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Relationship among pulmonary function, bronchial reactivity, and exhaled nitric oxide in a large group of asthmatic patients.
Langley S, Goldthorpe S, Custovic A, Woodcock AA
Ann Allergy Asthma Immunol. 2003;91( 4):398-404.
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Abstract
BACKGROUND: Bronchial reactivity and exhaled nitric oxide (eNO) are not often used to monitor control and severity of asthma in clinical practice.OBJECTIVE: To evaluate the relationship among different physiologicmeasures (pulmonary function, nonspecific bronchial reactivity, and eNO)in asthmatic patients. METHODS: Cross-sectional, hospital-based studyconducted in patients with varied asthma severity. RESULTS: A total of 392patients participated in the study. There was no difference in eNO levelsbetween patients taking inhaled corticosteroids (ICS group) and patientsnot receiving inhaled corticosteroids (NICS group). However, thepercentage of predicted forced expiratory volume in 1 second (FEV1) andthe provocative dose of methacholine causing a 20% decrease in FEV1 weresignificantly lower in the ICS group compared with the NICS group (mean,83.2%; 95% confidence interval [CI], 80.4%-86.0%; vs mean, 94.1%; 95% CI,91.1%-97.1%; P = .001; and geometric mean, 0.32 mg; 95% CI, 0.23-0.45 mg;vs geometric mean, 0.58 mg; 95% CI, 0.42-0.81 mg; P = .01; respectively).Patients with more severe bronchial hyperresponsiveness had a lowerpercentage of predicted FEV1 values (P < .001) and levels of eNO weresignificantly increased with increasing bronchial hyperresponsiveness (P< .001). There was no relationship between the percentage of predictedFEV1 and eNO. Atopic patients had significantly higher eNO levels thannonatopic patients (geometric mean, 11.21 ppb; 95% CI, 10.07-12.49 ppb; vsgeometric mean, 7.76 ppb; 95% CI, 6.11-9.85 ppb; P = .006; respectively).CONCLUSIONS: eNO values are not related to the degree of airwayobstruction but are related to airway reactivity and atopic statusindependent of inhaled corticosteroid use. Higher values of eNO are seenwith increased airway reactivity.
Keyword(s)
Adolescent; Adult; Aged; Breath Tests; Bronchial Hyperreactivity; Bronchial Provocation Tests; Child; Child, Preschool; Cross-Sectional Studies; Female; Forced Expiratory Volume; Hospitalization; Humans; Male; Middle Aged; Respiratory Function Tests; Severity of Illness Index; drug therapy: Asthma; physiology: Nitric Oxide; physiopathology: Hypersensitivity, Immediate