Allergy Asthma Immunol Res.  2014 Jan;6(1):27-32. 10.4168/aair.2014.6.1.27.

Fractional Exhaled Nitric Oxide and Impulse Oscillometry in Children With Allergic Rhinitis

Affiliations
  • 1Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea. kwkim@yuhs.ac

Abstract

PURPOSE
Airway inflammation, bronchial hyper-responsiveness (BHR), and bronchodilator response (BDR) are representative characteristics of asthma. Because allergic rhinitis (AR) is a risk factor for asthma development, we evaluated these 3 characteristics in AR using measurement of fractional exhaled nitric oxide (FeNO), a methacholine challenge test (MCT), and impulse oscillometry (IOS).
METHODS
This study included 112 children with asthma (asthma group), 196 children with AR (AR group), and 32 control subjects (control group). We compared pulmonary function parameters and FeNO levels among the 3 groups. The AR group was subdivided into 2 categories: the AR group with BHR and the AR group without, and again pulmonary function and FeNO levels were compared between the 2 subgroups.
RESULTS
FeNO levels were more increased in the AR and asthma groups than in the control group; within the AR group, FeNO was higher in the AR group with BHR than in the AR group without. The BDR was more increased in the AR group than in the control group when percent changes in reactance at 5 Hz (Delta X5) and reactance area (Delta AX) were compared. In the AR group, however, there was no difference in Delta X5 and Delta AX between the AR group with BHR and the AR group without.
CONCLUSIONS
Reversible airway obstruction on IOS and elevated FeNO levels were observed in children with AR. Because elevated FeNO levels can indicate airway inflammation and because chronic inflammation may lead to BHR, FeNO levels may be associated with BHR in AR. IOS can be a useful tool for detecting lower airway involvement of AR independent of BHR assessed in the MCT.

Keyword

Asthma; allergic rhinitis; bronchial hyper-responsiveness; bronchodilator effect; child; nitric oxide

MeSH Terms

Airway Obstruction
Asthma
Bronchodilator Agents
Child*
Humans
Inflammation
Methacholine Chloride
Nitric Oxide*
Oscillometry*
Rhinitis*
Risk Factors
Bronchodilator Agents
Methacholine Chloride
Nitric Oxide

Figure

  • Figure (A) Fractional exhaled nitric oxide (FeNO) in the control group, the allergic rhinitis (AR) group with bronchial hyper-responsiveness (BHR), the AR group without, and the asthma group. FeNO levels were higher in the asthma and AR groups than in the control group. The AR group with BHR tended to have higher FeNO than the AR group without (P=0.08). (B) BDR in reactance at 5 Hz (Δ X5) and reactance area (Δ AX) increased more in the asthma and AR groups than in the control group. Moreover, Δ X5 and Δ AX were not significantly different between the AR group with BHR and the AR group without.


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Clinical application of fractional exhaled nitric oxide in pediatric allergic rhinitis
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Fractional exhaled nitric oxide and forced expiratory volume in 1 second/ forced vital capacity have predictive value of asthma exacerbation in Korean school children
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