Thorax 2000;55:184-188 ( March )

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

Sam Lim, Anon Jatakanon, Sally Meah, Timothy Oates, Kian Fan Chung, Peter J Barnes

Department of Thoracic Medicine, Imperial College School of Medicine at the National Heart & Lung Institute and the Royal Brompton Hospital, London SW3 6LY, UK

Correspondence to: Professor P J Barnes

Received 24 March 1999; Returned to authors 7 July 1999; Revised version received 5 October 1999; Accepted for publication 21 October 1999

BACKGROUNDExhaled 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.
METHODSThe 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.
RESULTSThere 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).
CONCLUSIONSExhaled 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.


Keywords: nitric oxide; asthma; eosinophils; airway inflammation

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© 2000 by Thorax
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