Journal of Shanghai Jiao Tong University (Medical Science) >

2023 , Vol. 43 >Issue 6: 673 - 679

DOI: https://doi.org/10.3969/j.issn.1674-8115.2023.06.003

Pediatric asthma column

Clinical study of exhaled nitric oxide in children with asthma and allergic rhinitis

  • Pengyun LI ,
  • Yinfang DAI ,
  • Yanhong LU ,
  • Xingmei YU ,
  • Lina XU ,
  • Wujianfeng DI ,
  • Chuangli HAO
Expand
  • 1.Department of Respiratory, Children's Hospital of Soochow University, Suzhou 215002, China
    2.Department of Pediatrics, Xunyi County Hospital, Shaanxi Province, Xunyi 711300, China
HAO Chuangli, E-mail: hcl_md@163.com.

Received date: 2023-02-28

  Accepted date: 2023-06-01

  Online published: 2023-06-28

Supported by

Suzhou Science and Technology Development Plan Medical Device and New Medicine (Clinical Trial)-Medical and Industrial Cooperation Innovation Research Project(SLJ201905);Yili Kazak Autonomous Prefecture Science and Technology Plan Project(yl2020lh03);Medical and Health Science and Technology Plan Projects Directly under Ili Prefecture(YZ2021YD029);Suzhou "Clinical Medicine Expert Team" Introduction Project(SZYJTD201806)

Fold

Abstract

Objective ·To determine the levels of nasally exhaled nitric oxide (FnNO) combined with fractional concentration of exhaled nitric oxide (FeNO) in children with asthma (AS) complicated with allergic rhinitis (AR), and analyze the levels of FnNO and FeNO in different clinical stages of AS with different severities of AR, so as to provide basis for guiding clinical diagnosis and treatment. Methods ·Children diagnosed with AR with AS in the Department of Respiratory and Otolaryngology of Children's Hospital of Soochow University from April 2021 to November 2021 were included, and healthy children who visited the Department of Pediatrics for normal physical examination during the same period were enrolled as the control group. FeNO and FnNO were measured in all children to assess the severity of the children's diseases. The levels of FeNO and FnNO in children with AR and AS at different clinical stages of AS and their correlation with pulmonary function were compared and analyzed. Results ·The proportion of persistent moderate-to-severe rhinitis was higher in the acute exacerbation stage of AS, and the proportion of intermittent mild rhinitis was higher in the clinical remission stage of AS. The FeNO level in the acute exacerbation stage were higher than that in the chronic persistent stage and clinical remission stage of AS (adjusted P=0.022, 0.000), and higher in the chronic persistent stage than that in the clinical remission stage of AS (adjusted P=0.002). The FnNO level in the acute exacerbation stage was higher than that in the clinical remission stage of AS (adjusted P=0.044). In the chronic persistent stage of AS, the FnNO levels in the persistent mild group and persistent moderate-to-severe control group were higher than those in the intermittent mild group (adjusted P=0.001, 0.000). In the clinical remission stage of AS, the FnNO levels in the persistent mild group and persistent moderate to severe control group were higher than those in the intermittent mild group (adjusted P=0.001, 0.007). In the intermittent mild group of AR, the FnNO levels in the acute exacerbation stage were higher than those in the chronic persistent stage and clinical remission stage of AS (adjusted P=0.010, 0.019). Part of pulmonary functions in the acute exacerbation stage of AS children were negatively correlated with the FeNO and FnNO levels (all P<0.05), while FEV1/pred in the chronic persistent stage was negatively correlated with FeNO level (P=0.010). Conclusion ·FeNO and FnNO levels increased in the acute exacerbation stage of AS, and symptom scores of AR also increased. FeNO and FnNO levels were negatively correlated with pulmonary function in AS with AR children.

Key words： asthma (AS); allergic rhinitis (AR); exhaled nitric oxide; children

Cite this article

Pengyun LI , Yinfang DAI , Yanhong LU , Xingmei YU , Lina XU , Wujianfeng DI , Chuangli HAO . Clinical study of exhaled nitric oxide in children with asthma and allergic rhinitis[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023 , 43(6) : 673 -679 . DOI: 10.3969/j.issn.1674-8115.2023.06.003

References

1 COMPALATI E, RIDOLO E, PASSALACQUA G, et al. The link between allergic rhinitis and asthma: the united airways disease[J]. Expert Rev Clin Immunol, 2010, 6(3): 413-423.
2 SAMITAS K, CARTER A, KARIYAWASAM H H, et al. Upper and lower airway remodelling mechanisms in asthma, allergic rhinitis and chronic rhinosinusitis: the one airway concept revisited[J]. Allergy, 2018, 73(5): 993-1002.
3 MENER D J, LIN S Y. Improvement and prevention of asthma with concomitant treatment of allergic rhinitis and allergen-specific therapy[J]. Int Forum Allergy Rhinol, 2015, 5(Suppl 1): S45-S50.
4 中华儿科杂志编辑委员会, 中华医学会儿科学分会呼吸学组, 中国医师协会儿科医师分会儿童呼吸专业委员会. 儿童支气管哮喘规范化诊治建议(2020年版)[J]. 中华儿科杂志, 2020, 58(9): 708-717.
4 The Editorial Board, Chinese Journal of Pediatrics, the Subspecialty Group of Respiratory Diseases, the Society of Pediatrics, Chinese Medical Association, the Children's Respiratory Professional Committee, the Society of Pediatrics of Chinese Medical Doctor Association. Recommendations for diagnosis and management of bronchial asthma in children (2020)[J]. Chinese Journal of Pediatrics, 2020, 58(9): 708-717.
5 《中华耳鼻咽喉头颈外科杂志》编辑委员会鼻科组,中华医学会耳鼻咽喉头颈外科学分会鼻科学组、小儿学组,《中华儿科杂志》编辑委员会. 儿童变应性鼻炎诊断和治疗的专家共识 (2010年,重庆)[J]. 中华儿科杂志, 2011, 49(2): 116-117.
5 The Subspecialty Group of Rhinology, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery, Subspecialty Group of Rhinology and Pediatrics, Dociety of Otprhinolaryngology Head and Neck Surgery, Chinese Medical Association, Editorial Board of Chinese Journal of Pediatrics. Guidelines for diagnosis and treatment of pediatric allergic rhinitis(2010, Chongqing)[J]. Chinese Journal of Pediatrics, 2011, 49(2): 116-117.
6 DWEIK R A, BOGGS P B, ERZURUM S C, et al. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FeNO) for clinical applications[J]. Am J Respir Crit Care Med, 2011, 184(5): 602-615.
7 ANTOSOVA M, MOKRA D, PEPUCHA L, et al. Physiology of nitric oxide in the respiratory system[J]. Physiol Res, 2017, 66(Suppl 2): S159-S172.
8 RIMMER J, HELLINGS P, LUND V J, et al. European position paper on diagnostic tools in rhinology[J]. Rhinology, 2019, 57(Suppl S28): 1-41.
9 LIPWORTH B, KUO C R, CHAN R. 2020 updated asthma guidelines: clinical utility of fractional exhaled nitric oxide (FeNO) in asthma management[J]. J Allergy Clin Immunol, 2020, 146(6): 1281-1282.
10 CINELLI M A, DO H T, MILEY G P, et al. Inducible nitric oxide synthase: regulation, structure, and inhibition[J]. Med Res Rev, 2020, 40(1): 158-189.
11 MATSUNAGA K, KUWAHIRA I, HANAOKA M, et al. An official JRS statement: the principles of fractional exhaled nitric oxide (FeNO) measurement and interpretation of the results in clinical practice[J]. Respir Investig, 2021, 59(1): 34-52.
12 吴琳琳, 黄晗, 叶乐平. 学龄期儿童哮喘检测呼出气一氧化氮、肺功能及外周血嗜酸性粒细胞的价值[J]. 临床肺科杂志, 2021, 26(10): 1501-1506.
12 WU L L, HUANG H, YE L P. Value of exhaled nitric oxide,pulmonary function and peripheral blood eosinophils in school-age children with asthma[J]. Journal of Clinical Pulmonary Medicine, 2021, 26(10): 1501-1506.
13 王婧婧. 呼出气一氧化氮检测在儿童支气管哮喘中的应用[J]. 健康大视野, 2020(15): 8.
13 WANG J J. Fractional exhaled nitric oxide for childhood bronchial asthma[J]. Healthy Vision, 2020(15): 8.
14 MOELLER A, CARLSEN K H, SLY P D, et al. Monitoring asthma in childhood: lung function, bronchial responsiveness and inflammation[J]. Eur Respir Rev, 2015, 24(136): 204-215.
15 MENZIES-GOW A, MANSUR A H, BRIGHTLING C E. Clinical utility of fractional exhaled nitric oxide in severe asthma management[J]. Eur Respir J, 2020, 55(3): 1901633.
16 XIE Z C, CHAI M R, GU W Q, et al. Changes in fractional exhaled nitric oxide, exhaled carbon monoxide and pulmonary function during the acute attack, treatment and remission phases of pediatric asthma[J]. Transl Pediatr, 2020, 9(6): 784-794.
17 KONRADSEN J R, SKANTZ E, NORDLUND B, et al. Predicting asthma morbidity in children using proposed markers of Th2-type inflammation[J]. Pediatr Allergy Immunol, 2015, 26(8): 772-779.
18 MOGENSEN I, ALVING K, JACINTO T, et al. Simultaneously elevated FeNO and blood eosinophils relate to asthma morbidity in asthmatics from NHANES 2007-12[J]. Clin Exp Allergy, 2018, 48(8): 935-943.
19 DE GOUW H W, HENDRIKS J, WOLTMAN A M, et al. Exhaled nitric oxide (NO) is reduced shortly after bronchoconstriction to direct and indirect stimuli in asthma[J]. Am J Respir Crit Care Med, 1998, 158(1): 315-319.
20 HO L P, WOOD F T, ROBSON A, et al. The Current single exhalation method of measuring exhales nitric oxide is affected by airway calibre[J]. Eur Respir J, 2000, 15(6): 1009-1013.
21 VAN MUYLEM A, MALINOVSCHI A, HACCURIA A, et al. Exhaled nitric oxide and its predictive power related to lung function and bronchial inflammation[J]. Biochem Pharmacol, 2020, 179: 114101.
22 HACCURIA A, VAN MUYLEM A, MALINOVSCHI A, et al. Small airways dysfunction: the link between allergic rhinitis and allergic asthma[J]. Eur Respir J, 2018, 51(2): 1701749.
23 CRYSTAL-PETERS J, NESLUSAN C, CROWN W H, et al. Treating allergic rhinitis in patients with comorbid asthma: the risk of asthma-related hospitalizations and emergency department visits[J]. J Allergy Clin Immunol, 2002, 109(1): 57-62.
24 CORREN J, MANNING B E, THOMPSON S F, et al. Rhinitis therapy and the prevention of hospital care for asthma: a case-control study[J]. J Allergy Clin Immunol, 2004, 113(3): 415-419.
25 ADAMS R J, FUHLBRIGGE A L, FINKELSTEIN J A, et al. Intranasal steroids and the risk of emergency department visits for asthma[J]. J Allergy Clin Immunol, 2002, 109(4): 636-642.
26 KHAN D A. Allergic rhinitis and asthma: epidemiology and common pathophysiology[J]. Allergy Asthma Proc, 2014, 35(5): 357-361.
27 BOUSQUET J, ANTO J M, BACHERT C, et al. Allergic rhinitis[J]. Nat Rev Dis Primers, 2020, 6(1): 95.
28 RICCA V, LANDI M, FERRERO P, et al. Minimal persistent inflammation is also present in patients with seasonal allergic rhinitis[J]. J Allergy Clin Immunol, 2000, 105(1 Pt 1): 54-57.
29 GREVE J M, DAVIS G, MEYER A M, et al. The major human rhinovirus receptor is ICAM-1[J]. Cell, 1989, 56(5): 839-847.
Options
Outlines

/

〈 〉