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Original Research: ASTHMA |

Differential Flow Analysis of Exhaled Nitric Oxide in Patients With Asthma of Differing Severity*

Caterina Brindicci, MD; Kazuhiro Ito, PhD; Peter J. Barnes, DM, DSc, FCCP; Sergei A. Kharitonov, MD, PhD
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*From the Section of Airway Diseases, National Heart and Lung Institute, Imperial College, London, UK.

Correspondence to: Sergei A. Kharitonov, MD, PhD, Section of Airway Disease, National Heart and Lung Institute, Imperial College, Dovehouse St, London, SW3 6LY, UK; e-mail: s.kharitonov@imperial.ac.uk



Chest. 2007;131(5):1353-1362. doi:10.1378/chest.06-2531
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Background: The majority of asthmatic patients achieve control of their illness; others do not. It is therefore crucial to validate/develop strategies that help the clinician monitor the disease, improving the response to treatment.

Methods: We have quantified the inflammation in central and peripheral airways by measuring exhaled nitric oxide (NO) at multiple exhalation flows in 56 asthmatics at different levels of severity (mild, n = 10; moderate stable, n = 17; moderate during exacerbation, n = 11; severe, n = 18, 7 of whom were receiving oral corticosteroids) and 18 healthy control subjects. The reproducibility of the measurement was also assessed.

Results: Bronchial NO (Jno) in patients with mild asthma (2,363 ± 330 pL/s) [mean ± SD] was higher than in patients with moderate stable asthma (1,300 ± 59 pL/s, p < 0.0005), in patients with severe asthma receiving inhaled corticosteroids (ICS) [1,015 ± 67 pL/s, p < 0.0005], and healthy control subjects (721 ± 22 pL/s, p < 0.0001). There were no differences between Jno in patients with mild asthma compared to patients with severe asthma receiving ICS and oral corticosteroids (2,225 ± 246 pL/s). Patients with exacerbations showed a higher Jno (3,475 ± 368.9 pL/s, p < 0.05) compared to the other groups. Alveolar NO was higher in patients with severe asthma receiving oral corticosteroids (3.0 ± 0.1 parts per billion [ppb], p < 0.0001) than in the other groups but was not significantly higher than in patients with moderate asthma during exacerbation (2.8 ± 0.3 ppb). No differences were seen in NO diffusion levels between the different asthma groups. All the measurements were highly reproducible and free of day-to-day and diurnal variations.

Conclusions: Differential flow analysis of exhaled NO provides additional information about the site of inflammation in asthma and may be useful in assessing the response of peripheral inflammation to therapy.

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