Exhaled nitric oxide continues to reflect airway hyperresponsiveness and disease activity in inhaled corticosteroid‐treated adult asthmatic patients

Respirology - Tập 8 Số 4 - Trang 479-486 - 2003
David W. Reid1, DP Johns2, Bryce Feltis2, Chris Ward1, E. Haydn Walters2
1Department of Respiratory Medicine and Monash University Medical School, Alfred Hospital, Melbourne, Victoria and
2Discipline of Medicine, University of Tasmania Medical School, Hobart, Tasmania, Australia

Tóm tắt

Objective:  Exhaled nitric oxide (eNO) has been used as a surrogate of airway inflammation in mild asthma. However, whether eNO levels reflect disease activity in symptomatic asthmatics receiving moderate doses of inhaled corticosteroid (ICS) is more uncertain.Methodology:  To examine the relationship between eNO levels, sputum and blood eosinophils (SpE and PbE), PD20 methacholine as a marker of airway hyperresponsiveness (AHR) and clinical status in 28 ICS‐treated asthmatic subjects with persistent asthma compared to that in 25 symptomatic asthmatics managed with β2‐agonists alone.Results:  As expected, eNO levels were normalized in ICS‐treated subjects and significantly elevated in the β2‐agonist only group (P < 0.001). SpE, PbE and PD20M did not differ between asthmatic groups but FEV1 was significantly worse in ICS‐treated subjects (P < 0.01). Exhaled NO levels correlated with PbE within both asthmatic groups (P < 0.005), but with SpE only in ICS‐untreated subjects (r(s) = 0.6, P < 0.05). In contrast, PD20M was negatively correlated with eNO and PbE in ICS‐treated subjects only (r(s) = − 0.4, r(s) = − 0.4, respectively, P < 0.05). SpE and PbE were strongly correlated in both asthmatic groups (r(s) = 0.8, r(s) = 0.7, respectively, P < 0.005). Exhaled NO levels, SpE and PbE were all positively associated with increased nocturnal awakenings ( P < 0.05) in ICS‐treated subjects, but not in ICS‐untreated subjects.Conclusions:  In ICS‐treated asthma, eNO reflects clinical activity, PbE and AHR but not eosinophilic airway inflammation. Exhaled NO levels are quantitatively and relationally different in asthmatic subjects treated with ICS and continue to have potential for use as a surrogate of asthma pathophysiology in this group.

Từ khóa


Tài liệu tham khảo

10.1016/0091-6749(91)90160-P

Barnes PJ, 1990, Effect of corticosteroids on airway hyperresponsiveness, Am. Rev. Respir. Dis., 141, S70

10.1183/09031936.03.00066903a

10.1016/S0140-6736(94)90931-8

10.1136/thx.53.2.91

10.1067/mai.2000.109622

10.1159/000056294

10.1136/thorax.55.3.184

10.1164/ajrccm/136.1.225

10.1164/ajrccm.155.1.9001322

10.1164/ajrccm/147.5.1126

Kips JC, 1998, Methods for sputum induction and analysis of induced sputum: a method for assessing airway inflammation in asthma, Eur. Respir. J. Suppl., 26, 9S

10.1136/thx.48.3.239

10.1136/thx.54.5.403

10.1096/fasebj.12.11.929

10.1164/ajrccm.159.1.9706006

10.1183/09031936.01.00058601

10.1136/thx.48.10.1034

Barnes PJ, 1993, Nitric oxide and airways, Eur. Respir. J., 6, 163, 10.1183/09031936.93.06020163

10.1136/thorax.56.5.351

10.1006/bbrc.1999.2030

10.1084/jem.189.10.1621

10.1152/ajplung.1997.273.4.L883

10.1159/000236986

10.1016/S0140-6736(00)03496-6

10.1164/ajrccm.159.2.9712018

10.1159/000053829

10.1164/ajrccm.159.4.9806052

10.1136/thx.54.4.289

10.1136/thx.47.7.499

10.1111/j.1365-2222.1994.tb02721.x

10.1136/thx.47.1.25

Thông tin
Thông tin xuất bản

Respirology

Tập 8 Số 4

479-486

Thông tin tác giả