Document Detail

Exhaled nitric oxide levels during acute asthma exacerbation.
MedLine Citation:
PMID:  15995087     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: Fractional exhaled nitric oxide (FE(NO)) has been shown in laboratory settings and trials of patients with stable asthma to correlate with the degree of airway inflammation. The authors hypothesized that the technique of measuring FE(NO) would be reproducible in the setting of acute asthma in the emergency department (ED) and that the FE(NO) results during ED visits would potentially predict disposition, predict relapse following discharge, and correlate with the National Institutes of Health (NIH) asthma severity scale and peak expiratory flow measurements. METHODS: The authors prospectively measured FE(NO) in a convenience sample of ED patients with acute exacerbations of asthma, both at the earliest possible opportunity and then one hour later. Each assessment point included triplicate measurements to assess reproducibility. The authors also performed spirometry and classified asthma severity using the NIH asthma severity scale. Discharged patients were contacted in 72 hours to determine whether their asthma had relapsed. RESULTS: The authors discontinued the trial (n = 53) after a planned interim analysis demonstrated reproducibility (coefficient of variation, 15%) substantially worse than our a priori threshold for precision (4%). There was no association between FE(NO) response and corresponding changes in spirometry or clinical scores. Areas under the receiver operating characteristic curves for the prediction of hospitalization and relapse were poor (0.579 and 0.713, respectively). CONCLUSIONS: FE(NO) measurements in ED patients with acute asthma exacerbations were poorly reproducible and did not correlate with standard measures of asthma severity. These results suggest that using existing technology, FE(NO) is not a useful marker for assessing severity, response to treatment, or disposition of acute asthmatic patients in the ED.
Michelle Gill; Scott Walker; Aqeel Khan; Steven M Green; Lillian Kim; Shaun Gray; Baruch Krauss
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Academic emergency medicine : official journal of the Society for Academic Emergency Medicine     Volume:  12     ISSN:  1553-2712     ISO Abbreviation:  Acad Emerg Med     Publication Date:  2005 Jul 
Date Detail:
Created Date:  2005-07-04     Completed Date:  2006-03-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9418450     Medline TA:  Acad Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  579-86     Citation Subset:  IM    
Department of Emergency Medicine, Loma Linda University School of Medicine, CA, USA. <>
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MeSH Terms
Acute Disease
Asthma / classification,  diagnosis*,  metabolism*
Breath Tests*
Child, Preschool
Middle Aged
Nitric Oxide / metabolism*
Prospective Studies
ROC Curve
Risk Assessment / methods
Reg. No./Substance:
10102-43-9/Nitric Oxide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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