Asthma, rhinitis, other respiratory diseases
Exhaled nitric oxide levels correlate with measures of disease control in asthma,☆☆

https://doi.org/10.1067/mai.2000.109618Get rights and content

Abstract

Background: Asthma guidelines emphasize maintaining disease control. However, objective measures of asthma disease control are lacking. Objective: We sought to examine the relationship between exhaled nitric oxide (NO) levels and measures of asthma disease control versus asthma disease severity. Methods: We performed a cross-sectional study of 100 patients (age range, 7-80 years) with asthma. We administered a questionnaire to identify characteristics of asthma, performed spirometric testing before and after administration of a bronchodilator, and measured exhaled NO levels in all participants. Results: Exhaled NO was significantly correlated with the following markers of asthma disease control: asthma symptoms within the past 2 weeks (P = .02), dyspnea score (P = .02), daily use of rescue medications (P = .01), and reversibility of airflow obstruction (P = .02). Exhaled NO levels were not correlated with the following markers of asthma disease severity: history of respiratory failure (P = .20), health care use (P = .08), fixed airflow obstruction (P = .91), or a validated asthma severity score (P = .19). Markers with relevance to both disease control and severity showed either a weak correlation (FEV1 and FEV1 percent predicted) or no correlation (controller drug use) with exhaled NO. Conclusion: We conclude that exhaled NO levels are correlated predominantly with markers of asthma control rather than asthma severity. Monitoring of exhaled NO may be useful in outpatient asthma management. (J Allergy Clin Immunol 2000;106:645-50.)

Section snippets

Methods

We conducted a cross-sectional survey of patients with physician-diagnosed asthma whose cases were followed by allergy specialists in two community-based practices in Portland, Oregon. Our institutional review board approved the research protocol, and written informed consent was obtained from all subjects. Inclusion criteria included both a history of physician-diagnosed asthma11 and current use of antiasthma medications. Patients were excluded if they were currently smoking or if they had

Results

The mean age of participants was 41.8 ± 18 years (range, 7-80 years), and the majority of subjects were female (Table I).

. Baseline demographic characteristics of the study group (n = 100)

VariableEmpty Cell
Age, y (mean ± SD)41.8 ± 18
Sex, F (%)72
Race, white (%)97
Hospital-based asthma care during past year (%)15
Burst of prednisone during past year (%)38
Current steroid inhaler use (%)55
Less severe asthma (validated asthma severity score*; %)89
Ever smoker (%)19
Current smoker (%)0
Atopy (self-reported hay

Discussion

The results of this study support the concept that exhaled NO levels correlate with measures of asthma control, as defined by recent symptoms or dyspnea, use of rescue medications, and reversibility of airflow obstruction. Exhaled NO levels did not correlate with several measures of asthma severity, including a history of mechanical ventilation, health care use in the past year, fixed airflow obstruction, or a validated asthma severity score.9

Although our findings may suggest a clinical role

Acknowledgements

We thank the Portland, Oregon, VAMC, for the use of space and equipment provided for this study.

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    Supported by The American Lung Association of Oregon.

    ☆☆

    Reprint requests: Molly L. Osborne, MD, PhD, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd #L102, Portland, OR 97201-3098.

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