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Low levels of exhaled nitric oxide are associated with impaired lung function in cystic fibrosis
Author(s) -
Keen C.,
Gustafsson P.,
Lindblad A.,
Wennergren G.,
Olin AC.
Publication year - 2010
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.21137
Subject(s) - exhaled nitric oxide , medicine , cystic fibrosis , gastroenterology , asthma , nitric oxide , lung function , pulmonary function testing , airway , lung , cardiology , anesthesia
Abstract Fraction of exhaled nitric oxide (FENO) is often reduced in cystic fibrosis (CF). FENO at different expiratory flows can provide an indication of the site of nitric oxide production. The aim of this study was to examine whether NO parameters are related to overall (FEV 1 ) or peripheral (lung clearance index, LCI, measured by multiple breath SF 6 washout) airway function and systemic inflammation in CF. Secondary aim was to compare alveolar NO and bronchial NO flux calculated by two different mathematical models, a linear and a nonlinear method. Thirty‐five healthy and 45 CF children were recruited. FENO at 50 ml/sec (FENO 50 ) and bronchial NO flux were lower in CF than controls, 9.5 (2.7–38.8) (median (range)) versus 12.4 (5.2–40.1) ppb, P = 0.029, and 391 (97–1772) versus 578 (123–1993) (pl/sec), P = 0.036, respectively. No difference in alveolar NO was shown. The nonlinear method resulted in lower alveolar NO and higher bronchial flux, than the linear method, but the result was closely correlated in both groups. LCI was higher in CF than controls, 8.4 (6.5–12.9) versus 5.9 (5.1–7.8), P < 0.001. FENO 50 was negatively correlated with LCI (r = −0.43; P = 0.003) and positively correlated with FEV 1 (r = 0.42, P = 0.004) in CF. Alveolar NO correlated negatively with inflammatory markers: orosomucoid (r = −0.42, P = 0.005), platelets (r = −0.50, P < 0.001) and white blood cell count (r = −0.48, P = 0.001). In conclusion, FENO 50 and bronchial NO flux are reduced in young CF subjects and low FENO 50 is associated with overall and small airway obstruction. NO parameters derived from the different models were closely related but the values differed slightly. Pediatr Pulmonol. 2010; 45:241–248. © 2010 Wiley‐Liss, Inc.