|Diagnostic value of exhaled carbon monoxide as an early marker of exacerbation in children with chronic lung diseases.|
|Jump to Full Text|
|PMID: 22997589 Owner: NLM Status: PubMed-not-MEDLINE|
|Chronic airways infection and inflammation are leading causes of morbidity and mortality in chronic lung diseases (CLD). Pulmonary exacerbations are major causes of morbidity in CLD. Exhaled carbon monoxide (eCO) is a product of endogenous metabolic processes whose presence in exhaled breath is considered an index of inflammatory processes. Objective. To evaluate carbon monoxide (eCO) as inflammatory marker for early detection of acute exacerbation in CLD. Methods. Case control study included 40 children with CLD (twenty in exacerbation, group I and twenty in quiescent period, group II) recruited from the Chest Clinic, Children's Hospital, Ain Shams University. Twenty apparently healthy children were included as controls (group III). Results. Patients' mean age was 9.98 ± 3.29 years: 24 (60%) males and 16 (40%) females. The mean eCO level among patients during exacerbation was 5.35 ± 1.35 (ppm) compared to 2.65 ± 0.49 (ppm) in quiescent stage and 1.30 ± 0.47 (ppm) in controls. eCO cutoff value discriminating cases and control was 1.5 (ppm) (sensitivity; 100% and specificity 70%) and cutoff value discriminating group I from group II was 3 (ppm) (sensitivity: 100% and specificity: 100%). Conclusion. Exhaled CO can be considered a noninvasive early marker of acute exacerbation of CLD.|
|Karima A Abd El Khalek; Magda Y El Seify; Omneya I Youssef; Mona M Badr|
Related Documents :
|19254999 - Pain symptoms and stooling patterns do not drive diagnostic costs for children with fun...
23122319 - Association between childhood leukaemia and exposure to power-frequency magnetic fields...
10895749 - Sedation and general anaesthesia in children undergoing mri and ct: adverse events and ...
7573879 - The effect of a combination of rectal diclofenac and caudal bupivacaine on postoperativ...
13679999 - Mesenteric lymphadenopathy in children examined by us for chronic and/or recurrent abdo...
23558709 - Alterations in nk cell phenotype in relation to liver steatosis in children with chroni...
12787159 - Fathers of children with down's syndrome versus other types of intellectual disability:...
12880759 - Pectus deformities of the anterior chest wall.
11929059 - Acute mountain sickness in tourists with children at lake chungará (4400 m) in norther...
|Type: Journal Article Date: 2012-09-11|
|Title: ISRN pediatrics Volume: 2012 ISSN: 2090-4703 ISO Abbreviation: ISRN Pediatr Publication Date: 2012|
|Created Date: 2012-09-21 Completed Date: 2012-09-24 Revised Date: 2013-04-02|
Medline Journal Info:
|Nlm Unique ID: 101568077 Medline TA: ISRN Pediatr Country: Egypt|
|Languages: eng Pagination: 859873 Citation Subset: -|
|Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo 11321, Egypt.|
|APA/MLA Format Download EndNote Download BibTex|
Journal ID (nlm-ta): ISRN Pediatr
Journal ID (iso-abbrev): ISRN Pediatr
Journal ID (publisher-id): ISRN.PEDIATRICS
Publisher: International Scholarly Research Network
Copyright © 2012 Karima A. Abd EL Khalek et al.
Received Day: 14 Month: 7 Year: 2012
Accepted Day: 9 Month: 8 Year: 2012
collection publication date: Year: 2012
Electronic publication date: Day: 11 Month: 9 Year: 2012
Volume: 2012E-location ID: 859873
PubMed Id: 22997589
|Diagnostic Value of Exhaled Carbon Monoxide as an Early Marker of Exacerbation in Children with Chronic Lung Diseases|
|Karima A. Abd EL KhalekI1|
|Magda Y. EL SeifyI1|
|Omneya I. YoussefI1*|
|Mona M. BadrI1|
|Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo 11321, Egypt
|Correspondence: *Omneya I. Youssef: firstname.lastname@example.org
[other] Academic Editors: T. V. Brogan and J. A. O'Neill
Chronic lung diseases (CLDs) including cystic fibrosis, asthma, chronic obstructive pulmonary disease (COPD), and other types of bronchiectasis represent a major challenge for health care . Chronic infection and inflammation of the airways are the leading causes of morbidity and mortality in CLD . Pulmonary exacerbations are a major cause of morbidity and decreased quality of life for patients with chronic lung diseases .
Exhaled breath analysis has enormous potential as an easy, non invasive means of monitoring inflammation and oxidative stress in the airway . CO represents a product of endogenous metabolic processes whose presence on exhaled breath is considered as indices of inflammatory processes . Exhaled Co not only can be used as an oxidative stress marker, but also can reflect the severity of chronic lung diseases (CLD). Also exhaled CO could serve as an indicator of acute exacerbations in children with CLD .
The present study aimed to detect the diagnostic value of carbon monoxide (CO) as inflammatory marker for early detection of acute exacerbation of chronic lung diseases.
Case control study was carried at the Chest Clinic, Children's hospital, Ain Sham University in the period from April 2010 to February 2011.
The present study was carried out on forty (40) children with chronic lung diseases including bronchiectasis, interstitial lung disease, and cystic fibrosis their ages ranged from 5 to 17 years with a mean age 9.98 ± 3.29 years, twenty to four (60%) were males and sixteen (40%) were females. Twenty were in exacerbation (group I); they were 11 (55%) males and 9 (45%) females. Their ages ranged from 5 to 17 years with a mean age 9.98 ± 3.29 years. Criteria for pulmonary exacerbation were considered the presence of one or more of the following symptoms: increased cough, increased sputum production, change in the quality of the sputum (more purulent, increased thickness, or presence of blood), increased dyspnea, pleuritic chest pain, wheezing, increase of C-reactive protein (CRP), and worsening of FEV1% . Twenty patients were not fulfilling these criteria and were considered to be in quiescent period (group II); they were 14 (70%) males and 6 (30%) females. Their ages ranged from 5 to 17 years with a mean age 10.58 ± 3.44 years. Another twenty healthy age- and sex- matched children without evidence of infection were included as a control group (group III), (50% males and 50% females with a mean age 7.65 ± 2.323 years).
Informed consents were taken from parents or care givers of studied children. The local pediatric board ethically approved the study.
Patients with diseases that may affect exhaled CO as bronchial asthma, tuberculosis, and diabetes mellitus were excluded from the study.
All patients were subjected to careful history taking, through clinical examination laying stress on chest examination; laboratory investigations: complete blood with total and differential picture using coulter counter (T660), erythrocyte sedimentation rate by Westergren method and C-reactive protein (CRP) using latex agglutination, radiological investigations including chest X-rays and CT scan and spirometric pulmonary function testing for selected cases.
Exhaled Carbon Monoxide (CO) Measurement
Exhaled CO levels were measured by portable breath CO monitor (Bedfont Scientific piCO+ Smokerlyzer (Pico+), UK). The Smokerlyzer measures breath CO levels in parts per million (ppm) based on the conversion of CO to CO2 over catalytically active electrode.
The subjects under the study were asked to inhale deeply and hold their breath for 15 seconds then they were asked to blow slowly into mouthpiece, aiming to empty lungs completely. The procedure was repeated two times, with 1 min of normal breathing between each time, and the mean value was used for analysis. During the procedure, the nose of the subjects was clamped. This was done to remove any contribution from the paranasal sinuses to the exhaled CO levels. The ppm and equivalent % carboxyhemoglobin (CoHb) level were measured and appeared on the display monitor.
Collected data were entered in a PC (personal computer) using SPSS program (statistical package for social science) version (16) to be analyzed as follows: quantitative variables as mean (SD) and range, qualitative variables as number and percentage. Chi-Square test X2, ANOVA, unpaired (Student's) t-test, and correlation coefficient test were performed. P values less than 0.05 were considered statistically significant. ROC curve was used to assess cut-off value, specificity, and sensitivity.
Symptoms of exacerbation among group I (n = 20) were cough, fever, and dyspnea on exertion in 100% of patients, increased sputum 95%, and dyspnea at rest 85%. Laboratory investigations showed that total leucocytic count mean values were 14.76 ± 1.179 cells (×1000/cc). Erythrocyte sedimentation rate in the first-hour (ESR) mean values were 15.85 ± 7.177 (mm/hr). C-reactive protein (CRP) mean values were 23.40 ± 10.465 (mg/L). The mean value of FEV1% was 66.070 ± 10.265.
In contrast to group II (n = 20), total leucocytic count mean values were 9.55 ± 1.22 cells (×1000/cc). Erythrocyte sedimentation rate first-hour (ESR) mean values were 5.47 ± 1.17 (mm/hr). The mean values of FEV1% were 81.435 ± 5.978. These results were statistically significant as increase in mean values of group I when compared to group II. The mean level of exhaled CO among the three studied groups (I, II, and III) was (5.35, 2.65, and 1.3, resp.). This showed a highly statistically significant difference among the three studied groups (P < 0.05) Table 1.
Correlation coefficient test showed a statistically significant negative correlation between eCO levels and pulmonary function data (FEV1, FVC, FEV1/FVC ratio) in both group I and group II.
The severity score done in patients with exacerbation (group I) according to Kanga et al.  was negatively correlated with FEV1% and FVC% and positively correlated with the level of exhaled CO in patients of group I which agreed with Kanga et al. .
ROC curve showed that the cutoff value of exhaled Co which discriminates between cases and control is 1.5 (ppm) with sensitivity of 100% and specificity of 70% and the cutoff value which discriminates between group I (exacerbation group) and group II (quiescent group) is 3 (ppm) with sensitivity of 100% and specificity of 100%.
Chronic lung disease (CLD) is a major cause of morbidity and mortality and represents substantial economic and social burden throughout the world . Neutrophilic inflammation and infection lead to injury and breakdown of airway matrix constituents . Inflammation is triggered by inflammatory events as infection or hypersensitivity. Pulmonary exacerbations are a major cause of morbidity and decreased quality of life for patients with chronic lung diseases (CLD) . In the last decade, there has been an increased application of exhaled breath analysis, either considering exhaled gases or exhaled condensates. Exhaled breath analysis has enormous potential as an easy, non invasive means of monitoring inflammation and oxidative stress in the airway . CO represent a product of endogenous metabolic processes whose presence on exhaled breath may fluctuate with systemic, pulmonary, or airway inflammation, and therefore have been proposed as indices of disease states involving inflammatory processes .
Patients' age (n = 40) ranged between 5 to 17 years with a mean age 9.98 ± 3.29 years and this was needed for patients cooperation in performance of pulmonary function testing and CO analysis test which agreed with Freire et al. (2008) .
A statistically significant decrease was found in mean values of weight centile for age and sex and height centile for age and sex in patients of group I and patients of group II when compared to control group. This was explained by increased metabolic demand due to chronic illness and chronic lung infection and agreed with Alves et al. (2007) and Rabin et al. (2004) [12, 13].
A statistically significant increase was found in percentage of patients with expectoration, dyspnea at rest, dyspnea on exertion, and fever in patients of group I compared to group II. Also a statistically significant increase was found in percentage of ronchi (sibilant, sonorous), crepitations (fine, coarse), diminished air entry, and respiratory rate (normal rate, tachypnea) in patients of group I when compared to group II. This came in agreement with the criteria of pulmonary exacerbations by Kapur et al. (2012) .
In agreement with Kapur et al. (2012), Eichler et al. (1999), Tanrikulu et al. (2010), and El-Seify et al. (2011) [14–17], a statistically significant increase in mean values of CRP, ESR, and TLC in patients of group I when compared to group II were found.
Regarding pulmonary function tests results, patients of group I and group II had a statistically significant lower FEV1% and FVC% mean values when compared to control group which came in accordance to Sanders et al. (2011) and Kapur et al. (2012) [14, 18].
Statistically significant higher mean values of exhaled CO were found in patients of group I followed by patients of group II then control group (5.35, 2.65, 1.3 ppm, resp.). These data agreed with Antuni et al. (2000) and Babusikova et al. (2008) [6, 19].
Statistically significant negative correlation was found between eCO level and pulmonary function data (FEV1% and FVC %) in patients of group I and group II. This came in accordance with Antuni et al. (2000) and Babusikova et al. (2008) [6, 19].
The severity score done in patients with exacerbation according to Kanga et al. (1999)  was negatively correlated to FEV1%, FVC%. These results agreed with Kanga et al. (1999). Also, the severity score was positively correlated with the level of exhaled CO in patients of group I.
The cutoff value of exhaled CO which discriminates between cases and control is 1.5 (ppm) with sensitivity of 100% and specificity of 70% and the cutoff value which discriminates between group I (exacerbation group) and group II (quiescent group) is 3 (ppm) with sensitivity of 100% and specificity of 100%.
These findings suggested that increased eCO level may be an indicator of acute exacerbations in children with CLD and can be used as a simple method for monitoring disease progression.
Exhaled CO analysis can be considered as a non invasive marker of inflammation for early detection of acute exacerbation of chronic lung diseases. Further studies about exhaled carbon monoxide as a prognostic marker to assess exacerbation and the degree of inflammation in patients with chronic lung diseases are required for deciding the plan of the treatment.
|1.||Horváth I,Gajdócsy R. Exhaled carbon monoxide in airway diseases: from research findings to clinical relevanceJournal of Breath ResearchYear: 2010442-s2.0-78649879857047102|
|2.||Zhao J,Schloss PD,Kalikin LM,et al. Decade-long bacterial community dynamics in cystic fibrosis airwaysProceedings of the National Academy of SciencesYear: 20121091558095814|
|3.||Goss CH,Burns JL. Exacerbations in cystic fibrosis·1: epidemiology and pathogenesisThoraxYear: 20076243603672-s2.0-3414721599517387214|
|4.||Gerritsen WBM,Asin J,Zanen P,van den Bosch JMM,Haas FJLM. Markers of inflammation and oxidative stress in exacerbated chronic obstructive pulmonary disease patientsRespiratory MedicineYear: 200599184902-s2.0-1094424784515672854|
|5.||Hoffman LA,Choi J,Rodway GW,Sethi JM. Markers of lung disease in exhaled breath: nitric oxideBiological Research for NursingYear: 2006742412552-s2.0-3364646144216581895|
|6.||Babusikova E,Jesenak M,Durdik P,Dobrota D,Banovcin P. Exhaled carbon monoxide as a new marker of respiratory diseases in childrenJournal of Physiology and PharmacologyYear: 20085969172-s2.0-6454916368719218629|
|7.||Grasemann H,Ioannidis I,Tomkiewicz RP,De Groot H,Rubin BK,Ratjen F. Nitric oxide metabolites in cystic fibrosis lung diseaseArchives of Disease in ChildhoodYear: 199878149532-s2.0-00319567599534676|
|8.||Kanga J,Kuhn R,Craigmyle L,Haverstock D,Church D. Cystic fibrosis clinical score: a new scoring system to evaluate acute pulmonary exacerbationClinical TherapeuticsYear: 1999218134313562-s2.0-003287051810485506|
|9.||Halpin DMG,Tashkin DP. Defining disease modification in chronic obstructive pulmonary diseaseJournal of Chronic Obstructive Pulmonary DiseaseYear: 2009632112252-s2.0-7035045549219811377|
|10.||Laguna TA,Wagner BD,Starcher B,et al. Urinary desmosine: a biomarker of structural lung injury during CF pulmonary exacerbationPediatric PulmonologyYear: 201247985686322431382|
|11.||Freire ID,De Abreu E Silva FA,De Araújo MÂ. Comparison among pulmonary function test results, the Shwachman-Kulczycki score and the Brasfield score in patients with cystic fibrosisJornal Brasileiro de PneumologiaYear: 20083452802872-s2.0-4534909640218545823|
|12.||Alves CDAD,Aguiar RA,Alves ACS,Santana MA. Diabetes mellitus in patients with cystic fibrosisJornal Brasileiro de PneumologiaYear: 20073322132212-s2.0-3484889308517724542|
|13.||Rabin HR,Butler SM,Wohl MEB,et al. Pulmonary exacerbations in cystic fibrosisPediatric PulmonologyYear: 20043754004062-s2.0-244248084615095322|
|14.||Kapur N,Masters IB,Morris PS,Galligan J,Ware R. Defining pulmonary exacerbation in children with non-cystic fibrosis bronchiectasisPediatric PulmonologyYear: 20124768752-s2.0-7996115488621830316|
|15.||Eichler I,Nilsson M,Rath R,Enander I,Venge P,Koller DY. Human neutrophil lipocalin, a highly specific marker for acute exacerbation in cystic fibrosisEuropean Respiratory JournalYear: 1999145114511492-s2.0-003272087310596704|
|16.||Tanrikulu AC,Abakay A,Evliyaoglu O,Palanci Y. Coenzyme Q10, Copper, Zinc, and Lipid Peroxidation levels in serum of patients with chronic obstructive pulmonary diseaseBiological Trace Element ResearchYear: 20106596672-s2.0-7814934100121080098|
|17.||El-Seify MY,Kamel TA,El-Mogy MI,Ossman SH. Serum human neutrophil lipocalin in pediatric chronic lung diseases: a novel marker of ongoing neutrophilic inflammationEgyptian Journal of BronchologyYear: 201151|
|18.||Sanders DB,Bittner RCL,Rosenfeld M,Redding GJ,Goss CH. Pulmonary exacerbations are associated with subsequent FEV1 decline in both adults and children with cystic fibrosisPediatric PulmonologyYear: 20114643934002-s2.0-7995275357920967845|
|19.||Antuni JD,Kharitonov SA,Hughes D,Hodson ME,Barnes PJ. Increase in exhaled carbon monoxide during exacerbations of cystic fibrosisThoraxYear: 20005521381422-s2.0-003410830710639532|
Previous Document: A high dose intravenous immunoglobulin therapy for women with four or more recurrent spontaneous abo...
Next Document: CT Imaging of Coronary Stents: Past, Present, and Future.