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Clinical Investigations: PULMONARY FIBROSIS |

Exhaled Nitric Oxide Is Increased in Active Fibrosing Alveolitis*

Paolo Paredi, MD; S. A. Kharitonov, MD, PhD; S. Loukides, MD; P. Pantelidis, PhD; R. M. du Bois, MD; Peter J. Barnes, MA, DM, DSc
Author and Funding Information

*From the Departments of Thoracic Medicine (Drs. Paredi, Kharitonov, Loukides, and Barnes) and Occupational & Environmental Medicine (Drs. Pantelidis and du Bois), Imperial College School of Medicine at the National Heart and Lung Institute, London, UK. Supported by grants from the IRCCS University Respiratory Hospital Milan (Italy) and the British Lung Foundation (UK).

Correspondence to: Peter J. Barnes, MA, DM, DSc, Department of Thoracic Medicine, National Heart and Lung Institute, Dovehouse Street, London SW3 6LY, UK; e-mail: p.j.barnes@ic.ac.uk



Chest. 1999;115(5):1352-1356. doi:10.1378/chest.115.5.1352
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Study objectives: Interstitial inflammation is a major aggravating factor in fibrosing lung disease associated with scleroderma (FASSc) and cryptogenic fibrosing alveolitis (CFA). Exhaled nitric oxide (NO) production is increased in asthma and bronchiectasis and reflects the degree of inflammation. We investigated whether measuring levels of exhaled NO is valuable in assessing disease activity in patients with CFA and patients with FASSc.

Measurements and results: NO levels were measured in 11 patients with CFA (mean age ± SEM, 58 ± 12 years old; 5 were male) and 17 patients with FASSc (mean age, 48 ± 9 years old; 5 were male), and they were compared to BAL cell counts and lung function. Patients with CFA and FASSc had elevated NO levels (11.2 ± 1.0 parts per billion [ppb] and 9.8 ± 1.0 ppb, respectively; p > 0.05), whereas in a group of 13 nonsmoking normal subjects, the NO levels were not elevated (6.9 ± 0.5 ppb; p < 0.05). Patients with FASSc (n = 8) who had active BAL (defined as either lymphocytes > 14%, neutrophils > 4%, or eosinophils > 3%) had significantly higher NO levels (13.2 ± 1.8 ppb), and neutrophil (16.5 ± 4.0%) and lymphocyte (26.8 ± 3.4%) BAL cell counts than did patients with FASSc who had inactive BAL (6.7 ± 1.2 ppb; 1.3 ± 1.0% and 7.5 ± 1.3%, respectively; p < 0.05). There was a significant correlation between exhaled NO and lymphocyte cell count in patients with FASSc (r = 0.58; p < 0.05). All patients with CFA had active BAL; however, those treated with corticosteroids (12.9 ± 1.0% ppb, p < 0.05) had lower NO levels (9.0 ± 1 ppb) and higher BAL lymphocyte cell counts (16.6 ± 2.0%) than did those not treated with corticosteroids (7.2 ± 1.7%; p < 0.05).

Conclusions: We conclude that exhaled NO may be a useful addition to BAL cell counts in disease monitoring.

Abbreviations: CFA = cryptogenic fibrosing alveolitis, FASSc = fibrosing alveolitis associated with scleroderma; iNOS = inducible form of nitirc oxide synthase; NO = nitric oxide; ppb = parts per billion; TLCO = total lung transfer for CO

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