Pediatr Allergy Respir Dis.  2011 Jun;21(2):99-107.

Nitric Oxide Correlates with Exercise-Induced Bronchoconstriction in Asthmatic Children

• Baek HS
• Park YR
• Kim JH
• Oh JW
• Lee HB

Abstract

PURPOSE
Exercise-induced bronchoconstriction (EIB) affects daily activities as well as school performance in children. Exhaled nitric oxide (eNO) is a noninvasive test that measures airway inflammation in asthmatics. The aim of this study was to address the relationship between eNO and childhood EIB.
METHODS
Our study consisted of 101 children aged 6 to 18 years belonging to one of three groups, asthmatic children with EIB (n=31), asthmatic children without EIB (n=28), or healthy controls (n=42). After children were taken off drugs that treated their asthma, baseline (pre-exercise) eNO and biomarkers of inflammation were measured. All subjects underwent spirometry and the bronchial challenge by methacholine inhalation and outdoor free running.
RESULTS
eNO levels in asthmatic children with EIB were significantly greater than those in both asthmatic children without EIB (P=0.012) and controls (P<0.001). The median eNO (interquartile range) levels were 26.0 (15.0 to 46.0) parts per billion (ppb) in asthmatic children with EIB, 16.0 (12.5 to 28.0) ppb in asthmatic children without EIB, and 12.0 (10.0 to 15.3) ppb in controls. Post-exercise decrease of forced expiratory volume in 1 second correlated positively with eNO (r=0.637, P<0.001; r, partial correlation coefficient adjusted for age and height). The cutoff value for prediction of significant EIB was 20 ppb, and the overall sensitivity, specificity, positive predictive value, and negative predictive values were 61.3%, 80.0%, 57.6%, and 82.4%, respectively. The area under the receiver operating characteristic curve was 0.767 (95% confidence interval, 0.661 to 0.874).
CONCLUSION
Baseline eNO levels correlate with the post-exercise decrease of forced expiratory volume in 1 second, suggesting that eNO may be a tool in the prediction of EIB.

Keyword

Exercise-induced bronchoconstriction; Exhaled nitric oxide; Asthma; Child

MeSH Terms

Aged
Asthma
Biomarkers
Bronchoconstriction
Child
Forced Expiratory Volume
Humans
Inflammation
Inhalation
Methacholine Chloride
Nitric Oxide
ROC Curve
Sensitivity and Specificity
Spirometry
Methacholine Chloride
Nitric Oxide

Figure

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  Fig. 1. (A) Exhaled nitric oxide (eNO) levels of study subjects. (B) Association between post-exercise decrease of forced expiratory volume in 1 second (FEV1) and eNO levels (r=0.637, r=partial correlation coefficient adjusted for age and height, P <0.001). ppb, parts per billion; EIB, exercise-induced bronchoconstriction.

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  Fig. 2. Receiver operating characteristic curve for exhaled nitric oxide (eNO) predicting exercise-induced bronchoconstriction with representative values. AUC, area under curve; SE, standard error; CI, confidence interval.

Reference

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