Am. J. Respir. Crit. Care Med., Volume 165, Number 3, February 2002, 332-337

Increased Nitric Oxide Output from Alveolar Origin during Liver Cirrhosis versus Bronchial Source during Asthma

CHRISTOPHE DELCLAUX, BRUNO MAHUT, FRANÇOISE ZERAH-LANCNER, CHRISTOPHE DELACOURT, SYLVA LAOUD, DANIEL CHERQUI, CHRISTOPHE DUVOUX, ARIANE MALLAT, and ALAIN HARF

Service de Physiologie-Explorations Fonctionnelles, Service d'Hépato-Gastroentérologie, Consultation d'Allergologie, Service de Chirurgie Digestive, Hôpital Henri Mondor, Créteil, Assistance Publique-Hôpitaux de Paris, Service de Pédiatrie, Centre Hospitalier Intercommunal de Créteil, and Unité INSERM U 492-Université Paris XII, Faculté de Médecine de Créteil, Créteil, France

The aim of this study was to assess the usefulness of nitric oxide (NO) output measurement at multiple expiratory flow rates during diseases characterized by increased exhaled NO (FE_NO) that could come from alveolar (liver cirrhosis) or bronchial (asthma) sources. It has been proposed that NO output measurements expressed as a function of expiratory flow allow alveolar NO concentration (FA_NO) and maximal bronchial NO output (br,max _NO) to be computed. In 36 healthy nonsmoking subjects, we found that maximal bronchial NO output (37 ± 3 nl/min) was correlated with the height of the subjects (p = 0.02). Alveolar NO concentration was 5.1 ± 0.3 (SEM) ppb, which represented 31 ± 2% and 61 ± 3% of FE_NO at 50 and 200 ml/s expiratory flow rate, respectively. Nonsmoking subjects with asthma (n = 28) were characterized by an increase in br,max _NO (133 ± 14 nl/min) as compared with healthy nonsmoking subjects (p < 0.0001). FE_NO50, FE_NO200, and br,max _NO were equally efficient in differentiating subjects with asthma from healthy subjects. Patients with liver cirrhosis (n = 26, 14 smokers and 12 nonsmokers) had an increased FA_NO compared with healthy subjects (cirrhosis: 8.3 ± 0.9 ppb, healthy nonsmokers [n = 36] and smokers [n = 20], n = 56: 4.7 ± 0.3 ppb, p < 0.05), which was correlated with the alveolar-arterial oxygen difference (p = 0.007). FA_NO and FE_NO200, but not FE_NO50 values, allowed patients with liver cirrhosis to be differentiated from healthy subjects. These results suggest that a two-compartment model for NO output allows the increase in FE_NO from alveolar sources to be differentiated from the increase from bronchial sources.

This article has been cited by other articles:

				H. Lehtonen, P. Oksa, L. Lehtimaki, A. Sepponen, R. Nieminen, H. Kankaanranta, S. Saarelainen, R. Jarvenpaa, J. Uitti, and E. Moilanen Increased alveolar nitric oxide concentration and high levels of leukotriene B4 and 8-isoprostane in exhaled breath condensate in patients with asbestosis Thorax, July 1, 2007; 62(7): 602 - 607. [Abstract] [Full Text] [PDF]

				A. Malinovschi, C. Janson, T. Holmkvist, D. Norback, P. Merilainen, and M. Hogman Effect of smoking on exhaled nitric oxide and flow-independent nitric oxide exchange parameters Eur. Respir. J., August 1, 2006; 28(2): 339 - 345. [Abstract] [Full Text] [PDF]

				C. Delclaux, F. Zerah-Lancner, D. Bachir, A. Habibi, J.-L. Monin, B. Godeau, and F. Galacteros Factors Associated With Dyspnea in Adult Patients With Sickle Cell Disease Chest, November 1, 2005; 128(5): 3336 - 3344. [Abstract] [Full Text] [PDF]

				C. Delclaux, F. Zerah-Lancner, B. Mahut, S. Ribeil, A. Dubois, C. Larger, and A. Harf Alveolar Nitric Oxide and Effect of Deep Inspiration During Methacholine Challenge Chest, May 1, 2005; 127(5): 1696 - 1702. [Abstract] [Full Text] [PDF]

				R. Rodriguez-Roisin, M.J. Krowka, Ph. Herve, M.B. Fallon, and on behalf of the ERS Task Force Pulmonary-Hepatic Pulmonary-Hepatic vascular Disorders (PHD) Eur. Respir. J., November 1, 2004; 24(5): 861 - 880. [Full Text] [PDF]

				G. Rolla, L. Brussino, E. Scappaticci, M. Morello, R. Innarella, F. Rosina, and C. Bucca Source of Exhaled Nitric Oxide in Primary Biliary Cirrhosis Chest, November 1, 2004; 126(5): 1546 - 1551. [Abstract] [Full Text] [PDF]

				H. L. Attalah, S. Honore, S. Eddahibi, E. Marcos, C.-J. Soussy, S. Adnot, and C. Delclaux Decreased exhaled nitric oxide as a marker of postinsult immune paralysis J Appl Physiol, October 1, 2004; 97(4): 1188 - 1194. [Abstract] [Full Text] [PDF]

				F. L. M. Ricciardolo, P. J. Sterk, B. Gaston, and G. Folkerts Nitric Oxide in Health and Disease of the Respiratory System Physiol Rev, July 1, 2004; 84(3): 731 - 765. [Abstract] [Full Text] [PDF]

				A.T. Dinh-Xuan and R. Naeije The hepatopulmonary syndrome: NO way out? Eur. Respir. J., May 1, 2004; 23(5): 661 - 662. [Full Text] [PDF]

				B. Mahut, C. Delacourt, F. Zerah-Lancner, J. De Blic, A. Harf, and C. Delclaux Increase in Alveolar Nitric Oxide in the Presence of Symptoms in Childhood Asthma Chest, March 1, 2004; 125(3): 1012 - 1018. [Abstract] [Full Text] [PDF]

				P. Silkoff and A. Deykin Exhaled nitric oxide as a diagnostic tool Am. J. Respir. Crit. Care Med., February 15, 2003; 167(4): 665 - 666. [Full Text]

				M. J. Tobin Asthma, Airway Biology, and Nasal Disorders in AJRCCM 2002 Am. J. Respir. Crit. Care Med., February 1, 2003; 167(3): 319 - 332. [Full Text] [PDF]

				A. Deykin, A. F. Massaro, J. M. Drazen, and E. Israel Exhaled Nitric Oxide as a Diagnostic Test for Asthma: Online versus Offline Techniques and Effect of Flow Rate Am. J. Respir. Crit. Care Med., June 15, 2002; 165(12): 1597 - 1601. [Abstract] [Full Text] [PDF]