99 research outputs found

    Clinical patterns in asthma based on proximal and distal airway nitric oxide categories

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    <p>Abstract</p> <p>Background</p> <p>The exhaled nitric oxide (eNO) signal is a marker of inflammation, and can be partitioned into proximal [J'aw<sub>NO </sub>(nl/s), maximum airway flux] and distal contributions [CA<sub>NO </sub>(ppb), distal airway/alveolar NO concentration]. We hypothesized that J'aw<sub>NO </sub>and CA<sub>NO </sub>are selectively elevated in asthmatics, permitting identification of four inflammatory categories with distinct clinical features.</p> <p>Methods</p> <p>In 200 consecutive children with asthma, and 21 non-asthmatic, non-atopic controls, we measured baseline spirometry, bronchodilator response, asthma control and morbidity, atopic status, use of inhaled corticosteroids, and eNO at multiple flows (50, 100, and 200 ml/s) in a cross-sectional study design. A trumpet-shaped axial diffusion model of NO exchange was used to characterize J'aw<sub>NO </sub>and CA<sub>NO</sub>.</p> <p>Results</p> <p>J'aw<sub>NO </sub>was not correlated with CA<sub>NO</sub>, and thus asthmatic subjects were grouped into four eNO categories based on upper limit thresholds of non-asthmatics for J'aw<sub>NO </sub>(≥ 1.5 nl/s) and CA<sub>NO </sub>(≥ 2.3 ppb): Type I (normal J'aw<sub>NO </sub>and CA<sub>NO</sub>), Type II (elevated J'aw<sub>NO </sub>and normal CA<sub>NO</sub>), Type III (elevated J'aw<sub>NO </sub>and CA<sub>NO</sub>) and Type IV (normal J'aw<sub>NO </sub>and elevated CA<sub>NO</sub>). The rate of inhaled corticosteroid use (lowest in Type III) and atopy (highest in Type II) varied significantly amongst the categories influencing J'aw<sub>NO</sub>, but was not related to CA<sub>NO</sub>, asthma control or morbidity. All categories demonstrated normal to near-normal baseline spirometry; however, only eNO categories with increased CA<sub>NO </sub>(III and IV) had significantly worse asthma control and morbidity when compared to categories I and II.</p> <p>Conclusions</p> <p>J'aw<sub>NO </sub>and CA<sub>NO </sub>reveal inflammatory categories in children with asthma that have distinct clinical features including sensitivity to inhaled corticosteroids and atopy. Only categories with increase CA<sub>NO </sub>were related to poor asthma control and morbidity independent of baseline spirometry, bronchodilator response, atopic status, or use of inhaled corticosteroids.</p

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