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. 2000 Mar;55(3):184–188. doi: 10.1136/thorax.55.3.184

Relationship between exhaled nitric oxide and mucosal eosinophilic inflammation in mild to moderately severe asthma

S Lim 1, A Jatakanon 1, S Meah 1, T Oates 1, K F Chung 1, P Barnes 1
PMCID: PMC1745703  PMID: 10679535

Abstract

BACKGROUND—Exhaled levels of nitric oxide (NO) are raised in asthma but the relationship between exhaled NO levels and a direct measure of airway inflammation has not been investigated in asthmatic patients treated with inhaled steroids.
METHODS—The relationship between exhaled NO levels, clinical measures of asthma control, and direct markers of airway inflammation were studied in patients with asthma treated with and without inhaled corticosteroids. Thirty two asthmatic patients (16 not using inhaled steroids and 16 using inhaled beclomethasone dipropionate, 400-1000 µg/day) were monitored with respect to measures of asthma control including lung function, symptom scores, medication usage, and variability of peak expiratory flow (PEF) for one month. Measurements of exhaled NO and fibreoptic bronchoscopy were performed at the end of the monitoring period. Bronchial mucosal biopsy specimens were stained with an anti-MBP antibody for quantification of eosinophils.
RESULTS—There was no significant difference in lung function, symptom scores, or medication usage between the two groups, but there was a significant difference in PEF variability (8.7 (1.2)% in steroid naive patients versus 13.6 (1.9)% in steroid treated patients, p<0.05) and exhaled NO levels (9.9 (3.5) ppb in steroid naive patients versus 13.6 (2.0) ppb in steroid treated patients, p<0.05). There was no correlation between exhaled NO and mucosal eosinophils, or between NO and conventional measures of asthma control. There was a significant correlation between mucosal eosinophils and lung function (r = -0.43, p<0.05).
CONCLUSIONS—Exhaled NO levels do not reflect airway mucosal eosinophilia and these markers reflect different aspects of airway inflammation. The clinical usefulness of exhaled NO needs to be determined in prospective longitudinal studies.



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Selected References

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  1. Barnes P. J., Kharitonov S. A. Exhaled nitric oxide: a new lung function test. Thorax. 1996 Mar;51(3):233–237. doi: 10.1136/thx.51.3.233. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Barnes P. J., Liew F. Y. Nitric oxide and asthmatic inflammation. Immunol Today. 1995 Mar;16(3):128–130. doi: 10.1016/0167-5699(95)80128-6. [DOI] [PubMed] [Google Scholar]
  3. Bousquet J., Chanez P., Lacoste J. Y., Barnéon G., Ghavanian N., Enander I., Venge P., Ahlstedt S., Simony-Lafontaine J., Godard P. Eosinophilic inflammation in asthma. N Engl J Med. 1990 Oct 11;323(15):1033–1039. doi: 10.1056/NEJM199010113231505. [DOI] [PubMed] [Google Scholar]
  4. Cockcroft D. W., Swystun V. A. Asthma control versus asthma severity. J Allergy Clin Immunol. 1996 Dec;98(6 Pt 1):1016–1018. doi: 10.1016/s0091-6749(96)80185-0. [DOI] [PubMed] [Google Scholar]
  5. Dupont L. J., Rochette F., Demedts M. G., Verleden G. M. Exhaled nitric oxide correlates with airway hyperresponsiveness in steroid-naive patients with mild asthma. Am J Respir Crit Care Med. 1998 Mar;157(3 Pt 1):894–898. doi: 10.1164/ajrccm.157.3.9709064. [DOI] [PubMed] [Google Scholar]
  6. Fabbri L. M., Durham S., Holgate S. T., O'Byrne P. M., Postma D. S. Assessment of airway inflammation: an overview. Eur Respir J Suppl. 1998 Mar;26:6S–8S. [PubMed] [Google Scholar]
  7. Gibson P. G., Wong B. J., Hepperle M. J., Kline P. A., Girgis-Gabardo A., Guyatt G., Dolovich J., Denburg J. A., Ramsdale E. H., Hargreave F. E. A research method to induce and examine a mild exacerbation of asthma by withdrawal of inhaled corticosteroid. Clin Exp Allergy. 1992 May;22(5):525–532. doi: 10.1111/j.1365-2222.1992.tb00161.x. [DOI] [PubMed] [Google Scholar]
  8. Kharitonov S., Alving K., Barnes P. J. Exhaled and nasal nitric oxide measurements: recommendations. The European Respiratory Society Task Force. Eur Respir J. 1997 Jul;10(7):1683–1693. doi: 10.1183/09031936.97.10071683. [DOI] [PubMed] [Google Scholar]
  9. Kidd R. J., Kolbe J., Cochrane G. M. Peak expiratory flow rate processed electronically. N Z Med J. 1993 Dec 8;106(969):529–530. [PubMed] [Google Scholar]
  10. Kikuchi Y., Okabe S., Tamura G., Hida W., Homma M., Shirato K., Takishima T. Chemosensitivity and perception of dyspnea in patients with a history of near-fatal asthma. N Engl J Med. 1994 May 12;330(19):1329–1334. doi: 10.1056/NEJM199405123301901. [DOI] [PubMed] [Google Scholar]
  11. Laitinen L. A., Laitinen A., Haahtela T. A comparative study of the effects of an inhaled corticosteroid, budesonide, and a beta 2-agonist, terbutaline, on airway inflammation in newly diagnosed asthma: a randomized, double-blind, parallel-group controlled trial. J Allergy Clin Immunol. 1992 Jul;90(1):32–42. doi: 10.1016/s0091-6749(06)80008-4. [DOI] [PubMed] [Google Scholar]
  12. Laitinen L. A., Laitinen A., Haahtela T. Airway mucosal inflammation even in patients with newly diagnosed asthma. Am Rev Respir Dis. 1993 Mar;147(3):697–704. doi: 10.1164/ajrccm/147.3.697. [DOI] [PubMed] [Google Scholar]
  13. Lim S., Jatakanon A., John M., Gilbey T., O'connor B. J., Chung K. F., Barnes P. J. Effect of inhaled budesonide on lung function and airway inflammation. Assessment by various inflammatory markers in mild asthma. Am J Respir Crit Care Med. 1999 Jan;159(1):22–30. doi: 10.1164/ajrccm.159.1.9706006. [DOI] [PubMed] [Google Scholar]
  14. Pizzichini E., Pizzichini M. M., Efthimiadis A., Evans S., Morris M. M., Squillace D., Gleich G. J., Dolovich J., Hargreave F. E. Indices of airway inflammation in induced sputum: reproducibility and validity of cell and fluid-phase measurements. Am J Respir Crit Care Med. 1996 Aug;154(2 Pt 1):308–317. doi: 10.1164/ajrccm.154.2.8756799. [DOI] [PubMed] [Google Scholar]
  15. Saleh D., Ernst P., Lim S., Barnes P. J., Giaid A. Increased formation of the potent oxidant peroxynitrite in the airways of asthmatic patients is associated with induction of nitric oxide synthase: effect of inhaled glucocorticoid. FASEB J. 1998 Aug;12(11):929–937. [PubMed] [Google Scholar]
  16. Toogood J. H. High-dose inhaled steroid therapy for asthma. J Allergy Clin Immunol. 1989 Feb;83(2 Pt 2):528–536. doi: 10.1016/0091-6749(89)90034-1. [DOI] [PubMed] [Google Scholar]
  17. Yeung M., O'Connor S. A., Parry D. T., Cochrane G. M. Compliance with prescribed drug therapy in asthma. Respir Med. 1994 Jan;88(1):31–35. doi: 10.1016/0954-6111(94)90171-6. [DOI] [PubMed] [Google Scholar]

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