Measurement of Bronchial and Alveolar Nitric Oxide Production in Normal Children and Children with Asthma

• Published in: American journal of respiratory and critical care medicine 2006-08, Vol.174 (3), p.260-267
• Main Authors: Paraskakis, Emmanouil, Brindicci, Caterina, Fleming, Louise, Krol, Renata, Kharitonov, Sergei A, Wilson, Nicola M, Barnes, Peter J, Bush, Andrew
• Format: Article
• Language: English
• Subjects: Adolescent; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Asthma; Asthma - metabolism; Biological and medical sciences; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Breath Tests; Bronchi - metabolism; Child; Child, Preschool; Disease; Feasibility Studies; Female; Forced Expiratory Volume - physiology; Humans; Inflammation; Inflammation - metabolism; Inflammation - pathology; Intensive care medicine; Linear Models; Male; Medical sciences; Nitric oxide; Nitric Oxide - analysis; Nitric Oxide - metabolism; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Pulmonary Alveoli - metabolism; Reproducibility of Results; Spirometry; Steroids; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Victimology
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.200506-962OC

Airway inflammation is characteristic of asthma. Distal inflammation may be particularly important. To calculate alveolar nitric oxide (NO) concentration (C(alv)) and bronchial flux NO (J(NO)) in children. We measured C(alv) and J(NO) from the fractional exhaled NO (FeNO(50)) measured at multiple exhalation flow rates in 132 children (aged 4-18 yr) with known atopic status, medication, and asthma control. Of participants, 85% (112/132) completed all measurements. In 20 of 112, the result did not fit the linear model. Thus, J(NO) and C(alv) were assessed in 92 (70%) subjects. The median (range) values of asthmatic (n = 52), normal (n = 20), and nonasthmatic atopic (n = 20) children were as follows: FeNO(50): 28.1 (4.3-190), 10.35 (3.3-29), 21.8 (8.7-69) ppb, respectively; J(NO): 1,230 (204-9,236), 480 (196-1,913), 1,225 (486-4,119) pl/s, respectively; C(alv): 2.22 (0.44-6.63), 1.63 (0.44-3), 1.21 (0.03-2.85) ppb, respectively. A reproducibility study in 18 other children gave intraclass correlation coefficients (single measures) of 0.99 (J(NO)) and 0.81 (C(alv)). J(NO) and C(alv) were higher in children with asthma than normal children (p = 0.0004 and p = 0.0002, respectively). Children with poorly controlled asthma (n = 27) had higher FeNO(50) measurements than children with good symptom control (n = 25): C(alv): mean (+/- SD), 3.17 +/- 1.62 versus 2.26 +/- 1.30 ppb, p = 0.03; J(NO): mean (+/- SD), 2,634 +/- 2,255 versus 1,193 +/- 1,294 pl/s, p = 0.007, respectively. Measurement of J(NO) and C(alv) is feasible in 70% of school-age children. FeNO(50) and J(NO) give the same information (r = 0.97, p < 0.0001), C(alv) is higher in asthmatic children than in normal children and is affected by asthma control, but not by atopy. C(alv) may possibly reflect alveolar inflammation in asthma.