Published ahead of print on June 30, 2004, doi:10.1164/rccm.200403-408OC
Am. J. Respir. Crit. Care Med., Volume 170, Number 7, October 2004, 737-741
A more recent version of this article appeared on October 1, 2004
Submitted on March 30, 2004
Accepted on June 28, 2004
Alveolar and Airway Sites of Nitric Oxide Inflammation in Treated Asthmatics
Arthur F Gelb1*, Colleen Flynn Taylor, Eliezer Nussbaum2, Carlos Gutierrez3, Aaron Schein, Chris M Shinar4, Mark J Schein5, Joel D Epstein6, and Noe Zamel3
1 University of California at Los Angeles, Geffen School of Medicine, Los Angeles, CA, USA,
2 Department of Pediatrics, Miller Children's Hospital at Long Beach Memorial Hospital, Long Beach, CA, USA; University of California at Irvine, School of Medicine, Irvine, CA, USA,
3 Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,
4 Department of Pharmacy Services, Lakewood Regional Medical Center, Lakewood, CA, USA,
5 Department of Radiology, Lakewood Regional Medical Center, Lakewood, CA, USA,
6 Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, Lakewood, CA, USA
* To whom correspondence should be addressed. E-mail: afgelb{at}msn.com.
The goal of this study was to identify airway and alveolar site(s) of inflammation using exhaled nitric oxide as a marker in treated asthmatics, including response to oral corticosteroids, and correlate with expiratory airflow limitation. In 53(24M)asthmatics, age 43±23 yr (mean±SD), all on inhaled corticosteroids, post 180µg aerosolized albuterol,FEV1 was 74±23% predicted and FEV1/FVC was 68±11%. Exhaled nitric oxide at 100ml/s was 27±23ppb (p<0.001 compared to normal 12±15ppb). Bronchial nitric oxide maximal flux was 2.4±3.1 nl/s (p< 0.001 compared to normal 0.85±0.55).Alveolar nitric oxide concentration was 7.0±7.4 ppb (p=0.01 compared to normal value 3.2±2.0 ppb). There was no significant correlation between FEV1% predicted or lung elastic recoil and nitric oxide bronchial flux or alveolar concentration. However, there was a weak but significant correlation between nitric oxide bronchial flux and alveolar concentration (Spearman r=0.50,p<0.0001). In 10 asthmatics on inhaled corticosteroids, 5 days of 30 mg prednisone resulted in isolated significant decrease in nitric oxide alveolar concentration from 13±10 to 4±4 ppb (p = 0.002). Despite treatment, including inhaled corticosteroids, asthmatics may have ongoing separate airway and alveolar sites of nitric oxide inflammation, the latter responsive to oral corticosteroids.
Key words: asthma, exhaled nitric oxide, alveolitis, inflammation
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