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Published ahead of print on April 20, 2006, doi:10.1164/rccm.200506-962OC

Am. J. Respir. Crit. Care Med., Volume 174, Number 3, August 2006, 260-267

A more recent version of this article appeared on August 1, 2006
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Submitted on June 22, 2005
Accepted on April 20, 2006

Measurement of Bronchial and Alveolar Nitric Oxide Production in Normal and Asthmatic Children

Emmanouil Paraskakis1*, Caterina Brindicci2, Louise Fleming1, Renata Krol1, Sergei A Kharitonov2, Nicola M Wilson1, Peter J Barnes2, and Andrew Bush1

1 Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom, 2 Department of Thoracic Medicine, National Heart and Lung Institute, Imperial College London, London, United Kingdom

* To whom correspondence should be addressed. E-mail: paraskakis{at}edu.med.uoc.gr.

Rationale: Airway inflammation is characteristic of asthma. Distal inflammation may be particularly important. Objective: To calculate alveolar NO (Calv) concentration and bronchial NO (JNO) flux in children. Methods: We measured Calv and (JNO) from FeNO measured at multiple exhalation flow rates in 132 children (aged 4-18 yr) with known atopic status, medication and asthma control. Measurements and Main Results: 85% (112/132) completed all measurements. In 20/112 the result did not fit the linear model. Thus (JNO) and Calv were assessed in 92 (70%) subjects. The median (range) values of asthmatic (n=52), normal (n=20) and atopic, non-asthmatic (n=20) children were: FeNO50: 28.1 (4.3-190), 10.35 (3.3-29), 21.8 (8.7-69) ppb, JNO: 1230 (204-9236), 480 (196-1913), 1225 (486-4119) pl/s, Calv: 2.22 (0.44-6.63), 1.63 (0.44-3),1.21 (0.03-2.85) ppb respectively. A reproducibility study in 18 other children gave intraclass correlation coefficients (single measures) of 0.99 (JNO) and 0.81 (Calv). (JNO) and Calv were higher in asthmatics than normals (p=0.0004 and p=0.0002 respectively). Poorly controlled asthmatics (n=27) had higher Calv (mean (±SD) 3.17ppb ± 1.62 vs. 2.26±1.30, p=0.03) and JNO (mean (±SD) 2634pl/s ± 2255 vs. 1193 pl/s ± 1294, p=0.007) than patients with good symptom control (n=25). Conclusions: Measurement of JNO and Calv is feasible in 70% of school age children. FeNO and JNO give the same information (r=0.97, p<0.0001), Calv is higher in asthmatics than normals and is affected by asthmatic control, but not atopy. Calv may possibly reflect alveolar inflammation in asthma.
Key words: pulmonary, airway monitoring, exhaled




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