Asthma, Rhinitis, Other Respiratory DiseasesBoth inflammation and remodeling influence nitric oxide output in children with refractory asthma
Section snippets
Patients
Children with refractory asthma were included prospectively and investigated by fiberoptic bronchoscopy. The diagnosis of asthma was based on clinical symptoms and history of reversible airflow limitation. In accordance with the recent ATS workshop, refractory asthma was defined as presence of the major criterion, for example, need for high-dose inhaled corticosteroids and at least 2 of the following 5 minor criteria: (1) requirement for daily long-acting β-agonist or leukotriene antagonist in
Patients, pulmonary function testing
Twenty-eight children (16 boys and 12 girls) were enrolled (median age, 11 years; range, 10 to 14 years). All had asthma since early childhood and were atopic, as defined by one or more positive skin tests. All were receiving beclomethasone (1000 μg/d) or equivalent (major inclusion criterion) and a long-acting β-agonist (22 children) or leukotriene antagonist (6 children) (first minor inclusion criterion). The second minor criteria were (1) persistent airway obstruction defined as FEV1 < 80%
Discussion
In children with asthma, bronchoscopy, and BB are appropriate only to clarify the diagnosis and to assist in treatment decisions for patients with poorly controlled disease. The patients in this study were children with refractory asthma, for example, with frequent symptoms and/or airflow obstruction despite maximal conventional therapy. We examined relations between multiple-flow measurements of exhaled NO and evidence of airway inflammation or remodeling obtained by bronchoscopy and BB. Our
Acknowledgments
The authors wish to thank SERES Industry for providing the NO analyzer.
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Cited by (83)
Contribution of exhaled nitric oxide measurement in airway inflammation assessment in asthma. A position paper from the French Speaking Respiratory Society
2015, Revue des Maladies RespiratoiresCitation Excerpt :Au cours de l’atopie (avec ou sans asthme), il existe une augmentation de la production bronchique de NO (J’awNO) [26], expliquant l’augmentation de FENO. Au cours de l’asthme, J’awNO (et FENO) est corrélée à l’inflammation éosinophilique des voies aériennes [27,28]. Une inflammation distale, augmentation de CANO, caractérise un certain nombre de sujets asthmatiques, mais l’utilité de sa mesure reste à démontrer [29].
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2013, Journal of Allergy and Clinical ImmunologyDifficult Childhood Asthma. Management and Future
2012, Clinics in Chest MedicineDiagnostic tools assessing airway remodelling in asthma
2012, Allergologia et ImmunopathologiaCitation Excerpt :Ketai et al.43 demonstrated that FeNO levels were elevated during acute asthma exacerbations, related with bronchial wall area assessed by high-resolution computed tomography, but these elevated levels did not persist when acute exacerbations were treated. When the FeNO and airway remodelling relationship has been measured in children44 a positive correlation with FeNO has been demonstrated. This correlation has also been shown when adolescents were evaluated,45 and elevated levels of FeNO were related with AHR and airway remodelling in children ≥12 years of age.