Both inflammation and remodeling influence nitric oxide output in children with refractory asthma - 24/08/11
, Isabelle Tillie-Leblond, MD b, Philippe Gosset, MD, PhD b, Christophe Delacourt, MD, PhD c, Françoise Zerah-Lancner, MD a, Alain Harf, MD, PhD a, Jacques de Blic, MD d
Reprint requests: Dr Christophe Delclaux, MD, PhD, Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, FranceAbstract |
Background |
Exhaled nitric oxide can be used to monitor airway inflammation in asthma. We hypothesized that the strong link between nitric oxide and inflammation may obscure a weaker link with airway remodeling.
Objective |
The aim of this study was to determine whether airway remodeling influenced exhaled nitric oxide in 28 asthmatic children (median age [25th-75th], 11 [10-14] years old) with refractory asthma defined as airflow limitation and/or exacerbations despite high-dose inhaled steroids.
Methods |
Multiple-flow analysis of exhaled nitric oxide was used to correlate alveolar nitric oxide concentration and maximal conducting airway nitric oxide output to pulmonary function tests, bronchoalveolar lavage, and bronchial biopsy findings.
Results |
Nitric oxide measurements were related to inflammation and TH1/TH2 balance, that is, subepithelial eosinophilic infiltration and eosinophilic cationic protein and IFN-γ/IL-4 ratio in bronchoalveolar lavage fluids. Nitric oxide measurements were also correlated with several parameters of airway remodeling: alveolar nitric oxide concentration with TGF-β in bronchoalveolar lavage fluid (r = 0.42, P = .03) and maximal conducting airway nitric oxide output with reticular basement membrane thickness (r = 0.61, P = .0007) and tissue inhibitor of matrix metalloproteinases 1/matrix metalloproteinase 9 ratio in bronchoalveolar lavage fluid (r = 0.43, P = .04). Moreover, alveolar nitric oxide concentration was correlated with MEF25-75 (r = 0.60, P = .02).
Conclusions |
These findings suggest that both subacute inflammation and remodeling influence nitric oxide output in refractory asthma.
Le texte complet de cet article est disponible en PDF.Keywords : Bronchial biopsy, reticular basement membrane, eosinophil, exhaled nitric oxide
Abbreviations : BAL, BB, ECP, FANO, FENO, MMP-9, NO, QMAX, CA, RBM, TIMP-1
Plan
Vol 113 - N° 2
P. 252-256 - février 2004 Retour au numéro
Article précédent
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