Extended nitric oxide analysis may improve personalized anti-inflammatory treatment in asthmatic children with intermediate FENO50. (15th December 2015)

• Record Type: Journal Article
• Authors: Thornadtsson, A; Neerincx, A H; Högman, M; Hugen, C; Sintnicolaas, C; Harren, F J M; Merkus, P J F M; Cristescu, S M
• Is Part Of: Journal of breath research. Volume 9:Number 4(2015:Dec.)
• Publication Date: 2015-12-15
• Subjects: nitric oxide -- asthma -- children -- mathematical model; Volatile organic compounds -- Analysis -- Periodicals; Clinical chemistry -- Periodicals; Bad breath -- Periodicals; Bad breath -- Treatment -- Periodicals; Bad breath -- Diagnosis -- Periodicals; 616.0756
• DOI: 10.1088/1752-7155/9/4/047114
• Languages: English
• ISSNs: 1752-7155

Abstract

Abstract: Exhaled nitric oxide (FE NO) is elevated in asthma, and a clinical practice guideline has been published with recommendations for anti-inflammatory treatment. It summarizes that a FE NO at an expiratory flow rate of 50 ml s −1 (FE NO50 ) above 35 ppb in children indicates eosinophilic inflammation, and the most likely response is to use inhaled corticosteroids. Intermediate FE NO50 between 20–35 ppb should be interpreted cautiously. The aim of the study was to investigate this guideline in a small group of asthmatic children. Thirty-seven asthmatic children; 23 boys and 14 girls, visited the outpatient clinic, and provided exhaled breath samples for offline NO measurement. These samples were analysed with chemiluminescence techniques. Three flow rates, namely 16, 90 and 230 ml s −1 were used for the extended NO analysis (Högman–Meriläinen algorithm, HMA) to estimate the alveolar concentration (CA NO), diffusion rate of the airway wall (Daw NO) and airway wall content (Caw NO). For accuracy of the HMA, the estimated value of FE NO at 50 ml s −1 (FE NO50 ) was compared with measured FE NO50 . In nine children the difference was more than 5 ppb and the data were therefore excluded. Five children with FE NO50 <20 ppb had no known allergy and their FE NO50 geometrical mean (25th; 75th percentile) was 11 (10;14) and Caw NO was 32 (20;43) ppb. Ten children with FE NO50 > 35 ppb had an allergy and had FE NO50 of 56 (47;60) ppb and Caw NO of 140 (121;172) ppb. Thirteen children with allergies, with intermediate FE NO50, had FE NO50 of 27 (25;30) ppb with a wide range of Caw NO. In five of these children, values were comparable to healthy children, 44 (43;50) ppb while eight children had elevated Caw NO values of 108 (95;129) ppb. Our data indicate the clinical potential use of extended NO analysis to determine the personal target value of FE NO50 for monitoring the treatment outcome. Furthermore, for children with intermediate FE NO50 more than half of them could possibly benefit from an adjustment of inhaled corticosteroids if the Caw NO value was considered.