1
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Yamamoto N, Kasuga S, Kabata D, Ono M, Ando S, Hashimoto T, Fujikawa S, Fujitani H, Shintani A, Hamazaki T. Changes in FeNO, d-ROMs, and BH 4 by Intravenous L-Arginine in Children and Its Putative Role in Asthma Treatment. J Asthma Allergy 2024; 17:251-259. [PMID: 38524101 PMCID: PMC10961014 DOI: 10.2147/jaa.s445203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Purpose Pteridines are metabolites of tetrahydrobiopterin (BH4), being coenzymes for nitric oxide synthase (NOS). No study has clarified the relationship among pteridines and NOS, fractional exhaled nitric oxide (FeNO) generated by pteridines, and reactive oxygen species. In this study, we administered arginine, a precursor of NO, and confirmed changes in the levels of pteridines, FeNO, and reactive oxygen species and their relationship to clarify the pathogenesis of airway inflammation in which oxidative stress is involved, such as bronchial asthma. Patients and Methods This is a prospective, randomized open-label study. Children, aged 2 to 15 years, who were scheduled for growth hormone stimulation tests and were able to undergo a respiratory function test were recruited. They were randomly divided into two groups: arginine-administered and control groups. In the former, L-arginine hydrochloride was intravenously administered. After administration, the levels of diacron-reactive oxygen metabolites (d-ROMs), serum pteridines, serum amino acids, and fractional exhaled NO (FeNO) were measured. Results We analyzed 15 children aged 4 to 14 years. In the arginine-administered group, there was an increase in the FeNO level and a decrease in the d-ROMs level, reaching a peak 30 min after administration, compared with the control group. In addition, there was a decrease in the serum biopterin level and an increase in the d-ROMs level, reaching peak 60 min after administration. Conclusion The administration of L-arginine increased the NO level and decreased the d-ROMs level. Due to this, biopterin may be consumed and decreased, leading to an increase in the d-ROMs level. As a reduction in reactive oxygen species leads to the relief of inflammation, arginine and biopterin may be useful for inhibiting inflammation.
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Affiliation(s)
- Naho Yamamoto
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Saki Kasuga
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Daijiro Kabata
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Myu Ono
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Sakura Ando
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Taisuke Hashimoto
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Shiori Fujikawa
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | | | - Ayumi Shintani
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takashi Hamazaki
- Department of Pediatrics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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2
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Jeong JH. Nasal Nitric Oxide in the Upper Airway Inflammatory Diseases. JOURNAL OF RHINOLOGY 2021. [DOI: 10.18787/jr.2021.00361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Exhaled nitric oxide (eNO) from the lower respiratory tract is used commonly in diagnosis and treatment monitoring of asthma patients. However, nasal nitric oxide (nNO) has not been widely used in patients with upper airway inflammatory diseases due to its lack of standardized measurement methods. Nasal nitric oxide is produced mainly by the paranasal sinus mucosa and partially by the nasal mucosa and increases with inflammation. Nasal nitric oxide not only locally supports the defensive mechanism of the upper respiratory tract, but also remotely controls pulmonary function by acting as an aerocrine. Nasal NO can be affected by various physiologic and pathologic factors of the upper respiratory tract. This article will review the origin of nNO, its function, various measurement methods, and difference in presentation among upper respiratory tract inflammatory diseases such as allergic rhinitis, upper respiratory tract infection, nasal polyp, rhinosinusitis, primary ciliary dyskinesia, cystic fibrosis, Young’s syndrome, diffuse panbronchiolitis, empty nose syndrome, and obstructive sleep apnea. Future studies should identify the mechanism of action of nNO in various upper respiratory tract inflammatory diseases and obtain highly reproducible normal values of nNO based on a standardized measurement method with a deeper understanding of factors affecting nNO. Then, nNO will be useful for more rapid and simpler diagnosis of various upper respiratory tract diseases and for monitoring their treatment.
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3
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Takekawa D, Kudo T, Saito J, Nikaido Y, Sawada K, Takanashi S, Hirota K. Lower fractional exhaled nitric oxide levels are associated with depressive symptom in males: A population-based cross-sectional study. Psychiatry Res 2020; 293:113453. [PMID: 32971403 DOI: 10.1016/j.psychres.2020.113453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/13/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND We examined cross-sectional associations between depression and both inflammatory markers and fractional exhaled nitric oxide (FeNO). METHODS This cross-sectional study is a secondary analysis of the data of the Iwaki Health Promotion Project 2016 (1,148 subjects). We analyzed the subjects' characteristics and laboratory data including plasma interleukin (IL)-6, high-sensitivity C-reactive protein (hs-CRP), and FeNO. The subjects with Center for Epidemiologic Studies Depression Scale scores ≥16 were assigned to the depression group. We performed a multivariate logistic regression analysis to determine whether inflammatory markers and FeNO were associated with depression. RESULTS We assessed 1,099 subjects (430 males, 669 females). The depression group was 237 subjects (21.5%) [84 males (19.5%), 153 females (22.9%)]. The non-depression group was 862 subjects (346 males and 516 females). There were no significant differences in IL-6, hs-CRP, or FeNO between both groups. However, the multivariate logistic regression analysis indicated that lower FeNO was significantly associated with depression in males after adjusting for possible confounding factors (age, BMI, comorbidities, high-sensitivity troponin T, FEV1%, asthma, antidepressant use, smoker and alcohol drinker) (per 1 bpm increase, OR: 0.982; 95%CI: 0.967-0.998; p = 0.032). CONCLUSION Our findings indicate that lower FeNO may be associated with depression in males.
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Affiliation(s)
- Daiki Takekawa
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan.
| | - Takashi Kudo
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan
| | - Junichi Saito
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan
| | - Yoshikazu Nikaido
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan
| | - Kaori Sawada
- Department of Social Medicine, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Shingo Takanashi
- Department of Respiratory Medicine, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan
| | - Kazuyoshi Hirota
- Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan
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4
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Cavaliere C, Begvarfaj E, Incorvaia C, Sposato B, Brunori M, Ciofalo A, Greco A, de Vincentiis M, Masieri S. Long-term omalizumab efficacy in allergic rhinitis. Immunol Lett 2020; 227:81-87. [PMID: 32798500 DOI: 10.1016/j.imlet.2020.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Omalizumab therapy was found to be safe and effective as an add-on therapy for patients with poorly controlled severe asthma. Although several studies over the last decade have demonstrated its efficacy in other Immunoglobulin E related diseases, its use in such conditions is off-label. OBJECTIVE This study aimed to assess the effectiveness of long-term therapy with Omalizumab in patients with persistent severe allergic rhinitis and inadequately controlled severe asthma. METHODS Patients with poorly controlled severe asthma and persistent allergic rhinitis were enrolled and treated with Omalizumab for 36 months with every four-week subcutaneous administration. The efficacy assessment included the severity of AR symptoms every six months using Visual Analogue Scale, Asthma Control Test, nasal endoscopy, spirometry, and biomarkers (blood eosinophils and neutrophils, fractional exhaled nitric oxide, total IgE). RESULTS Eleven patients aged between 26 and 70 years were enrolled, and 10 completed the study. A significant improvement of allergic rhinitis symptoms, Asthma Control Test, and lung function was observed. There was also a reduction in the status of the biomarkers at the end of the study. CONCLUSION Long-term therapy with Omalizumab was effective and safe in treating severe persistent allergic rhinitis and concomitant asthma.
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Affiliation(s)
- Carlo Cavaliere
- Department of Oral and Maxillo-Facial Sciences, Sapienza University, Piazzale Aldo Moro, 5, 00185, Rome, Italy.
| | - Elona Begvarfaj
- Integrated Activity Head Neck Department, Federico II University, Naples, Italy
| | | | - Bruno Sposato
- Azienda USL Toscana Sud-Est Pneumology Department, "Misericordia" Hospital, Grosseto, Italy
| | - Marco Brunori
- Department of Cardiovascular, Respiratory, Nephrologic, Anaesthesiologic and Geriatric Sciences, Sapienza University, Rome, Italy
| | - Andrea Ciofalo
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University, Rome, Italy
| | - Marco de Vincentiis
- Department of Oral and Maxillo-Facial Sciences, Sapienza University, Piazzale Aldo Moro, 5, 00185, Rome, Italy
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5
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Oliver JD, Lim KG, O'Brien EK. Correlation of Exhaled Nasal Nitric Oxide With Sinus Computed Tomography and Sinonasal Outcome Test Scores: A Cross-sectional Pilot Study. Am J Rhinol Allergy 2018; 32:533-538. [PMID: 30238790 DOI: 10.1177/1945892418801389] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Computed tomography (CT) of the paranasal sinuses is the diagnostic reference standard for chronic rhinosinusitis and related inflammatory sinus pathology. Nasal nitric oxide (nNO) levels have been investigated as a diagnostic tool in sinus disease because it decreases with sinus obstruction. OBJECTIVE The primary aim of the study was to determine the correlation of passive (baseline) and dynamic (humming) nNO to CT findings of sinus inflammation and to sinonasal symptoms measured by the modified Sinonasal Outcome Test (26 items) (SNOT-26). METHODS From June 2015 through January 2016, subjects had baseline and humming nNO levels measured with a chemiluminescence NO analyzer, and each subject underwent CT imaging and completed the SNOT-26 survey. CT images were scored using the Lund-Mackay (LM) system (LM scores >3 indicated sinus inflammation). Correlation was measured by linear and ordinal regression analysis that compared SNOT-26 scores, LM scores, and nNO measurements. RESULTS Fourteen subjects were recruited. LM scores had a positive pairwise correlation with total SNOT-26 scores ( R2 = .1457; correlation = .3817) and nasal-specific SNOT-26 scores ( R2 = .4036; correlation = .6353). Baseline nasal nNO scores had a negative pairwise correlation with LM scores ( R2 = .1580; correlation = -.3582), total SNOT-26 scores ( R2 = .1515; correlation = -.3893), and nasal-specific SNOT-26 scores ( R2 = .0805; correlation = -.4343). Although baseline nNO levels correlated with LM and SNOT-26 scores, humming nNO levels did not show a similar correlation. CONCLUSION Baseline passive nNO may be a useful and inexpensive point-of-care screening test for sinonasal opacification.
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Affiliation(s)
- Jeremie D Oliver
- 1 Mayo Clinic School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Kaiser G Lim
- 2 Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota.,3 Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota
| | - Erin K O'Brien
- 4 Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
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6
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Manaker S. Fractional Exhaled Nitric Oxide: Inflamed Coverage Achieves Remission. Chest 2018; 149:1123-5. [PMID: 27157210 DOI: 10.1016/j.chest.2015.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 12/03/2015] [Accepted: 12/07/2015] [Indexed: 11/25/2022] Open
Affiliation(s)
- Scott Manaker
- Hospital of the University of Pennsylvania, Philadelphia, PA.
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7
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Zajda J, Schmidt NJ, Zheng Z, Wang X, Meyerhoff ME. Performance of Amperometric Platinized-Nafion Based Gas Phase Sensor for Determining Nitric Oxide (NO) Levels in Exhaled Human Nasal Breath. ELECTROANAL 2018; 30:1610-1615. [PMID: 31467468 PMCID: PMC6715298 DOI: 10.1002/elan.201800140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/21/2018] [Indexed: 11/08/2022]
Abstract
Nitric oxide (NO) levels in exhaled breath are a non-invasive marker that can be used to diagnose various respiratory diseases and monitor a patient's response to given therapies. A portable and inexpensive device that can enable selective NO concentration measurements in exhaled breath samples is needed. Herein, the performance of an amperometric Pt-Nafion-based gas phase sensor for detection of NO in exhaled human nasal breath is examined. Enhanced selectivity over carbon monoxide and ammonia is achieved via an in-line zinc oxide-based filter. Exhaled nasal NO levels measured in 21 human samples with the sensor are shown to correlate well with those obtained using a chemiluminescence reference method (R2 = 0.9836).
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Affiliation(s)
- Joanna Zajda
- Department of Chemistry, University of Michigan, 930 North University Avenue, Ann Arbor MI 48109-1055, USA
| | - Nicholas J. Schmidt
- Department of Chemistry, University of Michigan, 930 North University Avenue, Ann Arbor MI 48109-1055, USA
| | - Zheng Zheng
- Department of Chemistry, University of Michigan, 930 North University Avenue, Ann Arbor MI 48109-1055, USA
| | - Xuewei Wang
- Department of Chemistry, University of Michigan, 930 North University Avenue, Ann Arbor MI 48109-1055, USA
| | - Mark E. Meyerhoff
- Department of Chemistry, University of Michigan, 930 North University Avenue, Ann Arbor MI 48109-1055, USA
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8
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López JW, Loader MCI, Smith D, Pastorius D, Bravard M, Caviedes L, Romero KM, Clark T, Checkley W, Ticona E, Friedland JS, Gilman RH. Exhaled Nitric Oxide is Not a Biomarker for Pulmonary Tuberculosis. Am J Trop Med Hyg 2018; 98:1637-1639. [PMID: 29714162 PMCID: PMC6086145 DOI: 10.4269/ajtmh.17-0425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
To reduce transmission of tuberculosis (TB) in resource-limited countries where TB remains a major cause of mortality, novel diagnostic tools are urgently needed. We evaluated the fractional concentration of exhaled nitric oxide (FeNO) as an easily measured, noninvasive potential biomarker for diagnosis and monitoring of treatment response in participants with pulmonary TB including multidrug resistant–TB in Lima, Peru. In a longitudinal study however, we found no differences in baseline median FeNO levels between 38 TB participants and 93 age-matched controls (13 parts per billion [ppb] [interquartile range (IQR) = 8–26] versus 15 ppb [IQR = 12–24]), and there was no change over 60 days of treatment (15 ppb [IQR = 10–19] at day 60). Taking this and previous evidence together, we conclude FeNO is not of value in either the diagnosis of pulmonary TB or as a marker of treatment response.
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Affiliation(s)
- José W López
- Instituto Nacional de Salud del Niño, San Borja, Lima, Peru.,Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria-Cristina I Loader
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru.,Asociación Benéfica PRISMA, Lima, Peru.,Section of Infectious Diseases and Immunity, Wellcome Centre for Global Health, Imperial College London, London, United Kingdom
| | | | | | - Marjory Bravard
- Department of General Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Asociación Benéfica PRISMA, Lima, Peru.,Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luz Caviedes
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Taryn Clark
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.,Section of Emergency Medicine, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Asociación Benéfica PRISMA, Lima, Peru
| | - William Checkley
- CRONICAS Center in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Eduardo Ticona
- Facultad de Medicina de la Universidad Nacional Mayor de San Marcos, Lima, Peru.,Hospital Nacional Dos de Mayo, Lima, Peru
| | - Jon S Friedland
- Section of Infectious Diseases and Immunity, Wellcome Centre for Global Health, Imperial College London, London, United Kingdom
| | - Robert H Gilman
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.,Asociación Benéfica PRISMA, Lima, Peru.,Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
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9
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Ruggieri S, Drago G, Longo V, Colombo P, Balzan M, Bilocca D, Zammit C, Montefort S, Scaccianoce G, Cuttitta G, Viegi G, Cibella F. Sensitization to dust mite defines different phenotypes of asthma: A multicenter study. Pediatr Allergy Immunol 2017; 28:675-682. [PMID: 28783215 DOI: 10.1111/pai.12768] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Indoor allergens are risk factors for asthma: Thus, the characterization of indoor air quality is important for studying environment-health relationships in children. In particular, Dermatophagoides pteronyssinus is the dominant allergen for asthma. We cross-sectionally investigated the relationships among respiratory symptoms and function, airway inflammation, allergen sensitization, and indoor allergen concentration. METHODS One hundred and thirty-two children aging 10-14 years and living in a Southern Mediterranean area were evaluated by parental questionnaires. Spirometry, exhaled nitric oxide (FeNO), skin prick tests, total, and specific serum IgE analyses were performed along with the evaluation of home dust samples for the content in Der p 1 allergen. Three clusters were created on the basis of the presence/absence of wheeze in the last 12 months (Wh12m) and Der p 1-specific IgE level. RESULTS Cluster 1 (Wh12m+/high Der p 1 IgE) presented higher FeNO and poorer pulmonary function (lower FEV1 and FEF25%-75% ), while its symptom score was not different from Cluster 2 (Wh12m+/low Der p 1 IgE). Cluster 3 (Wh12m-/low IgE) showed the lowest FeNO values and pulmonary function similar to Cluster 2. Within Cluster 1, both Der p 1-specific IgE and FeNO were positively correlated with dust Der p 1. CONCLUSIONS Similar asthma phenotypes may occur in children despite differences in their atopic state. In atopic children, sensitizing allergens in the indoor environment may increase airway inflammation worsening pulmonary function. Moreover, environmental exposures may contribute to the development of asthma-like symptoms also in the absence of atopic sensitization, thus contributing to asthma overdiagnosis.
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Affiliation(s)
- Silvia Ruggieri
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy
| | - Gaspare Drago
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy
| | - Valeria Longo
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy
| | - Paolo Colombo
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy
| | - Martin Balzan
- Department of Respiratory Medicine, Mater Dei Hospital, Msida, Malta
| | - David Bilocca
- Department of Respiratory Medicine, Mater Dei Hospital, Msida, Malta
| | | | - Stephen Montefort
- Department of Respiratory Medicine, Mater Dei Hospital, Msida, Malta
| | - Gianluca Scaccianoce
- Department of Energy, Information Engineering and Mathematical Models, University of Palermo, Palermo, Italy
| | - Giuseppina Cuttitta
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy
| | - Giovanni Viegi
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy
| | - Fabio Cibella
- Institute of Biomedicine and Molecular Immunology, National Research Council of Italy, Palermo, Italy
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10
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Berry A, Busse WW. Biomarkers in asthmatic patients: Has their time come to direct treatment? J Allergy Clin Immunol 2017; 137:1317-24. [PMID: 27155028 DOI: 10.1016/j.jaci.2016.03.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/01/2016] [Accepted: 03/10/2016] [Indexed: 01/09/2023]
Abstract
Asthma is a heterogeneous disease with multiple phenotypes that have variable risk factors and responses to therapeutics. Mild-to-moderate asthma often responds to traditional medications, whereas severe disease can be refractory to inhaled corticosteroids, long-acting β-agonists, and leukotriene receptor antagonists. There is robust research into the variable phenotypes of asthma. Biomarkers help define the specific pathophysiology of different asthma phenotypes and identify potential therapeutic targets. The following review will discuss the current use of biomarkers for the diagnosis of asthma, triaging the severity of a patient's disease, and the potential efficacy of treatments. This information can be used to define certain patient populations that are more likely to respond to inhaled corticosteroids or biologics. As knowledge of patient phenotypes and endotypes and biological agents to target specific classes of asthma emerge, the ability to provide personalized care to asthmatic patients will follow.
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Affiliation(s)
- Alalia Berry
- Department of Medicine, Section of Allergy Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - William W Busse
- Department of Medicine, Section of Allergy Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
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11
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Caswell-Smith R, Cripps T, Charles T, Hosking A, Handigol M, Holweg C, Matthews J, Holliday M, Maillot C, Fingleton J, Weatherall M, Beasley R, Braithwaite I. Day-time variation of serum periostin in asthmatic adults treated with ICS/LABA and adults without asthma. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2017; 13:8. [PMID: 28194189 PMCID: PMC5299725 DOI: 10.1186/s13223-017-0182-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 01/26/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND We aimed to determine the effect of sampling time during the day on serum periostin levels in adult participants with and without asthma. METHODS Serum periostin was measured at 2-h intervals from 0800 to 1800 h in 16 adult participants with stable asthma prescribed inhaled corticosteroid and long-acting beta-agonist therapy, and in 16 otherwise healthy participants without asthma. Mixed linear models were used to compare time zero (08:00 h) with subsequent measurement time for serum periostin for both groups. RESULTS In both asthma and non-asthma, the mean (SD) serum periostin levels continuously reduced during the day from 53.5 (13.6) ng/mL at 0800 h to 50.9 (13.4) ng/mL at 1800 h (difference log periostin -0.05, P ≤ 0.001) and 50.5 (13.0) ng/mL at 0800 h to 46.2 (11.5) ng/mL at 1800 h (difference log periostin -0.08, P ≤ 0.001) respectively. CONCLUSIONS Periostin values are higher in the morning compared with the afternoon in asthmatic and non-asthmatic adults. The small magnitude of the variation in serum periostin levels suggests that the time of day in which the serum periostin measurements are made is unlikely to influence treatment decisions if a specific serum periostin level is used to predict treatment responsiveness. Trial registration Australia New Zealand Trials Registry (ACTRN12614000072617).
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Affiliation(s)
- Rachel Caswell-Smith
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
- Victoria University of Wellington, Wellington, New Zealand
| | - Terrianne Cripps
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
| | - Thom Charles
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
| | - Alexander Hosking
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
- University of Auckland, Auckland, New Zealand
| | | | | | | | - Mark Holliday
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
| | - Corentin Maillot
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
| | - James Fingleton
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
| | - Mark Weatherall
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
- University of Otago, Wellington, New Zealand
| | - Richard Beasley
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
- Victoria University of Wellington, Wellington, New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
| | - Irene Braithwaite
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
- Victoria University of Wellington, Wellington, New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
| | - On behalf of the Periostin Study Team
- Medical Research Institute of New Zealand, Private Bag 7902, Wellington, 6242 New Zealand
- Victoria University of Wellington, Wellington, New Zealand
- University of Auckland, Auckland, New Zealand
- Genentech Inc, San Francisco, CA USA
- University of Otago, Wellington, New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
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12
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Kearney GD, Gallagher B, Shaw R. Respiratory Protection Behavior and Respiratory Indices among Poultry House Workers on Small, Family-Owned Farms in North Carolina: A Pilot Project. J Agromedicine 2017; 21:136-43. [PMID: 26788985 DOI: 10.1080/1059924x.2016.1143429] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aim of this pilot study was to evaluate respiratory behavior and respiratory indices of poultry workers on family-owned, poultry farms with 10 or less employees in North Carolina. A field study was conducted to collect data on participants (N = 24) using spirometry, fractional exhaled nitric oxide (Feno), and an interviewer-administered questionnaire. The majority of workers (76%) ranked respiratory protection as being important, yet 48% reported never or rarely wearing respiratory protection when working in dusty conditions. A large percent of workers reported eye (55%) and nasal (50%) irritation and dry cough (50%). On average, pulmonary lung function and Feno tests were normal among nonsmokers. In bivariate analysis, significant associations were identified between working 7 days on the farm (P = .01), with eye irritation, and working 5 or fewer years in poultry farming (P = .01). Poultry workers on family-owned farms spend a considerable amount of work time in poultry houses and report acute respiratory-related health symptoms. Administrative controls among small, family-owned poultry farms are necessary to improve and promote safety and health to its employees.
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Affiliation(s)
- Gregory D Kearney
- a Department of Public Health , Brody School of Medicine, East Carolina University , Greenville , North Carolina , USA
| | - Barbara Gallagher
- b North Carolina Agromedicine Institute, AgriSafe Network of North Carolina, Brody School of Medicine, East Carolina University , Greenville , North Carolina , USA
| | - Robert Shaw
- c Division of Pulmonary, Critical Care and Sleep Medicine , Brody School of Medicine, East Carolina University , Greenville , North Carolina , USA
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Ricciardolo F, Sorbello V, Bellezza Fontana R, Schiavetti I, Ciprandi G. Exhaled nitric oxide in relation to asthma control: A real-life survey. Allergol Immunopathol (Madr) 2016; 44:197-205. [PMID: 26589339 DOI: 10.1016/j.aller.2015.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/16/2015] [Accepted: 05/26/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Asthma is characterised by chronic airway inflammation, a complex cascade of events, mostly sustained by eosinophil recruitment and activation. Fractional exhaled nitric oxide (FeNO) is a surrogate marker of airway inflammation closely associated with bronchial eosinophilia. FeNO is used to define asthma phenotype, to assess eosinophilic inflammatory severity and to predict corticosteroid responsiveness. OBJECTIVE The aim of this study was to investigate whether FeNO may be associated with some clinical and functional factors in asthmatics evaluated in a real life setting. METHODS Globally 363 patients (150 males, mean age 46.3 years) with asthma were consecutively evaluated. The following parameters were assessed: history, including comorbidities, physical examination, body mass index (BMI), lung function, asthma control grade, asthma control test (ACT), and FeNO. RESULTS FeNO values were significantly higher in patients with poorly controlled asthma (p<0.01), asthma symptoms (p=0.015), wheezing (p<0.001), rhinitis diagnosis, (p=0.049) and rhinitis symptoms (p=0.019), but lower in patients with GERD (p=0.024) and pneumonia history (p=0.048). FeNO values increased in patients with the lowest corticosteroid dose (p=0.031). FeNO values>25ppb were associated with poorly controlled asthma (OR 3.71), asthma signs (OR 3.5) and symptoms (OR 1.79). A FeNO value cut-off of 29.9ppb was fairly predictive of (AUC 0.7) poorly controlled asthma. CONCLUSIONS FeNO assessment in clinical practice may be a useful tool for monitoring asthmatics as it is associated with several clinical factors, including asthma control.
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Jacinto T, Alving K, Correia R, Costa-Pereira A, Fonseca J. Setting reference values for exhaled nitric oxide: a systematic review. CLINICAL RESPIRATORY JOURNAL 2016; 7:113-20. [PMID: 22789005 DOI: 10.1111/j.1752-699x.2012.00309.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The values obtained when the fraction of exhaled nitric oxide (FeNO) is measured are affected by several factors that are specific to the individual patient, making interpretation difficult, especially in the initial assessment of patients with respiratory symptoms. METHODS Systematic review of studies on FeNO reference values and individual-specific factors that influence them. RESULTS From 3739 references, 15 studies were included. Four studies included children and adolescents. In nine studies, samples were selected from the general population. Most studies reported objective measures for atopy (nine studies), but not for smoking status (one). Significant determinants of FeNO values reported were age and height (seven studies), atopy (six), smoking (four), weight (four), sex (three) and race (three). Additional factors were included in eight studies. R2 was reported in only five studies. The logarithmic transformation of FeNO was inadequately described in seven studies. CONCLUSION There are several equations for FeNO reference values that may be used in clinical practice, although the factors they include and the statistical methods they use vary considerably. We recommend the development of standard methods for the evaluation of normal FeNO data and that reference equations should be formulated based on a predetermined physiological model.
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Affiliation(s)
- Tiago Jacinto
- CINTESIS – Center for Research in Health Technologies and Information Systems, Faculty of Medicine, University of Porto, Porto, Portugal.
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15
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Ikonomi E, Rothstein RD, Ehrlich AC, Friedenberg FK. Measurement of Fractional Exhaled Nitric Oxide as a Marker of Disease Activity in Inflammatory Bowel Disease. ACTA ACUST UNITED AC 2016; 3. [PMID: 27398403 DOI: 10.15226/2374-815x/3/1/00146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Definitive diagnosis of IBD requires endoscopic and pathologic confirmation. These tools are also used to classify disease activity. Our aim was to determine if the fractional exhaled nitric oxide (FeNO) could be utilized to screen for IBD and assess for disease activity. METHODS We matched weighted IBD cases and controls from the 2009-2010 NHANES dataset. All subjects underwent measurement of FeNO using standardized techniques. We assessed for potential confounders for FeNO measurement including age, height, and asthma. For IBD subjects, we used the presence of diarrhea, fatigue, and weight loss as a proxy for IBD activity. Laboratory parameters examined to estimate disease activity included anemia (≤ 10 g/dl), iron deficiency (ferritin ≤ 20 ng/ml), hypoalbuminemia (≤ 3.2 g/dl), and CRP (≥ 1.1 mg/dl). RESULTS The weighted sample represented 199,414,901 subjects. The weighted prevalence of IBD was 2,084,895 (1.0%). IBD subjects had nearly the same FeNO level as those without IBD (17.0 ± 16.2 vs. 16.7 ± 14.5 ppb). The odds of a FeNO > 25 ppb was half (OR=0.501; 95% CI 0.497-0.504) for subjects with IBD compared to those without IBD after controlling for confounders. The AUROC curve for FeNO was 0.47 (0.35-0.59). FeNO levels were not higher in patients with laboratory values suggestive of active disease. FeNO levels were higher in IBD patients with diarrhea, rectal urgency, and fatigue but were lower in those with unintentional weight loss. CONCLUSION Measurement of FeNO does not appear to be useful to screen for IBD or assess disease activity.
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Affiliation(s)
- Erkanda Ikonomi
- Department of Medicine, Temple University School of Medicine, Philadelphia, PA
| | - Robin D Rothstein
- Temple Inflammatory Bowel Disease Program, Temple University School of Medicine, Philadelphia, PA
| | - Adam C Ehrlich
- Temple Inflammatory Bowel Disease Program, Temple University School of Medicine, Philadelphia, PA
| | - Frank K Friedenberg
- Temple Inflammatory Bowel Disease Program, Temple University School of Medicine, Philadelphia, PA
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16
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The Nasal Nitric Oxide Response to External Acoustic Energy: A Pilot Study of Sampling Dynamics. SINUSITIS 2015. [DOI: 10.3390/sinusitis1010013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kearney GD, Shaw R, Prentice M, Tutor-Marcom R. Evaluation of respiratory symptoms and respiratory protection behavior among poultry workers in small farming operations. J Agromedicine 2015; 19:162-70. [PMID: 24911691 DOI: 10.1080/1059924x.2014.886536] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Agricultural workers who work in enclosed poultry operations are at increased risk of respiratory exposure to atmospheric contaminants, including dusts, endotoxins, particulate from feathers, ammonia, and hydrogen sulfide from animal excrement. Given the relatively large number of small, family-run poultry farms in North Carolina, there has been relatively little research in the area documenting human lung function and perception of using respiratory protection among poultry workers. This study assesses respiratory health, knowledge, and perception of wearing respiratory protection among a sample of poultry workers attending a regional farm show in North Carolina. Lung function (spirometry), airway inflammation (exhaled nitric oxide), self-reported respiratory symptoms, and behavior of wearing respiratory protection were evaluated. Overall, mean lung function values were slightly lower than normal predicted values. The majority of participants ranked using respiratory protection as very important (51.9%); however, actual self-reported behavior was low (16.7%). In bivariate analysis, associations between the importance of wearing respiratory protection and the number of poultry houses (P=.04), as well as using a respirator and the number of poultry houses (P=.01) were statistically significant. Improved educational opportunities, including fit-testing and proper respiratory selection, should be emphasized for workers at small, poultry farm operations.
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Affiliation(s)
- Gregory D Kearney
- a Gregory D. Kearney is Assistant Professor, Department of Public Health, Brody School of Medicine , East Carolina University , Greenville , North Carolina , USA
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Nitric oxide sustains IL-1β expression in human dendritic cells enhancing their capacity to induce IL-17-producing T-cells. PLoS One 2015; 10:e0120134. [PMID: 25853810 PMCID: PMC4390375 DOI: 10.1371/journal.pone.0120134] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 02/04/2015] [Indexed: 01/09/2023] Open
Abstract
The role played by lung dendritic cells (DCs) which are influenced by external antigens and by their redox state in controlling inflammation is unclear. We studied the role played by nitric oxide (NO) in DC maturation and function. Human DCs were stimulated with a long-acting NO donor, DPTA NONOate, prior to exposure to lipopolysaccharide (LPS). Dose-and time-dependent experiments were performed with DCs with the aim of measuring the release and gene expression of inflammatory cytokines capable of modifying T-cell differentiation, towardsTh1, Th2 and Th17 cells. NO changed the pattern of cytokine release by LPS-matured DCs, dependent on the concentration of NO, as well as on the timing of its addition to the cells during maturation. Addition of NO before LPS-induced maturation strongly inhibited the release of IL-12, while increasing the expression and release of IL-23, IL-1β and IL-6, which are all involved in Th17 polarization. Indeed, DCs treated with NO efficiently induced the release of IL-17 by T-cells through IL-1β. Our work highlights the important role that NO may play in sustaining inflammation during an infection through the preferential differentiation of the Th17 lineage.
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19
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Żebrowska A, Głuchowska B, Jastrzębski D, Kochańska-Dziurowicz A, Stanjek-Cichoracka A, Pokora I. Endurance training and the risk of bronchial asthma in female cross-country skiers. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 840:29-34. [PMID: 25310943 DOI: 10.1007/5584_2014_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Exercise is one of the crucial factors responsible for asthma development and exacerbation. The purpose of the present study was to assess the risk of bronchial asthma in female athletes. Spirometric evaluations and physical exercise test were performed and exhaled nitric oxide (eNO) levels were measured in 12 female elite cross-country skiers. Serum concentrations of interleukin 1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α), and interleukin 6 (IL-6) were measured in all subjects before exercise, immediately after it, and after 15 min of recovery. Peak eNO values were 18.7±4.8 (ppb) and did not confirm the risk of early bronchial asthma symptoms. A graded exercise test caused significant increases in TNF-α and IL-1β concentration (p<0.05) after 15 min of recovery. A significant negative correlation was found between resting and post-exercise eNO and IL-6 levels (p<0.01). Our study did not confirm an increased risk of bronchial asthma or respiratory tract inflammatory conditions among female cross-country skiers exposed to physical exertion.
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Affiliation(s)
- A Żebrowska
- Department of Physiological and Medical Sciences, The Jerzy Kukuczka Academy of Physical Education, 72A, Mikołowska St., 40-065, Katowice, Poland,
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Abstract
Asthma has substantial impact on the patient, their family and health systems, and its control has gained increasing attention. Perception of asthma control has varied widely among patients as well as healthcare providers. Several clinical markers have been developed to define and standardize the measurement of asthma control. They are based primarily on patients' symptoms and have been popular in clinical practice and in clinical studies. With the advances in basic research on the pathology of asthma, several biological markers have evolved that have the advantages of being objective, quantitative and more reflective of the underlying pathology, which makes them a better guide for selecting optimal therapy. In addition to the cost and expertise required, biological makers are influenced by multiple factors that limit their application in clinical practice. Ongoing research is expected to define the role of individual biological markers, the optimal method of their application, and their appropriate interpretation.
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Affiliation(s)
- Hana M Tartibi
- Allergy and Immunology Section, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71130-3932, USA
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21
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Crisp HC. Utilization of exhaled nitric oxide measurement among United States allergists. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:621-3; quiz 623.e1-3. [DOI: 10.1016/j.jaip.2014.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/21/2014] [Accepted: 03/27/2014] [Indexed: 10/25/2022]
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Trueba AF, Rosenfield D, Smith NB, Gorena TL, Ritz T. Social support as a predictor exhaled nitric oxide in healthy individuals across time. Int J Psychophysiol 2014; 93:356-62. [PMID: 24882793 DOI: 10.1016/j.ijpsycho.2014.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/20/2014] [Accepted: 05/21/2014] [Indexed: 01/01/2023]
Abstract
Psychosocial factors such as social support and depression have long been associated with health outcomes. Elevated depressive symptoms are usually associated with worse health outcomes, whereas social support has been related to improvements in health. Nitric oxide levels are an important marker of both cardiovascular health and immune function. Research suggests that exhaled nitric oxide is affected by stress, negative affect, and depression; however, the effect of social support has not been previously explored. Thus, we sought to examine the association of social support, negative affect, and depression with exhaled nitric oxide in a group of 35 healthy individuals (10 males and 25 females) with a mean age of 20.5years across five weekly assessments. Results showed that changes in social support within individuals were positively associated with levels of exhaled nitric oxide independent of other psychosocial factors. Further exploration of the health implications of this positive relationship between airway nitric oxide and social support is necessary.
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Affiliation(s)
- Ana F Trueba
- Department of Psychology, Southern Methodist University, Dallas, TX, USA.
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Noelle Bassi Smith
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Tabitha L Gorena
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
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Paredi P, Kharitonov SA, Meah S, Barnes PJ, Usmani OS. A novel approach to partition central and peripheral airway nitric oxide. Chest 2014; 145:113-119. [PMID: 23989961 DOI: 10.1378/chest.13-0843] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Determining the site of airways inflammation may lead to the targeting of therapy. Nitric oxide (NO) is a biomarker of airway inflammation and can be measured at multiple exhalation flow rates to allow partitioning into bronchial (large/central airway maximal nitric oxide flux [J'awno]) and peripheral (peripheral/small airway/alveolar nitric oxide concentration [Cano]) airway contributions by linear regression. This requires a minimum of three exhalations. We developed a simple and practical method to partition NO. METHODS In 29 healthy subjects (FEV1, 97% ± 3% predicted), 13 patients with asthma (FEV1, 90% ± 4% predicted), 14 patients with COPD (FEV1, 59% ± 3% predicted), and 12 patients with cystic fibrosis (CF) (FEV1, 60% ± 3% predicted), we measured the area under the curve of the NO concentration/exhalation time plot (AUC-NO) at exhalation flow rates of 50, 100, 200, and 300 mL/s. We determined the change of the total AUC-NO production (ΔAUC-NO) among the four different exhalation flow rates and compared these levels to Cano and J'awno indices measured conventionally by linear regression. RESULTS The change in AUC-NO between increasing exhalation flow rates of 50 to 200 mL/s (ΔAUC-NO50-200) was strongly correlated with J'awno in all patient groups as follows: healthy subjects (r = 0.94, P < .001), patients with asthma (r = 0.98, P < .001), patients with COPD (r = 0.93, P < .001), and patients with CF (r = 0.74, P < .05). In all subjects, AUC-NO at an exhalation flow rate of 200 mL/s (AUC-NO200) correlated with Cano (r = 0.69, P < .01). CONCLUSIONS The bronchial production of NO can be determined by measuring ΔAUC-NO50-200, whereas AUC-NO200 measures its peripheral concentration. This approach is simple, quick, and does not require sophisticated equipment or mathematical models.
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Affiliation(s)
- Paolo Paredi
- Airways Disease Section, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, England.
| | - Sergei A Kharitonov
- Airways Disease Section, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, England
| | - Sally Meah
- Airways Disease Section, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, England
| | - Peter J Barnes
- Airways Disease Section, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, England
| | - Omar S Usmani
- Airways Disease Section, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, England
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24
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Ioannides SJ, Williams M, Jefferies S, Perrin K, Weatherall M, Siebers R, Crane J, Patel M, Travers J, Shirtcliffe P, Beasley R. Randomised placebo-controlled study of the effect of paracetamol on asthma severity in adults. BMJ Open 2014; 4:e004324. [PMID: 24525393 PMCID: PMC3927716 DOI: 10.1136/bmjopen-2013-004324] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To investigate the effect of regular paracetamol on bronchial hyper-responsiveness (BHR) and asthma control in adult asthma. SETTING Single research-based outpatient clinic. PARTICIPANTS 94 adults with mild-to-moderate asthma received randomised treatment; 85 completed the study. Key inclusion criteria were age 18-65 years, forced expiratory volume in 1 s (FEV1) >70% predicted, provocation concentration of methacholine causing a 20% reduction in FEV1 (PC20) between 0.125 and 16 mg/mL. Key exclusion criteria included an asthma exacerbation within the previous 2 months, current regular use of paracetamol, use of high-dose aspirin or non-steroidal anti-inflammatory drugs, current or past cigarette smoking >10 pack-years. INTERVENTIONS In a 12-week randomised, double-blind, placebo-controlled, parallel-group study, participants received 12 weeks of 1 g paracetamol twice daily or placebo twice daily. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome variable was BHR, measured as the PC20 at week 12. Secondary outcome variables included FEV1, fractional exhaled nitric oxide (FeNO) and asthma control questionnaire (ACQ) score. RESULTS At 12 weeks, the mean (SD) logarithm base two PC20 was 1.07 (2.36) in the control group (N=54) and 0.62 (2.09) in the paracetamol group (N=31). After controlling for baseline PC20, the mean difference (paracetamol minus placebo) was -0.48 doubling dose worsening in BHR in the paracetamol group (95% CI -1.28 to 0.32), p=0.24. There were no statistically significant differences (paracetamol minus placebo) in log FeNO (0.09 (95% CI -0.097 to 0.27)), FEV1 (-0.07 L (95% CI -0.15 to 0.01)) or ACQ score (-0.04 (95% CI -0.27 to 0.18)). CONCLUSIONS There was no significant effect of paracetamol on BHR and asthma control in adults with mild-to-moderate asthma. However, the study findings are limited by low power and the upper confidence limits did not rule out clinically relevant adverse effects. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry Number: NZCTR12609000551291.
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Affiliation(s)
- Sally J Ioannides
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
- University of Otago Wellington, Wellington, New Zealand
| | - Mathew Williams
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Sarah Jefferies
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
| | - Kyle Perrin
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
| | - Mark Weatherall
- Capital & Coast District Health Board, Wellington, New Zealand
- University of Otago Wellington, Wellington, New Zealand
| | | | - Julian Crane
- University of Otago Wellington, Wellington, New Zealand
| | - Mitesh Patel
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
| | - Justin Travers
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Philippa Shirtcliffe
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
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Lee BJ. Treatment of mild asthma: Is it necessary to keep regular inhaled corticosteroids? ALLERGY ASTHMA & RESPIRATORY DISEASE 2014. [DOI: 10.4168/aard.2014.2.3.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Byung-Jae Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Jeong JH, Yoo HS, Lee SH, Kim KR, Yoon HJ, Kim SH. Nasal and Exhaled Nitric Oxide in Chronic Rhinosinusitis with Polyps. Am J Rhinol Allergy 2014; 28:e11-6. [DOI: 10.2500/ajra.2014.28.3984] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The ciliary epithelial cells in the paranasal sinuses produce nasal nitric oxide (NO) continuously and plays a variety of roles in the paranasal sinuses. The purpose of this study was to assess whether we can use the levels of nasal NO (nNO) and exhaled NO (eNO) as a tool for evaluation in chronic rhinosinusitis (CRS) with nasal polyp patients. Methods We used chemiluminescent NO analyzer to measure nNO and eNO among normal controls (32) and CRS with polyp (30) and CRS with polyp and allergic rhinitis patients (27) and compared it with various clinical symptoms, laboratory data, and computed tomography (CT) scores. Results Levels of nNO were significantly lower in patients with CRS with polyps (88.5 ± 54.7 ppb) compared with controls (241.0 ± 89.5 ppb). Levels of nNO in CRS with polyps and allergic rhinitis (167.0 ± 47.6 ppb) were significantly higher than CRS with polyps and lower than controls. A significant inverse relationship was observed between nNO and sinus CT scores, severity of nasal obstruction, and purulent rhinorrhea in CRS with polyps. Low values of nNO separated well patients with CRS with polyps, and the cutoff value of <163 ppb was associated with the best com nation of specificity (93%) and sensitivity (81%). A significant positive relationship was observed between eNO and CT scores. Conclusion The nNO could be used for another screening of CRS with polyps for the more severe phenotypes, which may eventually have to be treated with surgery.
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Affiliation(s)
- Jin Hyeok Jeong
- Departments of Otolaryngology–Head and Neck Surgery and College of Medicine, Hanyang University, Seoul, Korea
| | - Han Seok Yoo
- Departments of Otolaryngology–Head and Neck Surgery and College of Medicine, Hanyang University, Seoul, Korea
| | - Seung Hwan Lee
- Departments of Otolaryngology–Head and Neck Surgery and College of Medicine, Hanyang University, Seoul, Korea
| | - Kyung Rae Kim
- Departments of Otolaryngology–Head and Neck Surgery and College of Medicine, Hanyang University, Seoul, Korea
| | - Ho Joo Yoon
- Departments of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Sang Heon Kim
- Departments of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
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27
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Tarnoki DL, Tarnoki AD, Medda E, Littvay L, Lazar Z, Toccaceli V, Fagnani C, Stazi MA, Nisticó L, Brescianini S, Penna L, Lucatelli P, Boatta E, Zini C, Fanelli F, Baracchini C, Meneghetti G, Koller A, Osztovits J, Jermendy G, Preda I, Kiss RG, Karlinger K, Lannert A, Horvath T, Schillaci G, Molnar AA, Garami Z, Berczi V, Horvath I. Genetic influence on the relation between exhaled nitric oxide and pulse wave reflection. J Breath Res 2013; 7:026008. [PMID: 23660450 DOI: 10.1088/1752-7155/7/2/026008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Nitric oxide has an important role in the development of the structure and function of the airways and vessel walls. Fractional exhaled nitric oxide (FE(NO)) is inversely related to the markers and risk factors of atherosclerosis. We aimed to estimate the relative contribution of genes and shared and non-shared environmental influences to variations and covariation of FE(NO) levels and the marker of elasticity function of arteries. Adult Caucasian twin pairs (n = 117) were recruited in Hungary, Italy and in the United States (83 monozygotic and 34 dizygotic pairs; age: 48 ± 16 SD years). FE(NO) was measured by an electrochemical sensor-based device. Pulse wave reflection (aortic augmentation index, Aix(ao)) was determined by an oscillometric method (Arteriograph). A bivariate Cholesky decomposition model was applied to investigate whether the heritabilities of FE(NO) and Aix(ao) were linked. Genetic effects accounted for 58% (95% confidence interval (CI): 42%, 71%) of the variation in FE(NO) with the remaining 42% (95%CI: 29%, 58%) due to non-shared environmental influences. A modest negative correlation was observed between FE(NO) and Aix(ao) (r = -0.17; 95%CI:-0.32,-0.02). FE(NO) showed a significant negative genetic correlation with Aix(ao) (r(g) = -0.25; 95%CI:-0.46,-0.02). Thus in humans, variations in FE(NO) are explained both by genetic and non-shared environmental effects. Covariance between FE(NO) and Aix(ao) is explained entirely by shared genetic factors. This is consistent with an overlap among the sets of genes involved in the expression of these phenotypes and provides a basis for further genetic studies on cardiovascular and respiratory diseases.
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Affiliation(s)
- David Laszlo Tarnoki
- Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary, 78/a Ulloi Street, Budapest 1082, Hungary.
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Glas N, Vergnon JM, Pacheco Y. [Interest for evaluation of bronchial inflammation in asthma]. REVUE DE PNEUMOLOGIE CLINIQUE 2013; 69:76-82. [PMID: 23434035 DOI: 10.1016/j.pneumo.2012.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 09/18/2012] [Accepted: 10/30/2012] [Indexed: 06/01/2023]
Abstract
Asthma is a heterogeneous chronic inflammatory disease. The respiratory functional tests are sometimes insufficient to confirm the diagnosis. Other tools are developed to estimate the bronchial inflammation such as tests of bronchial provocation, measure of exhaled nitric oxide, induced sputum and exhaled breath condensate. This review presents these non-invasive methods, approaches their interests on the identification of the disease and the treatment.
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Affiliation(s)
- N Glas
- Service de Pneumologie et D'oncologie Thoracique, Hôpital Nord, CHU de Saint-Étienne, France.
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Miller MR, Shaw CA, Langrish JP. From particles to patients: oxidative stress and the cardiovascular effects of air pollution. Future Cardiol 2012; 8:577-602. [PMID: 22871197 DOI: 10.2217/fca.12.43] [Citation(s) in RCA: 167] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Air pollution, especially airborne particulate matter (PM), is associated with an increase in both morbidity and mortality from cardiovascular disease, although the underlying mechanisms remain incompletely established. The one consistent observation that links the pulmonary and cardiovascular effects of inhaled PM is oxidative stress. This article examines the evidence for the role of oxidative stress in the cardiovascular effects of air pollution, beginning with observations from epidemiological and controlled exposure studies and then exploring potential mechanistic pathways involving free radical generation from PM itself, to effects of PM on cell cultures, isolated organs, healthy animals and animal models of disease. Particular emphasis is placed on the vascular and atherosclerotic effects of urban air pollution and diesel exhaust emissions as rich sources of environmental ultrafine particles.
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Affiliation(s)
- Mark R Miller
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Queens Medical Research Institute, 47 Little France Crescent, Edinburgh, Scotland, UK.
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Polychronakis I, Thanasias E, Raulf-Heimsoth M, Merget R. Occupational non-immediate type allergic asthma due to ammonium persulfate. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 755:79-84. [PMID: 22826052 DOI: 10.1007/978-94-007-4546-9_10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
While numerous cases of immediate-type occupational asthma due to persulfates with positive skin prick test reactions to ammonium persulfate are well documented, few non-immediate type reactions have been described in the literature. We report the case of an atopic worker who developed work-related asthmatic symptoms shortly after he began his job in persulfate production. The diagnosis of asthma was corroborated by methacholine testing. The patient showed a positive patch test reaction to ammonium persulfate, while skin prick test was negative. He presented an isolated late symptomatic airway obstruction after a cumulative dose of 0.6 mg ammonium persulfate administered by a dosimeter method. An immunologic mechanism was demonstrated by a significant increase in exhaled nitric oxide and the number of eosinophils in induced sputum. These findings suggest that isolated late bronchial reactions to persulfates are mediated by eosinophilic inflammatory responses.
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Occupational immediate-type allergic asthma due to potassium tetrachloroplatinate in production of cytotoxic drugs. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 755:47-53. [PMID: 22826048 DOI: 10.1007/978-94-007-4546-9_6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Allergic immediate-type reactions by halogenated compounds of platinum (Pt) (platinum salts) have been described in workers in precious metal refineries and catalyst productions. In both industries there are exposures to many different Pt compounds. It is believed that the most important allergens are those compounds with the highest number of halide ligands. It is unknown whether sensitizations to compounds with a lower number of halide ligands represent co-sensitizations or are due to cross-reactivity. We report a worker engaged in the production of cytotoxic drugs with occupational asthma and exposure to only one Pt salt with four halide ligands. The 22-year-old worker developed work-related sneezing, runny nose, and variable dyspnea about a year after he had started to work in the cytotoxic drugs production with exposure to potassium tetrachloroplatinate(II) (K(2)PtCl(4)). He was immediately removed from his workplace and admitted for a medical opinion about 6 months afterwards. Spirometry was normal, but asthma was corroborated by a positive response to methacholine. The results of skin prick testing could not be interpreted due to urticaria factitia. Challenge with K(2)PtCl(4) by a dosimeter method yielded a clear immediate-type reaction with an increase of exhaled nitric oxide from 32 to 156 ppb after 24 h indicating an increased airway inflammation. Pt salts with four halide ligands like K(2)PtCl(4) may cause an allergic immediate-type reaction and occupational asthma. Workers in the production of Pt-containing cytotoxic drugs with exposure to these substances should be included in medical surveillance programs for the prevention of occupational asthma caused by Pt salts.
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Ciprandi G, Tosca MA, Capasso M. High exhaled nitric oxide levels may predict bronchial reversibility in allergic children with asthma or rhinitis. J Asthma 2012; 50:33-8. [PMID: 23157515 DOI: 10.3109/02770903.2012.740119] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Allergic asthma and rhinitis may be associated. Airway inflammation is shared by both disorders. The measure of the fractional concentration of exhaled nitric oxide (FeNO) may be considered as a surrogate marker for airway inflammation, mainly in allergic patients. Reversibility to bronchodilation (BD) testing is a functional characteristic of asthma. OBJECTIVE The aim of this study was to evaluate whether FeNO may predict reversibility to BD in a pediatric cohort of allergic subjects with asthma (180) or rhinitis (150). METHODS Lung function (including forced expiratory volume at the first second (FEV(1)), forced volume capacity (FVC), forced expiratory flow at 25-75% of volume capacity (FEF (25-75))), FeNO measurement, and BD testing were performed in all children. RESULTS Lung function, FeNO, and sensitization type were significantly different in the two groups. A strong correlation was found between FeNO and ΔFEV(1) after BD. Two main predictors of reversibility were FeNO values >34 ppb [Odds RatioAdj (ORAdj) = 1.9] and sensitization to perennial allergens (ORAdj = 1.7). CONCLUSIONS This study provided evidence that FeNO was strongly related with the response to BD testing and could predict bronchial reversibility in children with allergic rhinitis or asthma. Therefore, a simple FeNO measurement could suggest relevant information about bronchial reversibility.
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Affiliation(s)
- Giorgio Ciprandi
- IRCCS-Azienda Ospedaliera Universitaria San Martino, Genoa, Italy.
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Cirillo I, Ricciardolo FLM, Medusei G, Signori A, Ciprandi G. Exhaled nitric oxide may predict bronchial hyperreactivity in patients with allergic rhinitis. Int Arch Allergy Immunol 2012; 160:322-8. [PMID: 23052027 DOI: 10.1159/000341675] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 07/06/2012] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Nowadays it is possible to assess airway inflammation by measuring the fractional concentration of exhaled nitric oxide (FeNO) during an office visit and there is international consensus on the testing methodology. The aim of this study was to evaluate whether FeNO measurement may be a predictor of bronchial hyperreactivity (BHR) in patients with allergic rhinitis (AR). METHODS Two hundred eleven patients (196 males, median age 28.5 years) suffering from persistent AR were evaluated. Values for bronchial function (FVC, FEV(1), and FEF(25-75)), bronchial provocation tests (methacholine), exhaled nitric oxide (FeNO), a visual analogue scale for nasal and bronchial symptoms, and sensitization were assessed. RESULTS A strong and inverse correlation between FeNO levels and BHR severity was found (r = -0.58). FeNO was a predictive factor for BHR, and 37 ppb was found to be the best cutoff (area under the curve 0.90) to define the presence of BHR in patients with AR. CONCLUSIONS This study highlights the relevance of FeNO as a possible predictive marker for BHR in AR patients and underlines the close link between upper and lower airways. Thus, FeNO measurement could be a useful screening tool in identifying subjects with rhinitis at risk of developing asthma.
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Should exhaled nitric oxide measurement be part of routine asthma management? Ann Allergy Asthma Immunol 2012; 109:289-91. [PMID: 23062380 DOI: 10.1016/j.anai.2012.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 08/20/2012] [Indexed: 11/20/2022]
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Shusterman DJ, Weaver EM, Goldberg AN, Schick SF, Wong HH, Balmes JR. Pilot evaluation of the nasal nitric oxide response to humming as an index of osteomeatal patency. Am J Rhinol Allergy 2012; 26:123-6. [PMID: 22487289 DOI: 10.2500/ajra.2012.26.3745] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Paranasal sinuses are reservoirs for nitric oxide (NO), and humming facilitates nasal diffusion of NO. The nasal NO response to humming has previously been shown to be blunted with chronic sinusitis and nasal polyposis. We hypothesized that the nasal NO response to humming will be proportional to radiographic osteomeatal patency when comparing allergic rhinitis (AR) patients (without chronic sinusitis) with normal controls. METHODS Nonsmoking subjects completed questionnaires and skin-prick testing. Subjects underwent sinus CT scanning, followed by exhaled (oral) and nasal NO sampling (with and without humming). Humming-to-quiet (H/Q) nasal NO ratios were calculated. Three-dimensional reconstructions were used to trace the osteomeatal complex (OMC) and measure minimum cross-sectional area. Lund-Mackay scores were also documented. RESULTS A total of 33 subjects (22 women; mean age, 35.5 years) completed the study. Seventeen AR patients (5 IAR and 12 PAR) participated, as did 16 nonallergic controls. Among controls, quiet nasal NO levels--corrected for fractional exhaled NO--rose significantly with OMC area and fell significantly with Lund-Mackay scores (p < 0.05). However, we observed no proportionality between H/Q ratio and radiographic OMC patency. CONCLUSION Analysis of nasal NO samples taken under quiet conditions from normal controls was consistent with the paranasal sinuses acting as a reservoir of nasal NO and with OMC patency acting as a significant factor in NO diffusion. However, our results did not support a relationship between the nasal NO response to humming and radiographic OMC patency in a sample excluding subjects with severe rhinosinusitis.
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Dinakar C. Exhaled nitric oxide in asthma management. Ann Allergy Asthma Immunol 2012; 108:219-22. [PMID: 22469439 DOI: 10.1016/j.anai.2012.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 02/21/2012] [Accepted: 02/22/2012] [Indexed: 11/16/2022]
Affiliation(s)
- Chitra Dinakar
- Department of Pediatrics, University of Missouri in Kansas City, and Section of Allergy, Asthma, and Immunology, Children's Mercy Hospital, Kansas City, Missouri 64108, USA.
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A cross-sectional study assessing the relationship between BMI, asthma, atopy, and eNO among schoolchildren. Ann Allergy Asthma Immunol 2011; 107:330-6. [PMID: 21962093 DOI: 10.1016/j.anai.2011.08.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 07/29/2011] [Accepted: 08/05/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND Increased body weight may influence airway inflammatory mechanisms. OBJECTIVE To assess whether overweight-obesity (OW-O), evaluated as increased body mass index, is associated either with exhaled nitric oxide (eNO), a marker of airway inflammation, or with allergic sensitization in a large sample of children and adolescents. METHODS A cross-sectional, epidemiological study was performed on a population sample of schoolchildren evaluating 708 subjects (age 10-16 years; BMI 13-39 kg/m(2)) by respiratory health questionnaire, skin prick tests, spirometry, and eNO measure. RESULTS Prevalence rates were: OW-O 16.4%, asthma ever (A) 11.9%, and rhinoconjunctivitis (RC) 14.8%. Asthma ever and allergic sensitization were significantly more frequent among OW-O (21.0 and 51.6%) than in non-OW-O (10.2 and 37.0%, respectively). The forced expiratory volume in 1 second (FEV(1))/forced vital capacity (FVC) ratio was not significantly different between OW-O and non-OW-O. Exhaled NO (median and interquartile range) was 15.3 (11.2-23.1) ppb in the overall sample, 20.3 (12.9-35.8) ppb among allergic subjects, and 13.9 (10.6-18.3) ppb among nonallergic subjects (P<.0001). No significant difference between OW-O and non OW-O subjects was found in eNO levels. Similarly, OW-O subjects with A or RC did not show significantly higher eNO levels than non-OW-O. In a logistic regression model, presence of allergic sensitization, A, and RC, and not OW-O, were significant predictors of increased eNO. CONCLUSIONS In children, OW-O was not associated with increased eNO levels, but it was an independent risk factor for asthma and allergic sensitization.
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Short PM, Lipworth SIW, Lipworth BJ. Relationships between airway hyperresponsiveness, inflammation, and calibre in asthma. Lung 2011; 189:493-7. [PMID: 21984113 DOI: 10.1007/s00408-011-9328-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 09/19/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous studies have focused upon the relationship between airway inflammation and hyperresponsiveness with different conclusions. We re-examined the relationship between airway inflammation (FE(NO)), hyperresponsiveness to methacholine (AHR), and calibre (FEV(1) % predicted) in mild-to-moderate asthmatics. METHODS We searched our database for asthmatics who had attended our research department. FEV(1) % predicted, FE(NO), and methacholine PC(20) were collected. Patients were divided into groups based upon AHR as follows: severe (<0.5 mg/ml, group A), moderate (>0.5-2 mg/ml, group B), and mild (>2-8 mg/ml, group C), and upon FE(NO): low (<25 ppb, group D), medium (25-50 ppb, group E), and high (>50 ppb, group F). RESULTS In 208 asthmatics, when stratified by AHR, there was an 8.5% difference in FEV(1) % predicted (95% CI 2.6-14.4%; P = 0.002) and a 29% difference in FE(NO) between groups A and C (95% CI 2-48%; P = 0.034). When stratified by FE(NO,) there was a 1.29 doubling dilution difference in methacholine PC(20) (95% CI 0.26-2.33; P = 0.009) between groups D and F. There was no difference between FEV(1) % predicted when grouped by FE(NO). Multivariate regression analysis with covariates, including inhaled corticosteroids, supported our findings from categorical analysis. CONCLUSIONS We found no relationship between airway inflammation and calibre, whilst showing significant relationships between AHR and airway calibre and AHR and airway inflammation. Whilst relationships exist, the lack of complete concordance highlights the important role each contributes to the assessment of the asthmatic individual.
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Affiliation(s)
- Philip M Short
- Division of Medical Sciences, Asthma and Allergy Research Group, Centre for Cardiovascular and Lung Biology, University of Dundee, Ninewells Hospital & Medical School, Dundee, DD1 9SY, UK
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Ferrer M, Jarque A, Tosca R, Michavila A. Is it necessary to treat all asthmatic children with raised levels of exhaled nitric oxide?: treating the patient or the data. Allergol Immunopathol (Madr) 2011; 39:280-3. [PMID: 21236551 DOI: 10.1016/j.aller.2010.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 09/05/2010] [Accepted: 09/16/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of the present study is to assess whether a single determination of the fraction of exhaled nitric oxide (FENO), added to the measurements usually taken during a routine checkup, helps in the prediction of the recurrence of asthma attacks in controlled patients who are not receiving any baseline treatment; and whether or not treatment of the said latent inflammation is appropriate. METHODS Observational study of prospective cohorts. Over a period of three months, data was collected from 28 patients (6 to 14 years) who met the conditions of the inclusion criteria, with a follow up appointment after six months. RESULTS Patients were divided into two groups: 13 with FENO values of 49 and over, and 15 with values of under 49. Five patients in the subgroup with low FENO values suffered recurrence, in contrast to only one in the group with high values. The positive predictive value of the high values of the FENO was 7.69, with no significant differences between the two groups. CONCLUSIONS Certain doubts were raised about the usefulness of the FENO, as opposed to the traditional methods of asthma control with regard to the therapeutic management of clinically controlled patients who are not receiving treatment and who have high FENO values. It would appear unwise to recommend the systematic treatment of patients with high FENO values, when measured during a routine check-up, in cases of asthma with an allergic component and are asymptomatic or in a phase of asthma under good control.
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Affiliation(s)
- M Ferrer
- Pediatric Allergy Unit, Departament of Pediatrics, Castellón General Hospital, Spain.
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Masri F. Role of nitric oxide and its metabolites as potential markers in lung cancer. Ann Thorac Med 2011; 5:123-7. [PMID: 20835304 PMCID: PMC2930648 DOI: 10.4103/1817-1737.65036] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 02/03/2010] [Accepted: 04/24/2010] [Indexed: 01/16/2023] Open
Abstract
Nitric oxide (NO) and reactive oxygen species (ROS) play important physiologic roles as mediators of signaling processes. However, high concentrations of NO and ROS result in damage to cellular and extracellular components. Excessive production of endogenous and/or exogenous ROS and NO is implicated in the pathogenesis of lung cancer. NO and its metabolites interact with ROS to generate potent nitrating agents leading to protein nitration, which is one of the several chemical modifications that occur during oxidative/nitrosative stress. Although there is considerable evidence in support of a role for NO in protein modifications and carcinogenesis, recent data suggest that NO has antagonistic cellular effects, leading to either promotion or inhibition of tumor growth. However, the role of NO in tumor biology is still poorly understood. This review demonstrates the role of NO and its metabolites as potential markers in lung cancer.
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Affiliation(s)
- Fares Masri
- Department of Biochemistry and Microbiology, University of Kalamoon, Deratiah, Syria.
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Dummer J, Storer M, Swanney M, McEwan M, Scott-Thomas A, Bhandari S, Chambers S, Dweik R, Epton M. Analysis of biogenic volatile organic compounds in human health and disease. Trends Analyt Chem 2011. [DOI: 10.1016/j.trac.2011.03.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Pala G, Pignatti P, Moscato G. The use of fractional exhaled nitric oxide in investigation of work-related cough in a hairdresser. Am J Ind Med 2011; 54:565-8. [PMID: 21394743 DOI: 10.1002/ajim.20948] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Occupational and environmental factors may be a cause of nonasthmatic eosinophilic bronchitis (NAEB). The diagnosis of occupational NAEB requires evidence of sputum eosinophilia. Nevertheless, a minority of patients are not able to produce suitable sputum specimens. METHODS This case report describes a 25-year-old woman, working as a hairdresser since the age of 20 years and handling ammonium persulfate, who came under our observation for work-related rhinitis and cough. RESULTS A specific inhalation challenge with ammonium persulfate elicited dry cough, without any significant change in forced expiratory volume in 1 s (FEV(1) ). Sputum induction was unsuccessful both pre- and after specific inhalation challenge. Fractional exhaled nitric oxide (FeNO) values significantly increased after specific inhalation challenge, suggesting a diagnosis of occupational NAEB due to ammonium persulfate. CONCLUSIONS From this observation we suggest that FeNO measurement should be added to the investigation of work-related cough during specific inhalation challenge, and may be considered as an alternative to induced sputum to evaluate bronchial inflammation when sputum collection is unavailable or unsuccessful.
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Affiliation(s)
- Gianni Pala
- Allergy and Immunology Unit, Fondazione 'Salvatore Maugeri', Institute of Care and Research, Scientific Institute of Pavia, Italy.
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Ekstrand Y, Ternesten-Hasséus E, Arvidsson M, Löfdahl K, Palmqvist M, Millqvist E. Sensitivity to environmental irritants and capsaicin cough reaction in patients with a positive methacholine provocation test before and after treatment with inhaled corticosteroids. J Asthma 2011; 48:482-9. [PMID: 21486197 DOI: 10.3109/02770903.2011.570405] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Increasing evidence points to a potential role for members of the transient receptor potential family of cation channels on several features of asthmatic disease. The cough sensitivity to inhaled capsaicin is known to reflect the reactivity of these airway sensory nerves. OBJECTIVE The aim was to study, among patients having a positive methacholine provocation and diagnosed with asthma, capsaicin cough sensitivity, sensitivity to methacholine, and levels of exhaled nitric oxide before and after treatment with inhaled steroids, and further, to measure the self-reported impact from environmental irritants. METHODS Eighteen steroid-naïve patients with a positive methacholine test underwent capsaicin inhalation provocation on two occasions, before and after regular use of inhaled steroids over at least 3 months. Comparisons were made to 21 healthy controls. Sensitivity to methacholine and levels of exhaled nitric oxide were measured before and after the treatment. The participants also answered a validated questionnaire regarding environmental irritants. RESULTS The patients displayed higher capsaicin cough sensitivity than the controls before the treatment period, but not afterward. Before treatment, capsaicin cough answer correlated significantly with levels of exhaled nitric oxide, but not with methacholine sensitivity. After treatment with inhaled corticosteroids, the capsaicin cough sensitivity and the inflammatory parameters were normalized. In comparison to the control group, the patients reported more affective reactions to and behavioral disruptions induced by environmental irritants. CONCLUSIONS In steroid-naïve patients with a positive methacholine test, there is a link between that part of the airway inflammation that is reflected by exhaled nitric oxide and that followed by an augmented reactivity of capsaicin-sensitive sensory nerves. This association disappears after steroid treatment.
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Affiliation(s)
- Ylva Ekstrand
- Department of Internal Medicine/Respiratory Medicine and Allergology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
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Stern G, de Jongste J, van der Valk R, Baraldi E, Carraro S, Thamrin C, Frey U. Fluctuation phenotyping based on daily fraction of exhaled nitric oxide values in asthmatic children. J Allergy Clin Immunol 2011; 128:293-300. [PMID: 21489612 DOI: 10.1016/j.jaci.2011.03.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 03/01/2011] [Accepted: 03/08/2011] [Indexed: 12/26/2022]
Abstract
BACKGROUND Fraction of exhaled nitric oxide (Feno), a marker of airway inflammation, has been proposed to be useful for asthma management, but conclusions are inconsistent. This might be due to the failure of mean statistics to characterize individual variability in Feno values, which is possibly a better indicator of asthma control than single measurements. OBJECTIVE We characterized fractal fluctuations in daily Feno values over time and the relationship between Feno values and symptom scores. We investigated whether these are associated with asthma severity, control, and exacerbation risk. METHODS Daily Feno values and symptom scores over 192 days in 41 atopic asthmatic children from the Childhood Asthma Respiratory Inflammatory Status Monitoring study were analyzed. Two methods of time-series analysis were used: detrended fluctuation analysis to quantify fractal patterns in fluctuations in daily Feno values (α value) and cross-correlation to quantify the strength of the relationship between daily Feno values and symptom scores. The associations of α values and cross-correlation with markers of asthma severity and control were assessed by means of regression analysis. RESULTS Daily fluctuations in Feno values exhibited fractal-type long-range correlations. Those subjects receiving higher doses of inhaled corticosteroids at study entry had a significantly lower α value, corresponding to more random fluctuations in Feno values in those with greater inhaled corticosteroid need. The cross-correlation between Feno values and symptom scores was significantly higher in those subjects who had exacerbations. CONCLUSIONS Fluctuation in Feno values and their cross-correlation to symptom scores contains information on asthma severity and control. Methods that quantify the complexity of asthma over time might assist in identifying asthmatic subjects with concordance between eosinophilic inflammation and symptoms and thus increased exacerbation risk.
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Affiliation(s)
- Georgette Stern
- Department of Pediatrics, University Hospital of Bern, Bern, Switzerland
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Yao TC, Ou LS, Lee WI, Yeh KW, Chen LC, Huang JL. Exhaled nitric oxide discriminates children with and without allergic sensitization in a population-based study. Clin Exp Allergy 2011; 41:556-64. [PMID: 21338427 DOI: 10.1111/j.1365-2222.2010.03687.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fraction of exhaled nitric oxide (FeNO) as a biomarker of airway inflammation in children warrants better clarification. OBJECTIVE To identify the determinants of FeNO in children and assess the validity of FeNO as a discriminative tool for asthma, rhinitis or allergic sensitization in a population setting. METHODS Children aged 5-18 years (N=1717) were evaluated using online FeNO measurements, questionnaires, anthropometric measurements, pulmonary function tests and total and specific serum IgE. RESULTS FeNO levels were age-dependent, with an average increase of 7.4% per year of age. It decreased with increasing body mass index (BMI), estimated at 1.5% decrease per kg/m(2) . Children with allergic sensitization had elevated FeNO independent of allergic symptoms. In the combined analyses of asthma, rhinitis and allergic sensitization, elevated FeNO levels were confined mainly to children having allergic sensitization. After adjusting for allergic sensitization, a significant association between rhinitis and FeNO remained, but no such association was seen with asthma. The sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) of FeNO at the optimum cut-off of 28 p.p.b. for diagnosing asthma were 64.3%, 69.9%, 8.8%, and 97.7%, respectively (area under the ROC curve [AUC] 0.67), and were slightly better for diagnosing allergic asthma: 70.0%, 70.4%, 9.0%, 98.3%, respectively (AUC 0.71). FeNO had modest accuracy in discriminating rhinitis with an AUC value of 0.70, and performed better in discriminating allergic rhinitis (AUC 0.78). FeNO was a robust discriminator of allergic sensitization independent of symptoms at a cut-off of 15.4 p.p.b. (AUC 0.80; sensitivity 72.2%; specificity 71.2%; PPV 76.9%; NPV 65.8%). CONCLUSION AND CLINICAL RELEVANCE FeNO measurement discriminates children with and without allergic sensitization independent of allergic symptoms. On the other hand, low FeNO levels in children may help exclude allergic asthma but high levels may be caused by allergic sensitization, older age, rhinitis, and lower BMI, in addition to asthma.
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Affiliation(s)
- T-C Yao
- Community Medicine Research Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan.
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Ciprandi G, Tosca MA, Capasso M. Exhaled nitric oxide in children with allergic rhinitis and/or asthma: a relationship with bronchial hyperreactivity. J Asthma 2010; 47:1142-7. [PMID: 20950134 DOI: 10.3109/02770903.2010.527026] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Nowadays, the measure of the fractional concentration of exhaled nitric oxide (FeNO) enables to assess airway inflammation during an office visit and there is international consensus on this testing methodology. The aim of this study was to evaluate whether FeNO measurement is predictable for bronchial hyperreactivity (BHR) in children with allergic rhinitis, asthma, or both. METHODS Two hundred and eighty children with allergic rhinitis, allergic asthma, or both were evaluated. Bronchial function (FEV₁ and FEF(25-75)), BHR (assessed by methacholine challenge), FeNO, and sensitizations were assessed. RESULTS Bronchial function, BHR, and FeNO were significantly different in the three groups (p < .001). A strong inverse correlation between FeNO and BHR was found in patients with asthma and with asthma and rhinitis (r = -0.63 and r = -0.61, respectively). A cutoff of 32 ppb of FeNO was a predictive factor for BHR. CONCLUSIONS This study highlights the relevance of FeNO as possible marker for BHR in allergic children and underlines the close link between upper and lower airways.
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Affiliation(s)
- Giorgio Ciprandi
- Department of Internal Medicine, Azienda Ospedaliera Universitaria San Martino-University of Genoa, Genoa, Italy.
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Barnes PJ, Dweik RA, Gelb AF, Gibson PG, George SC, Grasemann H, Pavord ID, Ratjen F, Silkoff PE, Taylor DR, Zamel N. Exhaled nitric oxide in pulmonary diseases: a comprehensive review. Chest 2010; 138:682-92. [PMID: 20822990 DOI: 10.1378/chest.09-2090] [Citation(s) in RCA: 270] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The upregulation of nitric oxide (NO) by inflammatory cytokines and mediators in central and peripheral airway sites can be monitored easily in exhaled air. It is now possible to estimate the predominant site of increased fraction of exhaled NO (FeNO) and its potential pathologic and physiologic role in various pulmonary diseases. In asthma, increased FeNO reflects eosinophilic-mediated inflammatory pathways moderately well in central and/or peripheral airway sites and implies increased inhaled and systemic corticosteroid responsiveness. Recently, five randomized controlled algorithm asthma trials reported only equivocal benefits of adding measurements of FeNO to usual clinical guideline management including spirometry; however, significant design issues may exist. Overall, FeNO measurement at a single expiratory flow rate of 50 mL/s may be an important adjunct for diagnosis and management in selected cases of asthma. This may supplement standard clinical asthma care guidelines, including spirometry, providing a noninvasive window into predominantly large-airway-presumed eosinophilic inflammation. In COPD, large/central airway maximal NO flux and peripheral/small airway/alveolar NO concentration may be normal and the role of FeNO monitoring is less clear and therefore less established than in asthma. Furthermore, concurrent smoking reduces FeNO. Monitoring FeNO in pulmonary hypertension and cystic fibrosis has opened up a window to the role NO may play in their pathogenesis and possible clinical benefits in the management of these diseases.
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Affiliation(s)
- Peter J Barnes
- Airway Disease Section, Imperial College London, National Heart and Lung Institute, London, England
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Laumbach RJ, Kipen HM. Acute effects of motor vehicle traffic-related air pollution exposures on measures of oxidative stress in human airways. Ann N Y Acad Sci 2010; 1203:107-12. [PMID: 20716291 DOI: 10.1111/j.1749-6632.2010.05604.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Epidemiological studies have linked exposure to traffic-related air pollutants to increased respiratory and cardiovascular morbidity and mortality. Evidence from human, animal, and in vitro studies supports an important role for oxidative stress in the pathophysiological pathways underlying the adverse health effects of air pollutants. In controlled-exposure studies of animals and humans, emissions from diesel engines, a major source of traffic-related air pollutants, cause pulmonary and systemic inflammation that is mediated by redox-sensitive signaling pathways. Assessment of human responses to traffic-related air pollution under realistic conditions is challenging due to the complex, dynamic nature of near-roadway exposure. Noninvasive measurement of biomarkers in breath and breath condensate may be particularly useful for evaluating the role of oxidative stress in acute responses to exposures that occur in vehicles or during near-roadway activities. Promising biomarkers include nitric oxide in exhaled breath, and nitrite/nitrate, malondialdehyde, and F2-isoprostanes in exhaled breath condensate.
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Affiliation(s)
- Robert J Laumbach
- University of Medicine and Dentistry of New Jersey - Robert Wood Johnson Medical School, Piscataway, New Jersey, USA.
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Bastain TM, Islam T, Berhane KT, McConnell RS, Rappaport EB, Salam MT, Linn WS, Avol EL, Zhang Y, Gilliland FD. Exhaled nitric oxide, susceptibility and new-onset asthma in the Children's Health Study. Eur Respir J 2010; 37:523-31. [PMID: 20634264 DOI: 10.1183/09031936.00021210] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A substantial body of evidence suggests an aetiological role of inflammation, and oxidative and nitrosative stress in asthma pathogenesis. Exhaled nitric oxide fraction (F(eNO)) may provide a noninvasive marker of oxidative and nitrosative stress, and aspects of airway inflammation. We examined whether children with elevated F(eNO) are at increased risk for new-onset asthma. We prospectively followed 2,206 asthma-free children (age 7-10 yrs) who participated in the Children's Health Study. We measured F(eNO) and followed these children for 3 yrs to ascertain incident asthma cases. Cox proportional hazard models were fitted to examine the association between F(eNO) and new-onset asthma. We found that F(eNO) was associated with increased risk of new-onset asthma. Children in the highest F(eNO) quartile had more than a two-fold increased risk of new-onset asthma compared to those with the lowest quartile (hazard ratio 2.1, 95% CI 1.3-3.5). This effect did not vary with the child's history of respiratory allergic symptoms. However, the effect of elevated F(eNO) on new-onset asthma was most apparent among those without a parental history of asthma. Our results indicate that children with elevated F(eNO) are at increased risk for new-onset asthma, especially if they have no parental history of asthma.
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Affiliation(s)
- T M Bastain
- Dept of Preventive Medicine, Keck School of Medicine, 1540 Alcazar Street, CHP 236, Los Angeles, CA 90033, USA
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Williamson PA, Vaidyanathan S, Clearie K, Stewart M, Lipworth BJ. Relationship between fractional exhaled nitric oxide and nasal nitric oxide in airways disease. Ann Allergy Asthma Immunol 2010; 105:162-7. [PMID: 20674828 DOI: 10.1016/j.anai.2010.05.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 05/03/2010] [Accepted: 05/11/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Invasive techniques show evidence of a unified allergic airway. Nitric oxide is measured noninvasively from the lungs (fractional exhaled nitric oxide [FeNO]) and nose (nasal nitric oxide [nNO]). OBJECTIVE To investigate the relationship between FeNO and nNO in different airway conditions. METHODS A total of 227 participants were assessed: 41 healthy volunteers (HVs), 33 patients with asthma, 52 patients with allergic rhinitis (AR), 63 with unified airway disease (UAD), and 38 with nasal polyposis (NP). Correlation and multiple linear regression analyses were performed. RESULTS Geometric means (95% confidence intervals) for FeNO were as follows: 14.7 (12.4-17.5) ppb for HVs, 29.0 (22.5-37.4) ppb for asthma patients, 23.1 (19.0-28.1) for AR patients, 27.2 (23.0-32.4) for UAD patients, and 28.5 (21.5-37.8) for NP patients. For nNO, the values were as follows: 878.1 (807.0-955.6) ppb for HVs, 674.1 (557.4-815.1) for asthma patients, 853.3 (778.8-934.8) ppb for AR patients, 763.4 (694.1-839.5) for UAD patients, and 388.6 (317.9-474.9) for NP patients. The nNO was lower in the NP group than the other groups (P < .001). The nNO and FeNO were correlated in the AR patients (r = 0.56; P < .0001) and HVs (r = 0.44; P = .004) but not significantly in the other groups. Multiple linear regression of the whole cohort demonstrated that after diagnosis, age, sex, and inhaled corticosteroids were taken into account nNO had a significant association with FeNO (P = .02). CONCLUSION Reduced nNO in NP patients is due to ostiomeatal complex obstruction. FeNO is sensitive to suppression by inhaled corticosteroids. The AR and HV groups have no such confounders; hence, correlation is most evident. Exclusion of confounders reveals a correlation between upper and lower airway inflammation with noninvasive techniques.
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