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Relationship between exhaled nitric oxide and childhood asthma
T L Frank1, A Adisesh, A C Pickering
1North West Lung Centre, Wythenshawe Hospital, and Royal College of General Practitioners Manchester Research Unit, Parkway House, Manchester, UK.
Insights
Exhaled nitric oxide levels are higher in children with atopic asthma. Nonatopic asthmatic children showed similar exhaled nitric oxide levels to nonasthmatic children.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Biomarkers
Background:
- Asthma diagnosis in children can be challenging.
- Exhaled nitric oxide (eNO) is a potential biomarker for airway inflammation.
- Atopy, a genetic tendency to develop allergic diseases, is common in childhood asthma.
Purpose of the Study:
- To investigate the relationship between exhaled nitric oxide levels and the asthmatic and atopic status in children.
- To evaluate eNO as a potential diagnostic marker differentiating asthma phenotypes.
Main Methods:
- Measured exhaled nitric oxide (eNO) in 93 children using chemiluminescence.
- Assessed asthma status through clinical consensus and exercise challenge tests.
- Determined atopic status via skin prick testing.
Main Results:
- Atopic asthmatic children exhibited significantly higher eNO levels (12.5 ppb) compared to nonatopic asthmatics (3.2 ppb), atopic nonasthmatics (3.8-5.7 ppb), and nonatopic nonasthmatics (3.4-3.5 ppb).
- eNO levels were elevated in atopic asthmatics but not in nonatopic asthmatics.
- Nonatopic asthmatics had eNO levels comparable to nonasthmatic children.
Conclusions:
- Exhaled nitric oxide is a useful biomarker for identifying atopic asthma in children.
- Elevated eNO levels may help distinguish atopic asthmatic phenotypes from other respiratory conditions.
- Further research can explore eNO's role in routine pediatric respiratory screening.
Abstract:
The purpose of the study was to determine if exhaled nitric oxide levels in children varied according to their asthmatic and atopic status. Exhaled nitric oxide was measured in a sample of 93 children attending the North West Lung Centre, Manchester, United Kingdom, for the clinical evaluation of a respiratory questionnaire being developed as a screening tool in general practice. The clinical assessment included full lung function, skin prick testing, and exercise challenge. Children were said to be asthmatic either by consensus decision of three independent consultant pediatricians, who reviewed all the clinical results except the nitric oxide measurements, or by positive exercise test. Atopic asthmatic children had higher geometric mean exhaled nitric oxide levels (consensus decision, 12.5 ppb [parts per billion] 95% CI, 8.3 to 18. 8; positive exercise test, 12.2 ppb 95% CI, 7.6 to 19.7) than did nonatopic asthmatic children (3.2 ppb 95% CI, 2.3 to 4.6; 3.2 ppb 95% CI, 2.0 to 5.0), atopic nonasthmatic children (3.8 ppb 95% CI, 2. 7 to 5.5; 5.7 ppb 95% CI, 4.1 to 8.0), or nonatopic nonasthmatic children (3.4 ppb 95% CI, 2.8 to 4.1; 3.5 ppb 95% CI, 3.0 to 4.1). Thus, exhaled nitric oxide was raised in atopic asthmatics but not in nonatopic asthmatics, and these nonatopic asthmatics had levels of exhaled nitric oxide similar to those of the nonasthmatics whether atopic or not.