The clinical use of exhaled nitric oxide in wheezing children

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.

Keywords: Wheezing. asthma. nitric oxide. FENO.

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Pedro Martins a, , Iolanda Caires b, José Rosado Pinto c, Pedro Lopes da Mata d, Simões Torres e, Joana Valente f, Carlos Borrego g, Nuno Neuparth h,

a 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
b 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)
c Director de Serviço, Serviço de Imunoalergologia, Hospital de Dona Estefânia / Allergy and Clinical Immunology Unit, Hospital de Dona Estefânia
d Especialista em Imunoalergologia, Instituto Clínico de Alergologia / Allergy and Clinical Immunology Specialist, Allergy and Clinical Immunology Institute
e Director de Serviço, Serviço de Pneumologia, Hospital de São Teotónio / Director, Pulmonology Unit, Hospital de São Teotónio
f Engenheira do Ambiente, Departamento de Ambiente e Ordenamento, Universidade de Aveiro / Environmental Engineer, Department of Environmental and Land Planning, Universidade de Aveiro
g Professor Catedrático, Departamento de Ambiente e Ordenamento, Universidade de Aveiro / Cathedratic Professor, Department of Environmental and Land Planning, Universidade de Aveiro
h 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