Exhaled nitric oxide predicts asthma relapse in children with clinical asthma remission
BACKGROUND: Nitric oxide in exhaled air (FE(NO)) is a marker of eosinophilic airway inflammation. A study was undertaken to determine whether FE(NO) predicts asthma relapse in asymptomatic asthmatic children in whom inhaled corticosteroids are discontinued. METHODS: Forty children (21 boys) of mean age 12.2 years on a median dose of 400 mug budesonide or equivalent (range 100-400) were included. FE(NO) was measured before and 2, 4, 12, and 24 weeks after withdrawal of steroids. A relapse was defined as more than one exacerbation per month, or need for beta agonist treatment on 4 days per week for at least 2 weeks, or diurnal peak flow variability of >20%. FE(NO) measurements were performed online with an expiratory flow of 50 ml/s. RESULTS: Nine patients relapsed. Two and 4 weeks after withdrawal of steroids geometric mean FE(NO) in children who were about to relapse was higher than in those who did not relapse: 35.3 ppb v 15.7 ppb at 2 weeks (ratio 2.3; 95% CI 1.2 to 4.1; p = 0.01) and 40.8 ppb v 15.9 ppb at 4 weeks (ratio 2.6; 95% CI 1.3 to 5.1). An FE(NO) value of 49 ppb at 4 weeks after discontinuation of steroids had the best combination of sensitivity (71%) and specificity (93%) for asthma relapse. CONCLUSION: FE(NO) 2 and 4 weeks after discontinuation of steroids in asymptomatic asthmatic children may be an objective predictor of asthma relapse.
|Keywords||Administration, Inhalation, Adolescent, Asthma/*diagnosis/physiopathology, Biological Markers/analysis, Breath Tests, Bronchodilator Agents/administration & dosage, Budesonide/administration & dosage, Child, Female, Forced Expiratory Volume/physiology, Humans, Male, Nitric Oxide/*analysis, Prospective Studies, Recurrence, Regression Analysis, Research Support, Non-U.S. Gov't, Statistics, Nonparametric, Vital Capacity/physiology|
Hofhuis, W., Hop, W.C.J., de Jongste, J.C., & Pijnenburg, M.W.H.. (2005). Exhaled nitric oxide predicts asthma relapse in children with clinical asthma remission. Thorax: an international journal of respiratory medicine. Retrieved from http://hdl.handle.net/1765/8477