Exhaled nitric oxide, lung function, and exacerbations in wheezy infants and toddlers - 07/08/11
, David C. Stamey, RRT a, Elizabeth S. Cochrane, BS a, Kim L. Gama, BA b, Gregory J. Redding, MD a
Reprint requests: Jason S. Debley, MD, MPH, Pulmonary Division (A-5937), Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105.Abstract |
Background |
There are limited data assessing the relationship between fraction of exhaled nitric oxide and lung function or exacerbations in infants with recurrent wheezing.
Objectives |
In a longitudinal pilot study of children less than 2 years old, we assessed whether baseline fraction of exhaled nitric oxide was associated with lung function, bronchodilator responsiveness, changes in lung function, or subsequent exacerbations of wheezing.
Methods |
Forced expiratory flows and volumes using the raised-volume rapid thoracic compression method were measured in 44 infants and toddlers (mean age, 15.7 months) with recurrent wheezing. Single-breath exhaled nitric oxide (SB-eNO) was measured at 50 mL/s. Lung function was again measured 6 months after enrollment.
Results |
At enrollment, forced expiratory volume in 0.5 seconds (FEV0.5), forced expiratory flow at 25% to 75% of expiration (FEF25-75), and forced expiratory flow at 75% of expiration (FEF75) z scores for the cohort were significantly less than zero. There was no correlation between enrollment SB-eNO levels and enrollment lung function measures. SB-eNO levels were higher in infants with bronchodilator responsiveness (46.1 vs 23.6 ppb, P < .001) and was associated with a decrease in FEV0.5 (r = −0.54, P = .001), FEF25-75 (r = −0.6, P < .001), and FEF75 (r = −0.55, P = .001) over 6 months. A 10-ppb increase in SB-eNO level was associated with a 0.4-point z score decrease in FEV0.5, a 0.4-point z score decrease in FEF25-75, and a 0.42-point z score decrease in FEF75. SB-eNO level was superior to lung function and bronchodilator responsiveness in predicting subsequent wheezing treated with systemic steroids.
Conclusions |
SB-eNO level might predict changes in lung function and risk of future wheezing and holds promise as a biomarker to predict asthma in wheezy infants and toddlers.
Le texte complet de cet article est disponible en PDF.Key words : Exhaled nitric oxide, fraction of exhaled nitric oxide, recurrent wheezing, infants, pulmonary function, raised-volume rapid thoracic compression
Abbreviations used : CV, FEF25-75, FEF75, FENO, FEV0.5, FVC, IPL, ROC, RVRTC, SB-eNO
Plan
| Supported by National Heart, Lung, and Blood Institute K23HL077626; CTSA grant no. I ULI RR025014-01; and Seattle Children’s Hospital. |
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| Disclosure of potential conflict of interest: J. S. Debley has received research support from the National Institutes of Health/National Heart, Lung, and Blood Institute, American Lung Association, and Merck & Co. The rest of the authors have declared they have no conflict of interest. |
Vol 125 - N° 6
P. 1228 - juin 2010 Retour au numéro
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