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Original Research: ASTHMA |

Exhaled Nitric Oxide and Exhaled Breath Condensate pH in Severe Refractory Asthma

Eleni Tseliou, MD; Vasiliki Bessa, MD; Georgios Hillas, MD; Vasiliki Delimpoura, MD; Georgia Papadaki, MD; Charis Roussos, MD; Spyros Papiris, MD, FCCP; Petros Bakakos, MD; Stelios Loukides, MD, FCCP
Author and Funding Information

From the Second Respiratory Medicine Department (Drs Tseliou, Bessa, Delimpoura, Papiris, and Loukides), University of Athens Medical School, Attikon Hospital; First Respiratory Medicine Department (Drs Papadaki, Roussos, and Bakakos), University of Athens Medical School, Sotiria Chest Hospital; and Department of Respiratory and Critical Care Medicine (Dr Hillas), Research Unit, Sotiria Chest Hospital, Athens, Greece.

Correspondence to: Stelios Loukides, MD, FCCP, Smolika 2 16673, Athens, Greece; e-mail: ssat@hol.gr


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(1):107-113. doi:10.1378/chest.09-1257
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Background:  Distinct inflammatory cellular phenotypes of severe refractory asthma (SRA) have been reported. Fractional exhaled nitric oxide (FeNO) primarily is related to eosinophilic inflammation. Exhaled breath condensate (EBC) pH has been suggested as a noninvasive tool in the assessment of patients with asthma. We sought to determine whether FeNO and EBC pH could identify the presence and type of the underlying cellular inflammation in patients with SRA.

Methods:  Twenty-nine patients with SRA, 27 patients with moderate asthma, and 17 healthy subjects underwent FeNO measurement, EBC collection for pH measurement, and sputum induction for cell count identification.

Results:  FeNO was significantly higher and pH significantly lower in patients with SRA than in the other groups. In SRA, FeNO levels of > 19 parts per billion were associated with a sensitivity of 0.78 and a specificity of 0.73 for sputum eosinophilia, whereas FeNO levels of < 19 parts per billion were associated with a sensitivity of 0.63 and a specificity of 0.9 for sputum neutrophilia irrespective of the presence of eosinophils. The pH failed to predict the cellular profile in SRA, but a cutoff value of < 7.37 could predict sputum eosinophilia in moderate asthma.

Conclusions:  In patients with SRA, different FeNO threshold values can identify those with predominant eosinophilia as well as those with neutrophilia. FeNO levels were reduced in patients with predominant neutrophilia regardless of the concomitant presence of eosinophilia. Although pH could not identify the cellular profile in SRA, it seemed to be a better index for predicting eosinophilia in moderate asthma.

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