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Exhaled nitric oxide and the risk of wheezing in infancy: the Generation R Study

C Gabriele1, V W Jaddoe, E van Mastrigt

  • 1Dept of Paediatrics/Respiratory Medicine, Erasmus University Medical Center, Rotterdam 3000 CB, The Netherlands.

The European Respiratory Journal
|September 17, 2011
PubMed

Insights

Exhaled nitric oxide fraction (F(eNO)) at 6 months is linked to a higher risk of wheezing in infants. While F(eNO) indicates inflammation, its predictive value for individual wheezing cases in the second year is limited.

Area of Science:

  • Pediatric respiratory health
  • Biomarkers of airway inflammation
  • Epidemiology of childhood respiratory diseases

Background:

  • Eosinophilic airway inflammation is a key factor in childhood wheezing disorders.
  • Exhaled nitric oxide fraction (F(eNO)) serves as a non-invasive marker for eosinophilic airway inflammation.
  • Early life respiratory symptoms and risk factors are crucial for understanding long-term respiratory morbidity.

Purpose of the Study:

  • To investigate the association between exhaled nitric oxide fraction (F(eNO)) measured at 6 months of age and the subsequent risk of wheezing in the first two years of life.
  • To evaluate F(eNO) as a potential predictor of wheezing in infants.
  • To explore the relationship between F(eNO) and other respiratory symptoms in early childhood.

Main Methods:

  • Utilized data from the Generation R birth cohort, assessing risk factors and respiratory symptoms via questionnaires.
  • Measured off-line mixed oral/nasal exhaled nitric oxide fraction (F(eNO)) during tidal breathing in 428 infants at 6 months.
  • Employed logistic regression analysis to determine the association between F(eNO) levels and wheezing risk, controlling for relevant factors.

Main Results:

  • F(eNO) levels were found to be higher in male infants and increased with age.
  • Higher F(eNO) was negatively associated with the presence of upper and lower respiratory symptoms within the first 6 months.
  • Each part per billion (ppb) increase in F(eNO) at 6 months correlated with a 1.06-fold increased risk of wheezing in the second year of life.
  • A high F(eNO) threshold (>17.5 ppb) demonstrated limited additional predictive value for second-year wheezing.

Conclusions:

  • Exhaled nitric oxide fraction (F(eNO)) at 6 months is significantly associated with an increased risk of wheezing in the second year of life.
  • While F(eNO) reflects airway inflammation, its utility in predicting individual wheezing cases in early childhood is constrained.
  • Further research may be needed to refine the predictive capabilities of F(eNO) in pediatric respiratory health.

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