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Exhaled nitric oxide as a better diagnostic indicator for evaluating wheeze and airway hyperresponsiveness in
Jung-Won Lee1, Jung Yeon Shim1, Ji-Won Kwon2
1a Department of Pediatrics , Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine , Seoul , Korea .
Insights
Fractional exhaled nitric oxide (FeNO) better identifies airway hyperresponsiveness and wheeze in preschoolers than impulse oscillometry or spirometry. FeNO is a more sensitive marker for these conditions in young children.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Respiratory Medicine
Background:
- Fractional concentration of exhaled nitric oxide (FeNO) is an established biomarker for airway inflammation.
- Assessing airway inflammation and hyperresponsiveness in preschool children presents unique challenges.
- Current diagnostic tools like spirometry and impulse oscillometry (IOS) may have limitations in this age group.
Purpose of the Study:
- To evaluate the utility of FeNO, IOS, and spirometry in preschool children.
- To investigate the relationship between these measurements and the presence of wheeze and airway hyperresponsiveness (AHR).
Main Methods:
- A population-based, cross-sectional study involving 544 children aged 5-6 years.
- Measurements included FeNO, spirometry, IOS, and methacholine bronchial provocation testing to assess AHR.
- AHR was defined by a 20% decrease in FEV1 (PC20) at a methacholine concentration ≤8.0 mg/dL.
Main Results:
- Children with wheeze or AHR exhibited significantly higher FeNO levels compared to those without.
- No significant differences in IOS or spirometry parameters were observed between children with and without wheeze or AHR.
- FeNO demonstrated a significant association with AHR and correlated positively with methacholine dose-response, unlike IOS or spirometry.
Conclusions:
- FeNO is a more sensitive indicator of AHR and wheeze in preschool children compared to spirometry and IOS.
- FeNO measurements offer a valuable, non-invasive tool for assessing airway inflammation and hyperresponsiveness in young children.
Objective:
Fractional concentration of exhaled nitric oxide (FeNO) is a known marker of airway inflammation. The aims of this study were to evaluate FeNO, impulse oscillometry (IOS), and spirometry in preschool children and to investigate their relationship with wheeze and airway hyperresponsiveness (AHR).
Methods:
We performed a population-based, cross-sectional study with 561 children aged 5-6 years. A total of 544 children completed a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and eligible for the study. We measured FeNO, spirometry, methacholine bronchial provocation, and IOS. AHR was defined as the induction of a 20% decrease in FEV(1)(PC(20)) by a methacholine concentration ≤8.0 mg/dL.
Results:
Children who had wheeze or AHR had higher FeNO levels than children without these symptoms. However, neither IOS nor spirometry parameters showed significant differences between children with wheeze or AHR and those without. FeNO was associated with AHR, whereas IOS or spirometry parameters showed no association. Mean FeNO levels were positively correlated with a dose-response slope for methacholine, but neither IOS nor spirometry parameters showed significant correlations.
Conclusions:
FeNO is a more sensitive measurement of AHR and wheeze than spirometry or IOS in preschool children.
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