Allergy Asthma Respir Dis.  2016 Jan;4(1):14-21. 10.4168/aard.2016.4.1.14.

Relationships between fractional exhaled nitric oxide levels and FEF25%-75% in children with asthma

Affiliations
  • 1Department of Pediatrics, Korea University College of Medicine, Seoul, Korea. yoolina@korea.ac.kr
  • 2Environmental Health Center, Korea University Anam Hospital, Seoul, Korea.
  • 3Allergy Immunology Center, Korea University, Seoul, Korea.

Abstract

PURPOSE
Fractional exhaled nitric oxide (FeNO) is considered an indirect marker of airway inflammation, and forced expiratory flow between 25% and 75% of vital capacity (FEF25%-75%) is widely used as a sensitive indicator of small airway obstruction in asthma. The aim of this study was to investigate relationships between FeNO and FEF25%-75% in children with asthma.
METHODS
A total of 118 children with asthma underwent spirometry and measurement of eosinophil markers. FeNO levels were measured, and skin prick tests to 13 common allergens were done. Study subjects were divided into 2 groups according to FEF25%-75% values (group 1, normal FEF25%-75%> or =65%pred, n=90; group 2, impaired FEF25%-75%<65%pred, n=28).
RESULTS
The mean (+/-standard deviation, SD) age was not significantly different between groups 1 and 2 (10.3+/-2.8 years vs. 11.1+/-3.4 years), and the sex ratio was also not significantly different between 2 groups. The geometric mean (range of 1 SD) concentration of FeNO was significantly higher in group 2 than in group 1 (25.8 ppb [14.2-46.9 ppb] vs. 37.2 ppb [24.2-57.2 ppb], P=0.008). A significant inverse correlation between FeNO and FEF25%-75% was observed in group 2 (r=-0.493, P=0.038), but not in group 1 (r=-0.037, P=0.749) after adjustment for confounders, such as atopy, age, sex, weight, and height.
CONCLUSION
FeNO levels were higher in group of asthmatic children with impaired FEF25%-75% level. FeNO levels were inversely correlated with FEF 25%-75% only in impaired small-airway obstruction group after adjustment for atopy. These results suggest that small-airway obstruction may relate more closely to airway inflammation in asthmatic children with impaired small-airway function.

Keyword

Asthma; Child; Spirometry; FeNO

MeSH Terms

Airway Obstruction
Allergens
Asthma*
Child*
Eosinophils
Humans
Inflammation
Nitric Oxide*
Sex Ratio
Skin
Spirometry
Vital Capacity
Allergens
Nitric Oxide

Figure

  • Fig. 1 FeNO values do not correlate with FEV1 %pred (r=–0.144, P=0.154; A), FVC %pred (r=–0.049, P=0.627; B) and FEV1/FVC (r=–0.195, P=0.053; C), but show significantly inverse correlation with FEF25%–75% %pred (r=–0.211, P=0.035; D) in total asthmatic children. FeNO, fractional exhaled nitric oxide; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; FEF25%–75%, forced expiratory flow between 25% and 75% of vital capacity.

  • Fig. 2 FeNO values show significant correlation with neither FEV1 %pred (r=–0.018, P=0.878; A), FVC %pred (r=–0.072, P=0.534; B), FEV1/FVC (r=–0.104, P=0.367; C) nor FEF25%–75% %pred (r=–0.037, P=0.749; D) in children with group 1 (normal FEF25%–75%, ≥65%pred). FeNO, fractional exhaled nitric oxide; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; FEF25%–75%, forced expiratory flow between 25% and 75% of vital capacity.

  • Fig. 3 FeNO values do not correlate with inversely correlate with with FEV1 %pred (r=–0.066, P=0.795; A) or FVC %pred (r=0.179, P=0.477; B), but show significant FEV1/FVC (r=–0.566, P=0.014; C), and FEF25%–75% %pred (r=–0.493, P=0.038; D) in children with group 2 (impaired FEF25%–75%, <65%pred). FeNO, fractional exhaled nitric oxide; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; FEF25%–75%, forced expiratory flow between 25% and 75% of vital capacity.


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