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A Novel Inhalation Mask System to Deliver High Concentrations of Nitric Oxide Gas in Spontaneously Breathing Subjects
Published on: May 4, 2021
Use of exhaled nitric oxide in children with bronchial asthma
A Rajeev1, S S Mathai2, V B Kulkarni3
1Classified Specialist (Pediatrics), INHS Dhanvantari, C/o Navy Office, Port Blair 744103, Andaman & Nicobar Islands, India.
Insights
High fractional nitric oxide (FeNO) levels in children with asthma at diagnosis predict a good response to inhaled corticosteroids. However, FeNO monitoring may not be reliable for long-term asthma management.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Immunology
Background:
- Airway inflammation is central to asthma pathophysiology.
- Measuring airway inflammation non-invasively aids asthma management.
- Fractional exhaled nitric oxide (FeNO) assesses airway inflammation in pediatric asthma.
Purpose of the Study:
- To evaluate the utility of FeNO in assessing asthma severity and treatment response in children.
- To correlate FeNO levels with spirometry and clinical parameters in pediatric asthma patients.
Main Methods:
- Study included 30 children (6-14 years) with newly diagnosed asthma.
- Assessments included history, clinical exam, spirometry, and FeNO measurement.
- Measurements were taken before treatment and during follow-up visits.
Main Results:
- Initial FeNO levels correlated significantly with spirometry and clinical profile.
- Children with higher initial FeNO showed better response to inhaled corticosteroids (ICS).
- FeNO levels decreased with treatment, but correlations weakened in later follow-ups.
Conclusions:
- High initial FeNO may predict ICS responsiveness in pediatric asthma.
- FeNO monitoring's long-term utility is limited due to confounding factors.
- FeNO is a useful initial marker but not for sustained follow-up.
Background:
Inflammation is an important aspect of the pathophysiology of bronchial asthma and measurement of inflammatory markers of airways can aid in management. Nitric oxide measurement in exhaled breath is a non-invasive method of determining airway inflammation which can be used in assessing severity and response to treatment in children with bronchial asthma.
Methods:
Thirty children in the age group 6-14 years with previously or newly diagnosed bronchial asthma reporting for the first time to a tertiary care hospital constituted the study group. Assessment was done by history, clinical examination, spirometry and measurement of fractional excretion of nitric oxide (FeNO) before commencement of treatment as per standard guidelines and on follow up at 2 to 4 weeks intervals for a minimum of three times.
Results:
There was significant correlation between FeNO values, spirometry parameters and clinical profile in the first visit before the initiation of therapy. Children with higher FeNO in the first visit responded better to Inhaled Corticosteroids (ICS) with good clinical and spirometry responses and fall in FeNO on second visit. However, in subsequent visits no significant correlation was observed between clinical control, FeNO levels and spirometry.
Conclusion:
High FeNO values at first presentation could give us a clue as to whether or not a child would respond to ICS but FeNO monitoring may not be helpful in long term follow up as various other factors can affect its value.
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