Extended NO analysis in asthma

The discovery of the flow dependence of exhaled NO made it possible to model NO production in the lung. The linear model provides information about the maximal flux of NO from the airways and the alveolar concentrations of NO. Nonlinear models give additional flow-independent parameters such as airway diffusing capacity and airway wall concentrations of NO. When these models are applied to patients with asthma, a clear-cut increase in NO flux is found, and this is caused by an increase in both airway diffusing capacity and airway wall concentrations of NO. There is no difference in alveolar concentrations of NO compared to healthy subjects, except in severe asthma where an increase has been found. Inhaled corticosteroids are able to reduce the airway wall concentrations but not diffusing capacity or alveolar concentrations. Oral prednisone affects the alveolar concentration, suggesting that in severe asthma there is a systemic component. Steroids distributed by any route do not affect the airway diffusing capacity. Therefore, the airway diffusing capacity should be in focus in testing new drugs or in combination treatment for asthma. Exhaled NO analysis is a promising tool in characterizing asthma in both adults and children. However, there is a strong need to agree on the models and to standardize the flow rates to be used for the modelling in order to perform a systematic and robust analysis of NO production in the lung.