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Published ahead of print on October 11, 2004, doi:10.1164/rccm.200403-298OC
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American Journal of Respiratory and Critical Care Medicine Vol 171. pp. 68-72, (2005)
© 2005 American Thoracic Society
doi: 10.1164/rccm.200403-298OC

Original Article

Low Exhaled Nitric Oxide in School-Age Children with Bronchopulmonary Dysplasia and Airflow Limitation

Eugenio Baraldi, Gea Bonetto, Franco Zacchello and Marco Filippone

Department of Pediatrics, School of Medicine, University of Padova, Padova, Italy

Correspondence and requests for reprints should be addressed to Eugenio Baraldi, Department of Pediatrics, Via Giustiniani 3, 35128 Padova, Italy. E-mail: baraldi{at}pediatria.unipd.it

Bronchopulmonary dysplasia (BPD), the chronic lung disease of prematurity, may be associated with long-term airflow limitation. Survivors of BPD may develop asthma-like symptoms in childhood, with a variable response to ß2-agonists. However, the pathologic pathways underlying these respiratory manifestations are still unknown. The aim of this study was to measure exhaled nitric oxide (FENO) and lung function in a group of 31 school-age survivors of BPD. They showed variable degrees of airflow obstruction (mean FEV1 77.8 ± 2.3% predicted) unresponsive to ß2-agonists in 72% of the subjects. Their FENO values (geometric mean [95% confidence interval]: 7.7 [± 1.1] ppb) were significantly lower than in a group of healthy matched control subjects born at term (10.7 [± 1.1] ppb, p < 0.05) and a group of preterm children without BPD (9.9 [± 1.1] ppb, p < 0.05). The children with BPD were also compared with a group of 31 patients with asthma with a comparable airflow limitation (FEV1 80.2 ± 2.1% predicted) and showed FENO values four times lower than in those with asthma (24.9 [± 1.2] ppb, p < 0.001). In conclusion, unlike children with asthma, school-age survivors of BPD have airflow limitation associated with low FENO values and lack of reversibility to ß2-agonists, probably as a result of mechanisms related to early life structural changes in the airways.

Key Words: airway remodeling • asthma • bronchopulmonary dysplasia • exhaled nitric oxide • flow limitation




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