The Role of Exhaled Nitric Oxide in Childhood Asthma Management

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Vesna Simo Micevska
Biserka Jovkovska-Kaeva


Asthma is a chronic inflammatory disorder of the airways characterized by reversible bronchoobstruction and symptoms of cough,wheezing and dyspnea. The main inflammation process is the oesinophilic infiltration.Therefore the fraction of exhaled nitric oxide (FeNO) plays an important role in measuring the level of inflammation in asthma patients.Nitric oxide NO is a biologic mediator produced from L-arginine by three enzymes called nitric oxide synthasis NOS. In airways NO is produced by NOS from the respiratory endothelial cells and passes inside its lumen. NO synthasis is initiated by the action of proinflammatory cytokines which have the  leading role of the inflammatory process. This is why FeNO is called an inflammometer.

All these features explain the role of FeNO values in asthma patients as an important biomarker in childhood asthma management. The increased values of FeNo in asthma patients makes it also an important diagnostic parameter together with the increased  total IgE blood level and the functional lung tests. FeNO measurement is made by a simple non-invasive method using chemiluminiscence with  a portable device so called NO analyzer. Normal FeNO values (measured in healthy children) are from 15 up to 25 ppb (parts per billion). Defining FeNO as a marker of the eosinophilic inflammation explains the interests in using it as an important follow up indicator of the effect of inhaled corticosteroids (ICS) in  treatment of asthma children. FeNo also has an important role in detecting the risk of a relaps of the disease in patinets on dicreased dose of ICS or in ones that stopped the ICS therapy. There is a positive correlation between FeNO values and presence of atopy in asthma patients, as well as in non-asthma atopic patients diagnosed for other allergic (non-asthma) disease. FeNO is non-invasive inflammatory biomarker that together with the rest of the parameters,  in future will take more important role in achieving a better disease control in asthma children.


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Micevska VS, Jovkovska-Kaeva B. The Role of Exhaled Nitric Oxide in Childhood Asthma Management. Maced Med Electron J [Internet]. 2015 Nov. 11 [cited 2024 Jul. 25];1(1):1-6. Available from:
Clinical Medicine


Pedijatriska pulmologija, Branimir Nestorovic i saradnici, 2011

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