SA Kharitonov, DH Yates and PJ Barnes
Department of Thoracic Medicine, National Heart and Lung Institute, London, United Kingdom.

Exhaled nitric oxide (NO) is elevated in untreated patients with asthma but not in patients treated with inhaled glucocorticoids. This may reflect an inhibitory effect of glucocorticoids on the induction of the enzyme NO synthase in the respiratory tract. We have now studied the effect of an inhaled glucocorticoid (budesonide 800 micrograms twice daily via a dry powder delivery system for 3 wk) on exhaled NO in 11 patients with mild asthma in a double-blind crossover randomized-order placebo-controlled study. Exhaled NO was reduced from a baseline value of 203 +/- 29 parts per billion (ppb) to 120 +/- 26 ppb after 3 wk of treatment (p < 0.01), whereas there was no change after a matched placebo (169 +/- 20 at baseline compared with 184 +/- 16 ppb after 3 wk). A significant and progressive fall in exhaled NO was found from 1 to 3 wk. There was no significant change in FEV1 after inhaled steroids (although mean FEV1 was 92% predicted normal at baseline), although there was a reduction in airway responsiveness to methacholine (approximately 2.5 doubling dilutions). These results add further support to the view that the elevated levels of exhaled NO in asthma may derive from induction of an inducible isoform of NO synthase and indicate that exhaled NO may be a useful way of monitoring the anti- inflammatory effects of glucocorticoids and other anti-inflammatory treatments in asthma.

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				F. M. Delen, J. M. Sippel, M. L. Osborne, S. Law, N. Thukkani, and W. E. Holden Increased Exhaled Nitric Oxide in Chronic Bronchitis: Comparison With Asthma and COPD Chest, March 1, 2000; 117(3): 695 - 701. [Abstract] [Full Text] [PDF]

				J. F. HUNT, K. FANG, R. MALIK, A. SNYDER, N. MALHOTRA, T. A. E. PLATTS-MILLS, and B. GASTON Endogenous Airway Acidification . Implications for Asthma Pathophysiology Am. J. Respir. Crit. Care Med., March 1, 2000; 161(3): 694 - 699. [Abstract] [Full Text] [PDF]

				S. A Little, G. W Chalmers, K. J MacLeod, C. McSharry, and N. C Thomson Non-invasive markers of airway inflammation as predictors of oral steroid responsiveness in asthma Thorax, March 1, 2000; 55(3): 232 - 234. [Abstract] [Full Text]

				A. JATAKANON, S. LIM, and P. J. BARNES Changes in Sputum Eosinophils Predict Loss of Asthma Control Am. J. Respir. Crit. Care Med., January 1, 2000; 161(1): 64 - 72. [Abstract] [Full Text]

				P. Silkoff Recommendations for Standardized Procedures for the Online and Offline Measurement of Exhaled Lower Respiratory Nitric Oxide and Nasal Nitric Oxide in Adults and Children---1999 . THIS OFFICIAL STATEMENT OF THE AMERICAN THORACIC SOCIETY WAS ADOPTED BY THE ATS BOARD OF DIRECTORS, JULY 1999 Am. J. Respir. Crit. Care Med., December 1, 1999; 160(6): 2104 - 2117. [Full Text]

				A. JATAKANON, C. UASUF, W. MAZIAK, S. LIM, K. F. CHUNG, and P. J. BARNES Neutrophilic Inflammation in Severe Persistent Asthma Am. J. Respir. Crit. Care Med., November 1, 1999; 160(5): 1532 - 1539. [Abstract] [Full Text]

				H. BISGAARD, L. LOLAND, and J. A. ØJ NO in Exhaled Air of Asthmatic Children Is Reduced by the Leukotriene Receptor Antagonist Montelukast Am. J. Respir. Crit. Care Med., October 1, 1999; 160(4): 1227 - 1231. [Abstract] [Full Text]

				G. M. Verleden, L. J. Dupont, A. C. Verpeut, and M. G. Demedts The Effect of Cigarette Smoking on Exhaled Nitric Oxide in Mild Steroid-Naive Asthmatics Chest, July 1, 1999; 116(1): 59 - 64. [Abstract] [Full Text] [PDF]

				A. SIMPSON, A. CUSTOVIC, S. PIPIS, A. ADISESH, B. FARAGHER, and A. WOODCOCK Exhaled Nitric Oxide, Sensitization, and Exposure to Allergens in Patients with Asthma Who Are Not Taking Inhaled Steroids Am. J. Respir. Crit. Care Med., July 1, 1999; 160(1): 45 - 49. [Abstract] [Full Text]

				P. MONTUSCHI, M. CORRADI, G. CIABATTONI, J. NIGHTINGALE, S. A. KHARITONOV, and P. J. BARNES Increased 8-Isoprostane, a Marker of Oxidative Stress, in Exhaled Condensate of Asthma Patients Am. J. Respir. Crit. Care Med., July 1, 1999; 160(1): 216 - 220. [Abstract] [Full Text]

				M. Corradi, M. Majori, G. C. Cacciani, G. F. Consigli, E. de'Munari, and A. Pesci Increased exhaled nitric oxide in patients with stable chronic obstructive pulmonary disease Thorax, July 1, 1999; 54(7): 572 - 575. [Abstract] [Full Text]

				J. M. CHATKIN, K. ANSARIN, P. E. SILKOFF, P. MCCLEAN, C. GUTIERREZ, N. ZAMEL, and K. R. CHAPMAN Exhaled Nitric Oxide as a Noninvasive Assessment of Chronic Cough Am. J. Respir. Crit. Care Med., June 1, 1999; 159(6): 1810 - 1813. [Abstract] [Full Text]

				G. T. De Sanctis, J. A. MacLean, K. Hamada, S. Mehta, J. A. Scott, A. Jiao, C. N. Yandava, L. Kobzik, W. W. Wolyniec, A. J. Fabian, et al. Contribution of Nitric Oxide Synthases 1, 2, and 3 to Airway Hyperresponsiveness and Inflammation in a Murine Model of Asthma J. Exp. Med., May 17, 1999; 189(10): 1621 - 1630. [Abstract] [Full Text] [PDF]

				E. L J van Rensen, K. C M Straathof, M. A Veselic-Charvat, A. H Zwinderman, E. H Bel, and P. J Sterk Effect of inhaled steroids on airway hyperresponsiveness, sputum eosinophils, and exhaled nitric oxide levels in patients with asthma Thorax, May 1, 1999; 54(5): 403 - 408. [Abstract] [Full Text]

				S. E. CRATER, E. J. PETERS, M. L. MARTIN, A. W. MURPHY, and T. A. E. PLATTS-MILLS Expired Nitric Oxide and Airway Obstruction in Asthma Patients with an Acute Exacerbation Am. J. Respir. Crit. Care Med., March 1, 1999; 159(3): 806 - 811. [Abstract] [Full Text]

				C. M. SALOME, A. M. ROBERTS, N. J. BROWN, J. DERMAND, G. B. MARKS, and A. J. WOOLCOCK Exhaled Nitric Oxide Measurements in a Population Sample of Young Adults Am. J. Respir. Crit. Care Med., March 1, 1999; 159(3): 911 - 916. [Abstract] [Full Text]