Relations between exhaled nitric oxide and measures of disease activity among children with mild-to-moderate asthma

• DOI: 10.1067/mpd.2003.187
• Publication Date: 2003-05-19T20:31:40Z
• Authors: Ronina A. Covar; Stanley J. Szefler; Richard J. Martin; D.A. Sundstrom; Philip E. Silkoff; James Murphy; David A. Young; Joseph D. Spahn
• Keywords: Male; Anti-Inflammatory Agents; Blood Proteins; Eosinophil Granule Proteins; Immunoglobulin E; Asthma; 3. Good health; Bronchoconstrictor Agents; Cohort Studies; Eosinophils; Leukocyte Count; 03 medical and health sciences; 0302 clinical medicine; Nedocromil; Child, Preschool; Forced Expiratory Volume; Hypersensitivity; Humans; Female; Anti-Asthmatic Agents; Budesonide; Child; Methacholine Chloride

Exhaled nitric oxide (FE(NO)) was evaluated in children with asthma after 4 to 6 years of treatment with budesonide, nedocromil, or albuterol as needed.FE(NO), spirometry, total eosinophil count, and serum eosinophil cationic protein levels were obtained from 118 children at the Denver site of the Childhood Asthma Management Program upon completion of treatment and after a 2- to 4-month washout.Budesonide-treated patients had significantly lower median (1st, 3rd quartile) FE(NO) (21.5 [13.2, 84.4] vs 62.5 [26.2, 115.0] ppb, P <.01) and eosinophil cationic protein levels (17.4 [10.1, 24.3] vs 24.0 [15.4, 33.9] mg/dL, P =.05) compared with placebo, whereas no differences were noted between nedocromil and placebo groups. After washout, FE(NO) levels were similar between the three treatments. FE(NO) levels significantly correlated with degree of bronchial hyperresponsiveness, bronchodilator reversibility, allergen skin prick tests, serum IgE, and total eosinophil count. FE(NO) levels were also higher in patients with nocturnal symptoms and in patients requiring beta-agonist use at least once weekly.Budesonide therapy was more effective than nedocromil in reducing FE(NO). Unfortunately, the effects of long-term budesonide were not sustained after its discontinuation. FE(NO) may be a complementary tool to current practice guidelines in assessing asthma control and medication response.