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Central and peripheral airway/alveolar sites of exhaled nitric oxide in acute asthma.
MedLine Citation:
PMID:  20627920     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Central airway nitric oxide flux (J'(awNO)) and peripheral airway/alveolar nitric oxide concentration (C(ANO)) during asthma exacerbation has not been investigated after correction for axial NO back-diffusion.
METHODS: After measuring exhaled NO (fraction of exhaled nitric oxide (F(E)NO); ppb) at 50, 100, 150 and 200 ml/s, J'(awNO) (nl/s) and C(ANO) (ppb) were calculated using the two-compartment model and corrected for axial NO back-diffusion. Fifteen (8 males), non-smoking, patients with moderate-to-severe treated (inhaled corticosteroid (ICS) and inhaled long-acting beta(2)-agonist (LABA)) asthma, age 57+/-13 years (mean+/-SD), were studied at baseline, during exacerbation prior to oral corticosteroid, and during recovery after an 8 day tapering prednisone course. Based on earlier asthma studies without correction, it was hypothesised that with correction for NO axial back-diffusion, the incidence of abnormal J'(awNO) and C(ANO) at baseline and after exacerbation would be > or = 30% in 15 patients with asthma with 80% power.
RESULTS: At baseline when clinically stable, after 180 microg of albuterol, forced expiratory volume in 1 s (FEV(1); litres) was 78+/-26% predicted (p=0.009) with increased F(E)NO at 50 ml/s (p=0.01) and J'(awNO) (p=0.02), but C(ANO) was normal compared with the controls. During exacerbation FEV(1) (litres) was 57+/-20% predicted (p=0.02), with increased F(E)NO at 50 ml/s (p=0.01) and J'(awNO) (p=0.004), but C(ANO) was normal. Recovery results were similar to baseline. Two of 15 patients with asthma always had normal exhaled NO gas exchange.
CONCLUSIONS: The central airways were the major site of abnormal NO flux in 13 of 15 patients with moderate-severe asthma when stable and during exacerbation and could be easily detected with abnormal F(E)NO at 50 ml/s. C(ANO) was normal.
Arthur F Gelb; Steven C George; Philip E Silkoff; Anita Krishnan; Christine Fraser; Colleen Flynn Taylor; Chris M Shinar; Tamara Maginot
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Thorax     Volume:  65     ISSN:  1468-3296     ISO Abbreviation:  Thorax     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-14     Completed Date:  2010-08-05     Revised Date:  2011-08-05    
Medline Journal Info:
Nlm Unique ID:  0417353     Medline TA:  Thorax     Country:  England    
Other Details:
Languages:  eng     Pagination:  619-25     Citation Subset:  IM    
Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center, and Geffen School of Medicine, University of California at Los Angeles Medical Center, Lakewood, California, USA.
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MeSH Terms
Acute Disease
Albuterol / analogs & derivatives,  therapeutic use
Androstadienes / therapeutic use
Anti-Asthmatic Agents / therapeutic use
Asthma / drug therapy,  metabolism*,  physiopathology
Breath Tests / methods
Bronchodilator Agents / therapeutic use
Drug Therapy, Combination
Forced Expiratory Volume
Glucocorticoids / therapeutic use
Middle Aged
Nitric Oxide / biosynthesis*
Prednisone / therapeutic use
Prospective Studies
Pulmonary Gas Exchange / physiology
Spirometry / methods
Vital Capacity
Reg. No./Substance:
0/Androstadienes; 0/Anti-Asthmatic Agents; 0/Bronchodilator Agents; 0/Glucocorticoids; 10102-43-9/Nitric Oxide; 18559-94-9/Albuterol; 53-03-2/Prednisone; 89365-50-4/salmeterol; 90566-53-3/fluticasone
Comment In:
Thorax. 2011 Jul;66(7):632-3; author reply 633   [PMID:  20837872 ]

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