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Published ahead of print on October 11, 2004, doi:10.1164/rccm.200403-298OC

Am. J. Respir. Crit. Care Med., Volume 171, Number 1, January 2005, 68-72

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Submitted on March 8, 2004
Accepted on October 4, 2004

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

Eugenio Baraldi1*, Gea Bonetto1, Franco Zacchello1, and Marco Filippone1

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

* To whom correspondence should be addressed. E-mail: baraldi{at}pediatria.unipd.it.

Bronchopulmonary dysplasia (BPD), the chronic lung disease of prematurity, may be associated with long-term airflow limitation. BPD survivors may develop asthma-like symptoms in childhood, with a variable response to {beta}2-agonists. However the pathological 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 BPD survivors. They showed variable degrees of airflow obstruction (mean FEV1 77.8 ±2.3% predicted) unresponsive to {beta}2-agonists in 72% of subjects. Their FENO values (geometric mean [95% confidence interval]: 7.7 [±1.1] ppb) were significantly lower than in a group of healthy matched controls born at term (10.7 [±1.1] ppb, p<0.05) and a group of preterm non-BPD children (9.9 [±1.1] ppb, p<0.05). The BPD children were also compared with a group of 31 asthmatic patients with a comparable airflow limitation (FEV1 80.2±2.1% predicted) and showed FENO values four times lower than in asthmatics (24.9 [±1.2] ppb, p<0.001). In conclusion, unlike asthmatic children, school-age BPD survivors have airflow limitation associated with low FENO values and lack of reversibility to {beta}2-agonists, probably as a result of mechanisms related to early life structural changes in the airways.
Key words: Bronchopulmonary dysplasia, exhaled nitric oxide, flow limitation, asthma, remodelling




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