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Exhaled nitric oxide concentrations during treatment of wheezing exacerbation in infants and young children
1Departments of Pediatrics and Anesthesia and Intensive Care, University of Padova, School of Medicine, Padova, Italy. eugi@child.pedi.unipd.it
Insights
Infants with recurrent wheeze exacerbation show elevated exhaled nitric oxide (ENO) levels, indicating airway inflammation. These levels decrease significantly after steroid therapy, suggesting early disease activity in young children.
Area of Science:
- Pediatric Pulmonology
- Biomarkers of Airway Inflammation
- Respiratory Medicine
Background:
- Exhaled nitric oxide (ENO) is a known marker for asthma exacerbation in older children and adults.
- Limited research exists on ENO levels in infants and young children experiencing recurrent wheeze exacerbations.
Purpose of the Study:
- To investigate whether exhaled nitric oxide (ENO) levels are elevated in young children with recurrent wheeze exacerbation.
- To assess the impact of oral prednisone therapy on ENO levels in this population.
- To establish a method for measuring ENO in infants and young children.
Main Methods:
- Exhaled nitric oxide (ENO) was measured using chemiluminescence in 13 young children with recurrent wheeze during acute episodes and after prednisone treatment.
- Control groups included nine healthy children and six children with a first-time viral wheezy episode.
- ENO measurements were validated by comparing pre- and post-intubation values in two healthy infants.
Main Results:
- Children with recurrent wheeze exhibited significantly higher mean ENO levels (14.1 ppb) during exacerbation compared to healthy controls (5.6 ppb).
- Following 5 days of oral prednisone, ENO levels in the recurrent wheeze group decreased by 52% (to 5.9 ppb).
- Mean ENO levels in children with first-time wheeze (8.3 ppb) were lower than in those with recurrent wheeze.
Conclusions:
- A reliable method for measuring exhaled nitric oxide (ENO) in infants and young children was established.
- Elevated ENO levels during exacerbations in young children with recurrent wheeze suggest early-stage airway inflammation.
- The rapid reduction in ENO after steroid therapy supports its role as an indicator of inflammatory activity in early wheeze.
Abstract:
While it is known that exhaled nitric oxide (ENO) is increased in adults and school children with asthma exacerbation probably as an expression of disease activity, no studies have investigated whether this phenomenon also occurs in infants and young children with recurrent wheeze exacerbation. We measured ENO in 13 young children (mean age 20.2 mo) with recurrent wheeze (Group 1) during an acute episode and after 5 d of oral prednisone therapy. ENO was measured also in nine healthy control subjects (Group 2) (mean age 16.9 mo) and in six children with a first-time viral wheezy episode (Group 3) (mean age 11 mo). To measure ENO, infants inhaled NO-free air via a face mask from a reservoir and, through a nonrebreathing valve, exhaled in a collecting bag that was analyzed by chemiluminescence. To address the question of whether the levels of ENO collected in the bag are a reflection of the pulmonary airway, ENO determinations were performed in two healthy infants before and after tracheal intubation for elective surgery. During the acute episode of wheezing the mean (+/- SEM) value of ENO in children with recurrent wheeze (Group 1) was 14.1 +/- 1.8 ppb, almost threefold higher than in healthy control subjects (5.6 +/- 0.5 ppb, p < 0.001). After steroid therapy we found a mean fall of 52% in ENO (5.9 +/- 0.7 ppb, p < 0.01) compared with baseline values. ENO values measured before and after intubation in two infants were 6 ppb and 5 ppb in one child and 7 ppb and 6 ppb in the other one. The mean value of ENO of children with first-time wheeze (Group 3) was 8.3 +/- 1.3 ppb, significantly lower (p < 0.05) than the value of children with recurrent wheeze (Group 1). In conclusion, we describe a method to measure ENO in young children and show that infants with recurrent wheeze have elevated levels of ENO during exacerbation that rapidly decrease after steroid therapy. This suggests that, in these children, airway inflammation could be present at a very early stage.