Relationship of exhaled nitric oxide to clinical and inflammatory markers of persistent asthma in children☆
Section snippets
Study population
Participants aged 6 to less than 18 years were successfully screened, characterized, and randomly assigned into the clinical trial, Characterizing the Response to a Leukotriene Receptor Antagonist and an Inhaled Corticosteroid (CLIC), at the 5 clinical centers of the Childhood Asthma Research and Education (CARE) Network funded by the National Heart, Lung, and Blood Institute (NHLBI). CLIC was designed to determine characteristics of children with asthma who had favorable responses to both a
Demographics and lung function results
Demographic characteristics and lung function results obtained during screening of the children entered into the trial are shown in Table II. The 144 participants had a mean age of 11 years, with 41% females and 48% minorities. Forty-one percent had used a controller medication, and 28% had used an ICS for a mean of 2.5 ± 3.5 months in the 12 months before entry but not in the last month before trial enrollment. Spirometry results at baseline demonstrated values for FVC and FEV1% predicted
Discussion
Although there have been many studies of eNO in asthma, the group of children enrolled in the CLIC trial offers several advantages in further defining the role of eNO in assessing asthma control and airway inflammation. The 144 children have mild to moderate persistent asthma clinically and by pulmonary function criteria (Table II) but differ from other groups of children in whom eNO has been studied in that they had not received oral or inhaled corticosteroids for at least 1 month and no other
Clinical centers
National Jewish Medical and Research Center, Denver: Stanley J. Szefler, MD (Principal Investigator); Gary Larsen, MD (Co-Investigator); Joseph Spahn, MD (Co-Investigator); Ronina Covar, MD (Co-Investigator); Andrew Liu, MD (Co-Investigator); D Sundström (Coordinator); Amy Grumann, RN (Coordinator); Melanie Phillips (Coordinator); Michael White (Research Assistant).
University of Wisconsin, Clinical Science Center, Madison: Robert F. Lemanske Jr, MD (Principal Investigator); Christine A.
Resource centers
Chair's Office, National Jewish Medical and Research Center, Denver: Lynn M. Taussig, MD (Study Chair).
Project Office, National Heart, Lung and Blood Institute, Bethesda: James Kiley, PhD (Director of the NHLBI Division of Lung Diseases); Virginia Taggart, MPH (NHLBI Project Scientist); Gail Weinmann, MD (Executive Secretary, Data Safety Monitoring Board); Gang Zeng, PhD.
Data Coordinating Center, Penn State University College of Medicine, Hershey: Vernon M. Chinchilli, PhD (Principal
Committees
Data and Safety Monitoring Board: Thomas F. Boat, MD (Chair), Children's Hospital Medical Center, Cincinnati; William C. Bailey, MD, The University of Alabama at Birmingham; Mary Kay Garcia, PhD, RN, CPNP; Carolyn M. Kercsmar, MD, Case Western Reserve University, Cleveland; H. William Kelly, PharmD, University of New Mexico Health Sciences Center, Albuquerque; Lester Lyndon Key Jr, MD, Medical University of South Carolina, Charleston; James Tonascia, PhD, Johns Hopkins University, Baltimore;
Pharmaceutical suppliers
GlaxoSmithKline, Inc, Research Triangle Park, NC; Merck & Co, Inc, West Point, Pa.
Equipment support
Lincoln Diagnostics (Multi-Test II kits), Decatur, Ill; Monaghan Medical (Aerochamber and masks), Plattsburgh, NY; MEMS, Medication Event MonitoringSystems, AARDEX, Zug, Switzerland; Aerocrine, Incorporated, Chicago, Ill; VIASYS Healthcare GmbH, Hoechberg, Germany.
References (47)
- et al.
Total eosinophil counts in the management of bronchial asthma
N Engl J Med
(1975) The total eosinophil count in obstructive pulmonary disease: editorial
N Engl J Med
(1975)- et al.
Non-invasive markers of airway inflammation as predictors of oral steroid responsiveness in asthma
Thorax
(2000) - et al.
Clinical control and histopathologic outcome of asthma when using airway hyperresponsiveness as an additional guide to long-term treatment. The AMPUL Study Group
Am J Respir Crit Care Med.
(1999) - et al.
Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial
Lancet
(2002) - et al.
Significant variability in response to inhaled corticosteroids for persistent asthma
J Allergy Clin Immunol
(2002) - et al.
The predictive value of exhaled nitric oxide measurements in assessing changes in asthma control
Am J Respir Crit Care Med
(2001) - et al.
FeNO measured at fixed exhalation flow rate during controlled tidal breathing in children from the age of 2 yr.
Am J Respir Crit Care Med.
(2001) - et al.
Airway nitrogen oxide measurements in asthma and other pediatric respiratory diseases
J Pediatr
(2000) - et al.
Relations between exhaled nitric oxide and measures of disease activity among children with mild-to-moderate asthma
J Pediatr
(2003)
Changes in the dose of inhaled steroid affect exhaled nitric oxide levels in asthmatic patients
Eur Respir J
Standardization of spirometry, 1994 update
Am J Respir Crit Care Med
Spirometric pulmonary function in healthy preschool children
Am J Respir Crit Care Med
Guidelines for methacholine and exercise challenge testing-1999
This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med
Recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide in adults and children-1999
Am J Respir Crit Care Med
Immunoaffinity resin for purification of urinary leukotriene E4
Lipid Mediators
Design and methods of the National Cooperative Inner-City Asthma Study
Pediatr Pulmonol
Pulmonary function between 6 and 18 years of age
Pediatr Pulmonol
A community study of exhaled nitric oxide in healthy children
Am J Respir Crit Care Med
Exhaled nitric oxide before and after montelukast sodium therapy in school-age children with chronic asthma: a preliminary study
Pediatr Pulmonol
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2019, Nitric Oxide - Biology and ChemistryCitation Excerpt :FeNO can play a role in differentiating chronic cough due to asthma and CVA from other causes [21], as well as to monitor disease treatment. It was reported that in bronchial asthma FeNO correlates with AHR and with the eosinophil ratio in induced sputum, bronchoalveolar lavage and blood eosinophils [23–25]. These results were extended to patients with CVA, correlating FeNO increase with other markers of eosinophilic inflammation [21,26].
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Supported by Grants 5U10HL064287, 5U10HL064288, 5U10HL064295, 5U10HL064307, 5U10HL064305 from the National Heart, Lung, and Blood Institute.
for the Childhood Asthma Research Education Network of the National Heart Lung, Blood Institute
This study was carried out in part in the General Clinical Research Centers at Washington University School of Medicine (MO1 RR00036) and National Jewish Medical and Research Center (MO1 RR00051).