Am. J. Respir. Crit. Care Med., Volume 165, Number 3, February 2002, 349-357

Flow-independent Nitric Oxide Exchange Parameters in Cystic Fibrosis

HYE-WON SHIN, CHRISTINE M. ROSE-GOTTRON, RAMINDRJIT S. SUFI, FEDERICO PEREZ, DAN M. COOPER, ARCHIE F. WILSON, and STEVEN C. GEORGE

Department of Chemical Engineering and Materials Science, Center for Biomedical Engineering, Department of Pediatrics, The General Clinical Research Center, Department of Medicine, Division of Pulmonary and Critical Care, University of California, Irvine, Irvine; and Miller Children's Hospital at Long Beach Memorial Medical Center, Long Beach, California

Exhaled nitric oxide (NO) remains a promising noninvasive index for monitoring inflammatory lung diseases; however, the plateau concentration (C_NO,plat) is nonspecific and requires a constant exhalation flow rate. We utilized a new technique that employs a variable flow rate to estimate key flow-independent parameters characteristic of NO exchange in a group (n = 9) of 10 to 14 yr-old healthy children and children with cystic fibrosis (CF): maximum flux of NO from the airways (J_NO,max, pl s¹), diffusing capacity of NO in the airways (D_NO,air, pl s¹ ppb¹), steady-state alveolar concentration (C_alv,ss, ppb), and mean tissue concentration of NO in the airways (C_tiss,air, ppb). We determined the following mean (± SD) values in the healthy children and patients with CF for J_NO,max, D_NO,air, C_alv,ss, and C_tiss,air, respectively: 784 ± 465 and 607 ± 648 pl s¹; 4.82 ± 3.07 and 17.6 ± 12.1 pl s¹ ppb¹; 4.63 ± 3.59 and 1.96 ± 1.18 ppb; and 198 ± 131 and 38 ± 25 ppb. D_NO,air is elevated (p = 0.007), and both C_alv,ss and C_tiss,air are reduced (p = 0.05 and 0.002, respectively) in CF. In contrast, C_NO,plat for healthy control subjects and patients with CF are not statistically different at both exhalation flow rates of 50 ml/s (17.5 ± 11.5 and 11.5 ± 8.97) and at 250 ml/s (7.11 ± 5.36 and 4.28 ± 3.43). We conclude that D_NO,air, C_tiss,air, and C_alv,ss may be useful noninvasive markers of CF.

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