Exhaled nitric oxide levels correlate with measures of disease control in asthma.

BACKGROUND Asthma guidelines emphasize maintaining disease control. However, objective measures of asthma disease control are lacking. OBJECTIVE We sought to examine the relationship between exhaled nitric oxide (NO) levels and measures of asthma disease control versus asthma disease severity. METHODS We performed a cross-sectional study of 100 patients (age range, 7-80 years) with asthma. We administered a questionnaire to identify characteristics of asthma, performed spirometric testing before and after administration of a bronchodilator, and measured exhaled NO levels in all participants. RESULTS Exhaled NO was significantly correlated with the following markers of asthma disease control: asthma symptoms within the past 2 weeks (P =.02), dyspnea score (P =. 02), daily use of rescue medications (P =.01), and reversibility of airflow obstruction (P =.02). Exhaled NO levels were not correlated with the following markers of asthma disease severity: history of respiratory failure (P =.20), health care use (P =.08), fixed airflow obstruction (P =.91), or a validated asthma severity score (P =.19). Markers with relevance to both disease control and severity showed either a weak correlation (FEV(1) and FEV(1) percent predicted) or no correlation (controller drug use) with exhaled NO. CONCLUSION We conclude that exhaled NO levels are correlated predominantly with markers of asthma control rather than asthma severity. Monitoring of exhaled NO may be useful in outpatient asthma management.

[1]  N. Barnes,et al.  No role for NO in asthma? , 2000, The Lancet.

[2]  W. Holden,et al.  Increased exhaled nitric oxide in chronic bronchitis: comparison with asthma and COPD. , 2000, Chest.

[3]  A. Zwinderman,et al.  Effect of inhaled steroids on airway hyperresponsiveness, sputum eosinophils, and exhaled nitric oxide levels in patients with asthma , 1999, Thorax.

[4]  Nathan J. Brown,et al.  Exhaled nitric oxide measurements in a population sample of young adults. , 1999, American journal of respiratory and critical care medicine.

[5]  A. Buist,et al.  Lack of correlation of symptoms with specialist-assessed long-term asthma severity. , 1999, Chest.

[6]  K. Chung,et al.  Effect of inhaled budesonide on lung function and airway inflammation. Assessment by various inflammatory markers in mild asthma. , 1999, American journal of respiratory and critical care medicine.

[7]  A. Boner,et al.  Influence of environmental concentrations of NO on the exhaled NO test. , 1998, American journal of respiratory and critical care medicine.

[8]  M. Corradi,et al.  Influence of atmospheric nitric oxide concentration on the measurement of nitric oxide in exhaled air. , 1998, Thorax.

[9]  A. Buist,et al.  20-year trends in the prevalence of asthma and chronic airflow obstruction in an HMO. , 1998, American journal of respiratory and critical care medicine.

[10]  A. Buist,et al.  Characteristics of patients with asthma within a large HMO: A comparison by age and gender , 1998 .

[11]  K. Kubo,et al.  Eosinophil cationic protein levels in induced sputum correlate with the severity of bronchial asthma. , 1997, Chest.

[12]  S. Wenzel,et al.  Bronchoscopic evaluation of severe asthma. Persistent inflammation associated with high dose glucocorticoids. , 1997, American journal of respiratory and critical care medicine.

[13]  Third Expert Panel on theDiagnosis,et al.  Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma , 1997 .

[14]  P. Barnes,et al.  Exhaled and nasal nitric oxide measurements: recommendations. The European Respiratory Society Task Force. , 1997, The European respiratory journal.

[15]  K L Linton,et al.  Specialty differences in the management of asthma. A cross-sectional assessment of allergists' patients and generalists' patients in a large HMO. , 1997, Archives of internal medicine.

[16]  J. Dötsch,et al.  Airway nitric oxide in asthmatic children and patients with cystic fibrosis. , 1996, The European respiratory journal.

[17]  K. Chung,et al.  Increased exhaled nitric oxide in asthma is mainly derived from the lower respiratory tract. , 1996, American journal of respiratory and critical care medicine.

[18]  P. Barnes,et al.  Exhaled nitric oxide: a new lung function test. , 1996, Thorax.

[19]  D. Yates,et al.  Changes in the dose of inhaled steroid affect exhaled nitric oxide levels in asthmatic patients. , 1996, The European respiratory journal.

[20]  B. Nejadnik,et al.  Nasal contribution to exhaled nitric oxide at rest and during breathholding in humans. , 1996, American journal of respiratory and critical care medicine.

[21]  D. Yates,et al.  Inhaled glucocorticoids decrease nitric oxide in exhaled air of asthmatic patients. , 1996, American journal of respiratory and critical care medicine.

[22]  A. Buist,et al.  Use of an automated prescription database to identify individuals with asthma. , 1995, Journal of clinical epidemiology.

[23]  P. Barnes,et al.  Allergen-induced late asthmatic reactions are associated with elevation of exhaled nitric oxide. , 1995, American journal of respiratory and critical care medicine.

[24]  R O Crapo,et al.  Pulmonary-function testing. , 1994, The New England journal of medicine.

[25]  P. Enright,et al.  Physiologic measures: pulmonary function tests. Asthma outcome. , 1994, American journal of respiratory and critical care medicine.

[26]  P. J. Barnes,et al.  Increased nitric oxide in exhaled air of asthmatic patients , 1994, The Lancet.

[27]  A. Buist,et al.  Temporal trends in hospital-based episodes of asthma care in a health maintenance organization. , 1993, The American review of respiratory disease.

[28]  Alfred O. Berg,et al.  Clinical Guidelines And Primary Care Guidelines For The Diagnosis And Management Of Asthma , 2012 .

[29]  A. Miller,et al.  Lung function testing: selection of reference values and interpretative strategies. , 1992, The American review of respiratory disease.

[30]  T. Haahtela,et al.  A comparative study of the effects of an inhaled corticosteroid, budesonide, and a beta 2-agonist, terbutaline, on airway inflammation in newly diagnosed asthma: a randomized, double-blind, parallel-group controlled trial. , 1992, The Journal of allergy and clinical immunology.

[31]  P. Howarth,et al.  Effect of an inhaled corticosteroid on airway inflammation and symptoms in asthma. , 1992, The American review of respiratory disease.

[32]  S. Kelsen,et al.  Comparison of scales used to quantitate the sense of effort to breathe in patients with chronic obstructive pulmonary disease. , 1990, The American review of respiratory disease.

[33]  E. Juniper,et al.  The perception of breathlessness in asthma. , 2015, The American review of respiratory disease.

[34]  G. Borg.  Perceived exertion as an indicator of somatic stress. , 2019, Scandinavian journal of rehabilitation medicine.