMM, Jöbsis Q, Nijhuis AJ, van Schayck OCP, Dompeling E. Early diagnosis of asthma in young children by using non-invasive biomarkers of airway inflammation and early lung function measurements: Study protocol of a case-control study. BMC Public Health 2009; 9(1): 210.
[http://dx.doi.org/10.1186/1471-2458-9-210] [PMID: 19563637]
[11]
Warke TJ, Fitch PS, Brown V, et al. Exhaled nitric oxide correlates with airway eosinophils in childhood asthma. Thorax 2002; 57(5): 383-7.
[http://dx.doi.org/10.1136/thorax.57.5.383] [PMID: 11978911]
[12]
Beck-Ripp J, Griese M, Arenz S, Köring C, Pasqualoni B, Bufler P. Changes of exhaled nitric oxide during steroid treatment of childhood asthma. Eur Respir J 2002; 19(6): 1015-9.
[http://dx.doi.org/10.1183/09031936.02.01582001] [PMID: 12108850]
[13]
Duong-Quy S, Nguyen-Thi-Bich H, Le-Thi-Minh H, et al. The use of exhaled nitric oxide (NO) to categorize asthma phenotype and treatment in children-Results from National Hospital of Pediatrics. Eur Respir J 2018; 52 (Suppl. 62): PA1315.
[14]
Dweik RA, Boggs PB, Erzurum SC, et al. An official ATS clinical practice guideline: Interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med 2011; 184(5): 602-15.
[http://dx.doi.org/10.1164/rccm.9120-11ST] [PMID: 21885636]
[15]
Dinh-Xuan AT, Annesi-Maesano I, Berger P, et al. Contribution of exhaled nitric oxide measurement in airway inflammation assessment in asthma. A position paper from the French Speaking Respiratory Society. Rev Mal Respir 2015; 32(2): 193-215.
[http://dx.doi.org/10.1016/j.rmr.2014.11.004] [PMID: 25704902]
[16]
Puckett JL, Taylor RWE, Leu SY, et al. Clinical patterns in asthma based on proximal and distal airway nitric oxide categories. Respir Res 2010; 11(1): 47.
[http://dx.doi.org/10.1186/1465-9921-11-47] [PMID: 20426813]
[17]
Paredi P, Kharitonov SA, Meah S, Barnes PJ, Usmani OS. A novel approach to partition central and peripheral airway nitric oxide. Chest 2014; 145(1): 113-9.
[http://dx.doi.org/10.1378/chest.13-0843] [PMID: 23989961]
[18]
Lehtimäki L, Kankaanranta H, Saarelainen S, Turjanmaa V, Moilanen E. Increased alveolar nitric oxide concentration in asthmatic patients with nocturnal symptoms. Eur Respir J 2002; 20(4): 841-5.
[http://dx.doi.org/10.1183/09031936.02.00202002] [PMID: 12412673]
[19]
Scichilone N, Battaglia S, Taormina S, Modica V, Pozzecco E, Bellia V. Alveolar nitric oxide and asthma control in mild untreated asthma. J Allergy Clin Immunol 2013; 131(6): 1513-7.
[http://dx.doi.org/10.1016/j.jaci.2013.03.009] [PMID: 23639306]
[20]
Berry M, Hargadon B, Morgan A, et al. Alveolar nitric oxide in adults with asthma: Evidence of distal lung inflammation in refractory asthma. Eur Respir J 2005; 25(6): 986-91.
[http://dx.doi.org/10.1183/09031936.05.00132404] [PMID: 15929952]
[21]
van Veen IH, Sterk PJ, Schot R, Gauw SA, Rabe KF, Bel EH. Alveolar nitric oxide versus measures of peripheral airway dysfunction in severe asthma. Eur Respir J 2006; 27(5): 951-6.
[http://dx.doi.org/10.1183/09031936.06.00087905] [PMID: 16446314]
[22]
Duong-Quy S, Nguyen Thi Bich H, Duong Thi Ly H, et al. Study of the correlations between fractional exhaled nitric oxide in exhaled breath and atopic status, blood eosinophils, FCER2 mutation, and asthma control in Vietnamese children. J Asthma Allergy 2016; 9: 163-70.
[http://dx.doi.org/10.2147/JAA.S107773] [PMID: 27695350]
[23]
Lötvall J, Akdis CA, Bacharier LB, et al. Asthma endotypes: A new approach to classification of disease entities within the asthma syndrome. J Allergy Clin Immunol 2011; 127(2): 355-60.
[http://dx.doi.org/10.1016/j.jaci.2010.11.037] [PMID: 21281866]
[24]
Haldar P, Pavord ID, Shaw DE, et al. Cluster analysis and clinical asthma phenotypes. Am J Respir Crit Care Med 2008; 178(3): 218-24.
[http://dx.doi.org/10.1164/rccm.200711-1754OC] [PMID: 18480428]
[25]
Global Strategy for Asthma Management and Prevention (GINA) 2015. Difficult-to-treat and severe asthma. Available from: www.ginasthma.org (Accessed on: September 8th 2019).
[26]
Alving K, Weitzberg E, Lundberg JM. Increased amount of nitric oxide in exhaled air of asthmatics. Eur Respir J 1993; 6(9): 1368-70.
[PMID: 7507065]
[27]
American Thoracic Society. Recommendations for standardized procedures for the on-line and off-line measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide in adults and children-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med 1999; 160(6): 2104-17.
[http://dx.doi.org/10.1164/ajrccm.160.6.ats8-99] [PMID: 10588636]
[28]
American Thoracic Society. European Respiratory Society. ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005. Am J Respir Crit Care Med 2005; 171(8): 912-30.
[http://dx.doi.org/10.1164/rccm.200406-710ST] [PMID: 15817806]
[29]
Duong-Quy S. Clinical Utility Of The Exhaled Nitric Oxide (NO) measurement with portable devices in the management of allergic airway inflammation and asthma. J Asthma Allergy 2019; 12: 331-41.
[http://dx.doi.org/10.2147/JAA.S190489] [PMID: 31632093]
[30]
Fukumitsu K, Nishiyama H, Kanemitsu Y, et al. Pretreatment alveolar nitric oxide levels predict improvement of pulmonary function 1 year following anti-asthma treatments in patients with inhaled corticosteroid-naïve asthma. Int Arch Allergy Immunol 2022; 183(5): 479-89.
[http://dx.doi.org/10.1159/000520508] [PMID: 35034020]
[31]
Sprio AE, Bertolini F, Fucà R, et al. Alveolar nitric oxide and peripheral oxygen saturation in frequent exacerbators with asthma: A pilot study. Int Arch Allergy Immunol 2022; 183(1): 105-15.
[http://dx.doi.org/10.1159/000518320] [PMID: 34515153]
[32]
Zinellu E, Piras B, Ruzittu GGM, Fois SS, Fois AG, Pirina P. Recent advances in inflammation and treatment of small airways in asthma. Int J Mol Sci 2019; 20(11): 2617.
[http://dx.doi.org/10.3390/ijms20112617] [PMID: 31141956]
[33]
Lázár Z, Horváth P, Puskás R, et al. A suitable protocol for measuring alveolar nitric oxide in asthma with differing severity to assess peripheral airways inflammation. J Asthma 2019; 56(6): 584-93.
[http://dx.doi.org/10.1080/02770903.2018.1477957] [PMID: 29923757]
[34]
Ngo-Minh X, Tang-Thi-Thao T, Doan-Thi-Quynh N, Craig TJ, Duong-Quy S. Study of the role of exhaled nitric oxide (NO) in predicting controlled or uncontrolled asthma in asthmatic children. Multidiscip Respir Med 2020; 15(1): 656.
[http://dx.doi.org/10.4081/mrm.2020.656] [PMID: 32431811]

Rights & Permissions Print Cite
Article Metrics
16
2
© 2024 Bentham Science Publishers | Privacy Policy