Pediatr Allergy Respir Dis.  2012 Sep;22(3):282-291.

Relationships between Fraction of Nitric Oxide, Airway Hyperresponsiveness, Blood Eoshinophil Counts and Serum Eosinophil Cationic Protein in Asthmatic Children

• Seo HS
• Chung BH
• Park HN
• Seo SC
• Siegfried
• Song DJ
• Choung JT
• Yoo Y

Abstract

PURPOSE
The measurement of fraction of nitric oxide (FeNO) is a noticeable tool that reflects airway inflammation in asthmatic patients. We wanted to find out the relationship between pulmonary function, bronchial hyperresponsiveness (AHR), blood eosinophilic inflammatory markers and FeNO level before and after methacholine bronchoprovocation test in asthmatic patients.
METHODS
Fifty-five children, who visited the Allergy Clinic of Korea University Anam Hospital from March 2011 to February 2012, due to asthmatic symptoms, such as history of episodic wheezing or dyspnea during the previous year and resolved after using bronchodilators, were enrolled. We performed the baseline pulmonary function and methacholine bronchoprovocation test in the enrolled patients. Blood eosinophil counts and blood eosinophil cationic protein (ECP) were measured. FeNO levels were measured before and after the methacholine bronchoprovocation test.
RESULTS
The mean FeNO levels (36.3 ppb) fell after methacholine bronchoprovocation test (25.7 ppb). Forced expiratory volume in one second (FEV1) %pred inversely correlated both with FeNO level before (R2=0.07, P=0.029) and after (R2=0.059, P=0.01) methacholine bronchoprovocation test. The provocative concentration, causing a 20% decrease in FEV1 to methacholine (methacholine PC20) inversely correlated both with FeNO levels before (R2=0.086, P=0.001) and after (R2=0.141, P=0.001) the challenge. FeNO level measured at bronchoconstriction state significantly correlated with blood eosinophil counts (R2=0.112, P=0.028). Serum ECP levels correlated FeNO level, neither before nor after bronchoprovocation.
CONCLUSION
The baseline FeNO levels were higher in asthmatic children. However, FeNO levels rather decreased after methacholine induced bronchoconstriction. Repeated spirometry maneuver was considered to have an effect on reducing FeNO levels. FeNO correlated with pulmonary function, airway AHR and blood eosinophil counts.

Keyword

Asthma; Methacholine bronchoprovocation; Airway hyperresponsiveness; FeNO; Blood eosinophils; ECP

MeSH Terms

Asthma
Bronchoconstriction
Bronchodilator Agents
Child
Dyspnea
Eosinophil Cationic Protein
Eosinophils
Forced Expiratory Volume
Humans
Hypersensitivity
Inflammation
Korea
Methacholine Chloride
Nitric Oxide
Respiratory Sounds
Spirometry
Bronchodilator Agents
Eosinophil Cationic Protein
Methacholine Chloride
Nitric Oxide

Figure

• 

  Fig. 1 Fraction of exhaled nitric oxide (FeNO) concentrations in before and after methacholine (MCh) challenge. Geometric mean values are represented by the longer horizontal bars, and 1 SD ranges represented by the quadrangles. Maximum values and minimum values are represented by the shorter horizontal bars.

• 

  Fig. 2 Correlation between fraction of exhaled nitric oxide (FeNO) concentrations and FEV1%pred. FeNO values were correlated negatively with FEV1%pred before (R2=0.07, P=0.029) and after methacholine (MCh) challenge. (R2=0.059, P=0.01) FEV1, forced expiratory volume in one second.

• 

  Fig. 3 Correlation between fraction of exhaled nitric oxide (FeNO) concentrations and methacholine (MCh) PC20. FeNO values were correlated negatively with PC20 before (R2=0.086, P=0.001) and after MCh challenge.(R2=0.141, P=0.001)

• 

  Fig. 4 Correlation between fraction of exhaled nitric oxide (FeNO) concentrations and blood eosinophils. FeNO values were correlated positively with blood eosinophils after methacholine (MCh) challenge (R2=0.112, P=0.028) but were not correlated with blood eosinophils before MCh challenge.(R2=0.082, P=0.211)

• 

  Fig. 5 Correlation between fraction of exhaled nitric oxide (FeNO) concentrations and blood eosinophil cationic protein (ECP). FeNO values were not correlated with blood ECP before (R2=0.0001, P=0.549) and after MCh challenge.(R2=0.014, P=0.203)

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