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Exhaled nitric oxide predicts persistence of wheezing, exacerbations, and decline in lung function in wheezy infants

M Elliott1, S L Heltshe, D C Stamey

  • 1Division of Pulmonary Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.

Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology
|November 23, 2013
PubMed

Insights

Single-breath fraction of exhaled nitric oxide (SB-FENO) effectively predicts persistent wheezing in young children. This method outperformed other tests in forecasting exacerbations and wheezing duration.

Area of Science:

  • Pediatric Pulmonology
  • Respiratory Medicine
  • Biomarkers in Asthma

Background:

  • Limited data exists on predicting wheezing persistence, exacerbations, and lung function decline in infants with recurrent wheezing.
  • Fraction of exhaled nitric oxide (FENO) is a potential non-invasive biomarker.

Purpose of the Study:

  • To compare the predictive values of single-breath FENO (SB-FENO), tidal-breathing FENO (tidal-FENO), bronchodilator responsiveness (BDR), and the Asthma Predictive Index (API) for clinical outcomes in infants with recurrent wheezing.
  • To assess these markers' ability to predict wheezing persistence, exacerbations, and lung function changes up to age 3 years.

Main Methods:

  • A longitudinal cohort study enrolled 44 infants and toddlers with recurrent wheezing.
  • Infant pulmonary function tests (iPFTs), SB-FENO, and tidal-FENO were measured at enrollment.
  • Clinical outcomes and follow-up iPFTs were assessed at age 3 years.

Main Results:

  • An enrollment SB-FENO level ≥ 30 p.p.b. predicted wheezing persistence at age 3 years with high accuracy (AUC 0.86).
  • SB-FENO demonstrated superior sensitivity and specificity compared to tidal-FENO, BDR, and API for predicting wheezing persistence and exacerbations.
  • Both SB-FENO and tidal-FENO were associated with a decline in lung function (FEV0.5 and FEF25-75) by age 3 years.

Conclusions:

  • SB-FENO is a more effective predictor of future exacerbations and persistent wheezing in infants and toddlers than tidal-FENO, BDR, or API.
  • Elevated SB-FENO and tidal-FENO levels at enrollment may indicate a risk of long-term lung function decline.
Abstract

Keywords:
FENOexhaled nitric oxideinfantspulmonary functionraised-volume rapid thoracic compressionrecurrent wheezing

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