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Original Research: EXHALED NITRIC OXIDE |

Airway Nitric Oxide in Patients With Cystic Fibrosis Is Associated With Pancreatic Function, Pseudomonas Infection, and Polyunsaturated Fatty Acids*

Christina Keen, MD; Anna-Carin Olin, MD, PhD; Asa Edentoft, MD; Eva Gronowitz, PhD; Birgitta Strandvik, MD, PhD
Author and Funding Information

*From the Departments of Pediatrics (Drs. Keen, Edentoft, Gronowitz, and Strandvik) and Occupational and Environmental Medicine (Dr. Olin), Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.

Correspondence to: Christina Keen, MD, Department of Pediatrics, Queen Silvia Children’s Hospital, S-416 85 Göteborg, Sweden; e-mail: Christina.keen@vgregion.se



Chest. 2007;131(6):1857-1864. doi:10.1378/chest.06-2635
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Background: Airway nitric oxide (NO) is low or normal in cystic fibrosis (CF) patients. This may affect bacterial status since NO has antimicrobial properties. Arachidonic acid (AA), which is increased in the serum and airways of CF patients, has been shown to reduce NO levels. The aim of this study was to investigate whether airway NO level correlates with genotype and pancreatic function, and whether low airway NO level is associated with bacterial infection and increased serum AA level in CF patients.

Method: Nasal NO (nNO) and exhaled NO (eNO) were measured according to the European Respiratory Society/American Thoracic Society standard in 59 CF patients aged 7 to 55 years, 80% of whom were pancreatic insufficient (PI) and 51% were chronically infected with Pseudomonas aeruginosa.

Results: PI CF patients had significantly lower nNO levels than pancreatic-sufficient (PS) patients. Airway NO level did not correlate with lung function or inflammatory parameters. PI patients chronically infected with P aeruginosa had significantly lower nNO levels than noninfected PI patients. nNO level correlated inversely with the AA/docosahexaenoic acid ratio, and eNO with the essential fatty acid (FA) deficiency index, which is the ratio between mead acid and AA.

Conclusions: CF patients with PI, which is associated with more severe genotypes, had lower airway NO levels than patients with PS. Low NO level was correlated to chronic P aeruginosa infection, and an association was found between airway NO level and the abnormal serum phospholipid FA pattern.

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