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Exhaled nitric oxide predicts persistence of wheezing, exacerbations, and decline in lung function in wheezy infants and toddlers
Author(s) -
Elliott M.,
Heltshe S. L.,
Stamey D. C.,
Cochrane E. S.,
Redding G. J.,
Debley J. S.
Publication year - 2013
Publication title -
clinical and experimental allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.462
H-Index - 154
eISSN - 1365-2222
pISSN - 0954-7894
DOI - 10.1111/cea.12171
Subject(s) - exhaled nitric oxide , medicine , persistence (discontinuity) , tidal volume , pediatrics , lung function , predictive value , bronchodilator , asthma , cohort , respiratory system , lung , geotechnical engineering , engineering
Summary Background There are limited data assessing the predictive value of fraction of exhaled nitric oxide ( FE NO ) for persistence of wheezing, exacerbations, or lung function change over time in infants/toddlers with recurrent wheezing. Objectives In an ongoing longitudinal cohort of infants and toddlers with recurrent wheezing, we compared predictive values of single‐breath FE NO ( SB ‐ FE NO ), tidal‐breathing mixed expired FE NO (tidal‐ FE NO ), bronchodilator responsiveness ( BDR ) and the Castro‐Rodriquez Asthma Predictive Index ( API ) for persistence of wheezing, exacerbations and lung function change through age 3 years. Methods Enrolment forced expiratory flows and volumes infant pulmonary function tests ( iPFT s) were measured in 44 infants/toddlers using the raised volume rapid thoracoabdominal compression method. SB‐FE NO was measured at 50 mL/s, and tidal‐FE NO was measured during awake tidal breathing. Clinical outcomes were assessed at age 3 years in 42 infants. Follow‐up iPFT s were completed between ages 2.5–3 years in 32 subjects. Results An enrolment SB‐FE NO concentration ≥ 30 p.p.b. predicted persistence of wheezing at age 3 years with a sensitivity of 77%, a specificity of 94%, and an area under the curve (AUC) of 0.86 (95% CI: 0.74–0.98). The sensitivity, specificity, positive predictive, and negative predictive values of SB‐FE NO for persistence of wheezing and exacerbations were superior to tidal‐FE NO , BDR, and the API. SB‐FE NO ≥ 30 p.p.b. and tidal‐FE NO ≥ 7 p.p.b. measured at enrolment was associated with a decline in both FEV 0.5 and FEF 25–75 between enrolment and age 3 years. Conclusions In wheezy infants/toddlers, SB ‐ FE NO was superior to tidal‐ FE NO , BDR , and the API in predicting future exacerbations and persistence of wheezing at age 3 years. Both SB ‐ FE NO and tidal‐ FE NO were associated with lung function decline over time.