The Role of Exhaled Nitric Oxide in Childhood Asthma Management

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Vesna Simo Micevska
Biserka Jovkovska-Kaeva

Abstract

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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How to Cite
1.
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: https://www.id-press.eu/mmej/article/view/423
Section
Clinical Medicine

References

Pedijatriska pulmologija, Branimir Nestorovic i saradnici, 2011

Dweik RA, Boggs PB, Erzurum SC, Irvin CG, Leigh MW, Lundberg JO, Olin AC, Plummer AL, Taylor DR. American Thoracic Society Committee on Interpretation of Exhaled Nitric Oxide Levels (FeNO) for Clinical Applications: An official ATS clinical practice guideline: interpretation of Exhaled Nitric Oxide Levels (FeNO) for Clinical Applications. Am J Respir Crit Care Med. 2011;184:602-615. http://dx.doi.org/10.1164/rccm.9120-11ST PMid:21885636 PMCid:PMC4408724 DOI: https://doi.org/10.1164/rccm.9120-11ST

Brussee JE, Smit HA, Kerkhof M, Koopman LP, Wijga AH, Postma DS, Gerritsen J, Grobbee DE, Brunekreef B, de Jongste JC. Exhaled nitric oxide in 4-year-old children: relationship with asthma and atopy. Eur Respir J. 2005;25(3):455-61. http://dx.doi.org/10.1183/09031936.05.00079604 PMid:15738288 DOI: https://doi.org/10.1183/09031936.05.00079604

Profita M, Riccobono L, Bonanno A, Chanez P, Gagliardo R, Montalbano AM, Albano GD, Liotta G, Gjomarkaj M, La Grutta S. Effect of nebulized beclomethasone on airway inflammation and clinical status of children with allergic asthma and rhinitis: a randomized, double-blind, placebo-controlled study. Int Arch Allergy Immunol. 2013;161(1):53-64. http://dx.doi.org/10.1159/000343137 PMid:23257680 DOI: https://doi.org/10.1159/000343137

Covar RA, Szefler SJ, Martin RJ, Sundstrom DA, Silkoff PE, Murphy J, Young DA, Spahn JD. Relations between exhaled nitric oxide and measures of disease activity among children with mild to- moderate asthma. J Pediatr. 2003; 142:469-475. http://dx.doi.org/10.1067/mpd.2003.187 PMid:12756375 DOI: https://doi.org/10.1067/mpd.2003.187

Dodig S, Richter D, Zrinski-Topic R. Inflammatory markers in childhood asthma. Clin Chem Lab Med. 2011;49:587-599. http://dx.doi.org/10.1515/CCLM.2011.094 PMid:21303302 DOI: https://doi.org/10.1515/CCLM.2011.094

Buchvald F, Baraldi E, Carraro S, Gaston B, De Jongste J, Pijnenburg MW, Silkoff PE, Bisgaard H. Measurements of exhaled nitric oxide in healthy subjects age 4 to 17 years. J Allergy Clin Immunol. 2005;115:1130-1136. http://dx.doi.org/10.1016/j.jaci.2005.03.020 PMid:15940124 DOI: https://doi.org/10.1016/j.jaci.2005.03.020

Yao TC, Lee WI, Ou LS, Chen LC, Yeh KW, Huang JL, PATCH Study Group. Reference values of exhaled nitric oxide in healthy asian children age 5 to 18 years. Eur Respir J. 2012; 39:378-384. http://dx.doi.org/10.1183/09031936.00013911 PMid:21622584 DOI: https://doi.org/10.1183/09031936.00013911

Wadsworth SJ, Sin DD, Dorscheid DR. Clinical update on the use of biomarkers of airway inflammation in the management of asthma. J Asthma Allergy. 2011;4:77-86. http://dx.doi.org/10.2147/JAA.S15081 PMid:21792321 PMCid:PMC3140298 DOI: https://doi.org/10.2147/JAA.S15081

Pedersen SE, Hurd SS, Lemanske RF Jr, Becker A, Zar HJ, Sly PD, Soto-Quiroz M, Wong G, Bateman ED; Global Initiative for Asthma. Global strategy for the diagnosis and management of asthma in children 5 years and younger. Pediatr Pulmonol. 2011;46(1):1-17. http://dx.doi.org/10.1002/ppul.21321 PMid:20963782 DOI: https://doi.org/10.1002/ppul.21321

Shaw DE, Berry MA, Thomas M, Green RH, Brightling CE, Wardlaw AJ, Pavord ID. The use of exhaled nitric oxide to guide asthma management: a randomized controlled trial. Am J Respir Crit Care Med. 2007;176:231-237. http://dx.doi.org/10.1164/rccm.200610-1427OC PMid:17496226 DOI: https://doi.org/10.1164/rccm.200610-1427OC

Szefler SJ, Mitchell H, Sorkness CA, Gergen PJ, O'Connor GT, Morgan WJ, Kattan M, Pongracic JA, Teach SJ, Bloomberg GR, Eggleston PA, Gruchalla RS, Kercsmar CM, Liu AH, Wildfire JJ, Curry MD, Busse WW. Management of asthma based on exhaled nitric oxide in addition to guideline-based treatment for inner-city adolescents and young adults: a randomised controlled trial. Lancet. 2008;372:1065-1072. http://dx.doi.org/10.1016/S0140-6736(08)61448-8 DOI: https://doi.org/10.1016/S0140-6736(08)61448-8

Paraskakis E, Brindicci C, Fleming L, Krol R, Kharitonov SA, Wilson NM, Barnes PJ, Bush A. Measurement of bronchial and alveolar nitric oxide production in normal children and children with asthma.Am J Respir Crit Care Med. 2006; 174(3):260-7. http://dx.doi.org/10.1164/rccm.200506-962OC PMid:16627868 DOI: https://doi.org/10.1164/rccm.200506-962OC

Mahr TA, Malka J, Spahn JD. Inflammometry in pediatric asthma: a review of fractional exhaled nitric oxide in clinical practice. Allergy Asthma Proc. 2013; 34(3):210-9. http://dx.doi.org/10.2500/aap.2013.34.3660 PMid:23462278 DOI: https://doi.org/10.2500/aap.2013.34.3660

Waibel V, Ulmer H, Horak E. Assessing asthma control: symptom scores, GINA levels of asthma control, lung function, and exhaled nitric oxide. Pediatr Pulmonol. 2012;47:113-118. http://dx.doi.org/10.1002/ppul.21529 PMid:22241569 DOI: https://doi.org/10.1002/ppul.21529

Green RJ, Klein M, Becker P, Halkas A, Lewis H, Kitchin O, Moodley T, Masekela R. Disagreement among common measures of asthma control in children. Chest. 2013;143:117-122. http://dx.doi.org/10.1378/chest.12-1070 PMid:22878380 DOI: https://doi.org/10.1378/chest.12-1070

Columbo M, Wong B, Panettieri RA, Rohr AS. Asthma in the elderly: the role of exhaled nitric oxide measurements.Respir Med. 2013; 107(5):785-7. http://dx.doi.org/10.1016/j.rmed.2013.01.018 PMid:23481173 PMCid:PMC4034737 DOI: https://doi.org/10.1016/j.rmed.2013.01.018

Jones SL, Herbison P, Cowan JO, Flannery EM, Hancox RJ, McLachlan CR, Taylor DR. Exhaled NO and assessment of anti-inflammatory effects of inhaled steroid: dose-response relationship. Eur Respir J. 2002;20(3):601-8. http://dx.doi.org/10.1183/09031936.02.00285302 PMid:12358335 DOI: https://doi.org/10.1183/09031936.02.00285302

Mattes J1, Storm van's Gravesande K, Reining U, Alving K, Ihorst G, Henschen M, Kuehr J. NO in exhaled air is correlated with markers of eosinophilic airway inflammation in corticosteroid-dependent childhood asthma. Eur Respir J. 1999;13(6):1391-5. PMid:10445617 DOI: https://doi.org/10.1183/09031936.99.13613969

Sachs-Olsen C, Lí¸drup Carlsen KC, Mowinckel P, Hí¥land G, Devulapalli CS, Munthe-Kaas MC, Carlsen KH. Diagnostic value of exhaled nitric oxide in childhood asthma and allergy. Pediatr Allergy Immunol. 2010;21(1 Pt 2):e213-21. http://dx.doi.org/10.1111/j.1399-3038.2009.00965.x PMid:21083852 DOI: https://doi.org/10.1111/j.1399-3038.2009.00965.x

Choi BS, Kim KW, Lee YJ, Baek J, Park HB, Kim YH, Sohn MH, Kim KE. Exhaled nitric oxide is associated with allergic inflammation in children. J Korean Med Sci. 2011;26(10):1265-9. http://dx.doi.org/10.3346/jkms.2011.26.10.1265 PMid:22022176 PMCid:PMC3192335 DOI: https://doi.org/10.3346/jkms.2011.26.10.1265

Paiola G, Tenero L, Piacentini G. The measurement of exhaled nitric oxide in routine practice. Eur Ann Allergy Clin Immunol. 2009; 41(5):131-5. PMid:20101925

Straub DA, Minocchieri S, Moeller A, Hamacher J, Wildhaber JH. The effect of montelukast on exhaled nitric oxide and lung function in asthmatic children 2 to 5 years old. Chest. 2005; 127(2):509-14. http://dx.doi.org/10.1378/chest.127.2.509 PMid:15705989 DOI: https://doi.org/10.1378/chest.127.2.509

Straub DA, Moeller A, Minocchieri S, Hamacher J, Sennhauser FH, Hall GL, Wildhaber JH. The effect of montelukast on lung function and exhaled nitric oxide in infants with early childhood asthma. Eur Respir J. 2005;25(2):289-94. http://dx.doi.org/10.1183/09031936.05.00031904 PMid:15684293 DOI: https://doi.org/10.1183/09031936.05.00031904

Grzelewski T, Grzelewska A, Majak P, Stelmach W, Kowalska A, Stelmach R, Janas A, Stelmach I. Fractional exhaled nitric oxide (FeNO) may predict exercise-induced bronchoconstriction (EIB) in schoolchildren with atopic asthma. Nitric oxide. 2012; 27(2):82-7. http://dx.doi.org/10.1016/j.niox.2012.05.002 PMid:22584259 DOI: https://doi.org/10.1016/j.niox.2012.05.002

Chinellato I, Piazza M, Peroni D, Sandri M, Chiorazzo F, Boner AL, Piacentini G. Bronchial and alveolar nitric oxide in exercise-induced bronchocostriction in asthmatic children. Clin Exp Allergy. 2012;42:1190-1196.

http://dx.doi.org/10.1111/j.1365-2222.2012.03973.x PMid:22805466 DOI: https://doi.org/10.1111/j.1365-2222.2012.03973.x