Am. J. Respir. Crit. Care Med., Volume 158, Number 1, July 1998, 315-319

Exhaled Nitric Oxide (NO) Is Reduced Shortly after Bronchoconstriction to Direct and Indirect Stimuli in Asthma

HEIDI W. F. M. de GOUW, JENNY HENDRIKS, ANDREA M. WOLTMAN, IRENE M. TWISS, and PETER J. STERK

Department of Pulmonology, Department of Clinical Pharmacy and Toxicology, Leiden University Medical Centre, Leiden, The Netherlands

Exhaled NO is increased in patients with asthma and may reflect disease severity. We examined whether the level of exhaled NO is related to the degree of airway obstruction induced by direct and indirect stimuli in asthma. Therefore, we measured exhaled NO levels before and during recovery from histamine and hypertonic saline (HS) challenge (Protocol 1) or histamine, adenosine 5'-monophosphate (AMP), and isotonic saline (IS) challenge (Protocol 2) in 11 and in nine patients with mild to moderate asthma, respectively. The challenges were randomized with a 2-d interval. Exhaled NO and FEV₁ were measured before and at 4, 10, 20, and 30 min after each challenge. NO was measured during a slow VC maneuver with a constant expiratory flow of (0.05 × FVC)/s against a resistance of 1 to 2 cm H₂O. Baseline exhaled NO levels were not significantly different between study days in Protocol 1 (mean ± SD: 4.8 ± 1.8 ppb [histamine] versus 5.4 ± 2.1 ppb [HS], p = 0.4) or in Protocol 2 (7.9 ± 4.7 ppb [histamine], 8.3 ± 5.2 ppb [AMP], and 7.2 ± 3.7 ppb [IS], p = 0.7). A significant reduction in exhaled NO was observed directly after HS (mean ± SEM: 39.2 ± 3.9 %fall) and AMP challenge (32.3 ± 7.3 %fall) (MANOVA, p < 0.001), respectively, whereas exhaled NO levels tended to decrease after histamine challenge. Isotonic saline challenge did not induce changes in exhaled NO (p = 0.7). There was a positive correlation between %fall in FEV₁ and the %fall in exhaled NO after histamine, HS, and AMP challenge as indicated by the mean slope of the within-subject regression lines (p  0.04). We conclude that acute bronchoconstriction, as induced by direct and indirect stimuli, is associated with a reduction in exhaled NO levels in asthmatic subjects. This suggests that airway caliber should be taken into account when monitoring exhaled NO in asthma.

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