The clinical use of exhaled nitric oxide in wheezing children
Medição do óxido nítrico no ar exalado: Utilização na avaliação de crianças com história de sibilância
Pedro Martins1, , Iolanda Caires2, José Rosado Pinto3, Pedro Lopes da Mata4, Simões Torres5, Joana Valente6, Carlos Borrego7, Nuno Neuparth8
1 Assistente Convidado, Departamento Universitário de Fisiopatologia, Faculdade de Ciências Médicas, Universidade Nova de Lisboa (Centro de Estudos de Patologia Respiratória); Assistente Eventual, Serviço de Imunoalergologia, Hospital de Dona Estefânia / Guest Consultant, Department of Physiopathology, Faculty of Medical Sciences, Universidade Nova de Lisboa (Centre for Respiratory Pathology Studies); Future Consultant, Allergy and Clinical Immunology Unit, Hospital de Dona Estefânia
2 Técnica de Cardiopneumologia, Departamento Universitário de Fisiopatologia, Faculdade de Ciências Médicas, Universidade Nova de Lisboa (Centro de Estudos de Patologia Respiratória) / Cardiopulmonology Technician, Department of Physiopathology, Faculty of Medical Sciences, Universidade Nova de Lisboa (Centre for Respiratory Pathology Studies)
3 Director de Serviço, Serviço de Imunoalergologia, Hospital de Dona Estefânia / Allergy and Clinical Immunology Unit, Hospital de Dona Estefânia
4 Especialista em Imunoalergologia, Instituto Clínico de Alergologia / Allergy and Clinical Immunology Specialist, Allergy and Clinical Immunology Institute
5 Director de Serviço, Serviço de Pneumologia, Hospital de São Teotónio / Director, Pulmonology Unit, Hospital de São Teotónio
6 Engenheira do Ambiente, Departamento de Ambiente e Ordenamento, Universidade de Aveiro / Environmental Engineer, Department of Environmental and Land Planning, Universidade de Aveiro
7 Professor Catedrático, Departamento de Ambiente e Ordenamento, Universidade de Aveiro / Cathedratic Professor, Department of Environmental and Land Planning, Universidade de Aveiro
8 Professor Auxiliar, Departamento Universitário de Fisiopatologia, Faculdade de Ciências Médicas, Universidade Nova de Lisboa (Centro de Estudos de Patologia Respiratória); Especialista em Imunoalergologia, Serviço de Imunoalergologia, Hospital de Dona Estefânia / Assistant Professor, Department of Physiopathology, Faculty of Medical Sciences, Universidade Nova de Lisboa (Centre for Respiratory Pathology Studies); Allergy and Clinical Immunology Specialist, Allergy and Clinical Immunology Unit, Hospital de Dona Estefânia
Received 05 November 2007, Accepted 04 January 2008
Abstract

The body of published work on the role of exhaled nitric oxide (FENO) in the study of bronchial inflammation allows it to be classed as a simple, non-invasive measurement that is very useful in evaluating asthmatic patients.

During a prospective study into the effects of air pollution on the health of the population of Viseu (Saud’AR Project), children with a clinical history of wheezing were identified through using the International Study of Asthma and Allergy in Childhood (ISAAC) questionnaire. Children later filled in a new standardised questionnaire and underwent skin-prick-tests, spirometry and FENO measurement. Their mean age was 7.8±1.1 years. Comparing those who wheezed in the 6 months before evaluation (n=27) with those who didn’t, statistical differences for ΔFEV1 (8% median versus 4.5%, p=0.0399) and for FENO (23 ppb median versus 12 ppb, p=0.0195, respectively) were observed. Concerning children who needed a bronchodilator in the six previous months (n=19) and those who didn’t, there was also a statistically significant difference in FENO: 27 ppb median versus 11 ppb median, respectively; p<0.0001. When comparing children who needed an unscheduled medical appointment in the six months previous to the evaluation (n=9) and those who didn’t, there was also significant differences for FENO: 28 ppb median versus 13 ppb median, p=0.0029. In conclusion, the existence of symptoms seems to be better related to FENO than spirometry.

Resumo

Encontram-se publicados múltiplos trabalhos sobre o papel das determinações do óxido nítrico no ar exalado (FENO) no âmbito do estudo da inflamação brônquica que nos permitem afirmar que se trata duma medição simples, não invasiva e de grande utilidade na avaliação do doente asmático.

No decurso de um estudo prospectivo sobre o impacto da poluição do ar sobre a saúde da população na cidade de Viseu (Projecto Saud’AR), foram identificadas crianças com história clínica de sibilância, mediante a aplicação de questionários do International Study of Asthma and Allergy in Childhood (ISAAC). As crianças foram submetidas posteriormente a um questionário padronizado, testes cutâneos prick para aeroalergénios, espirometria com prova de broncodilatação e medição de FENO. A idade média era de 7,8±1,1 anos. Comparando os doentes com queixas de sibilância e/ou dispneia nos 6 meses anteriores à avaliação (n=27) com os que não apresentaram estes sintomas, observaram -se diferenças estatisticamente significativas para o ΔFEV1 (mediana: 4,5% vs 8%, p=0,0399) e para o FENO (mediana: 12 ppb vs 23 ppb, p=0,0195, respectivamente). Se olharmos para as crianças que recorreram a broncodilatador nos seis meses anteriores à avaliação (n=19) e as compararmos com as que não necessitaram, encontramos diferenças para o FENO: mediana de 27 ppb versus mediana de 11 ppb, respectivamente; p<0,0001. Ao compararmos as crianças que recorreram a uma consulta de urgência nos seis meses anteriores à avaliação (n=9) e as compararmos com as que não recorreram, encontramos também diferenças estatisticamente significativas para o FENO: mediana de 28 ppb versus mediana de 13 ppb, p=0.0029.

Constatou-se assim que a existência de sintomas se associou melhor com o FENO de que com a espirometria.

Key-words
Wheezing, asthma, nitric oxide, FENO
Palavras-chave
Sibilância, asma, óxido nítrico, FENO
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Este estudo foi realizado no âmbito do projecto Saud’AR (A Saúde e o Ar que Respiramos), uma parceria entre o Departamento de Ambiente e Ordenamento da Universidade de Aveiro e a Faculdade de Ciências Médicas da Universidade Nova de Lisboa, e foi financiado pela Fundação Calouste Gulbenkian. Os doentes foram avaliados no Serviço de Pneumologia do Hospital de São Teotónio (Director: Dr. Simões Torres) / This study was part of the Saud’AR (Health is the Air that we Breathe) Project and was undertaken jointly with the Department of Environmental and Land Planning of the Universidade de Aveiro and the Faculty of Medical Sciences, Universidade Nova de Lisboa. It was funded by the Calouste Gulbenkian Foundation. Patients were evaluated by the Pulmonology Unit of the Hospital de São Teotónio (Director: Dr. Simões Torres).

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