The Journal of Allergy and Clinical Immunology
Volume 121, Issue 3 , Pages 705-709, March 2008

Exhaled nitric oxide distinguishes between subgroups of preschool children with respiratory symptoms

  • Alexander Moeller, MD

      Affiliations

    • Swiss Pediatric Respiratory Research Group and Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
    • Corresponding Author InformationReprint requests: Alexander Moeller, MD, Division of Respiratory Medicine, University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland.
    • ,
  • Corinne Diefenbacher, MD

      Affiliations

    • Swiss Pediatric Respiratory Research Group and Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
    • ,
  • Andrea Lehmann, MD

      Affiliations

    • Swiss Pediatric Respiratory Research Group and Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
    • ,
  • Mascha Rochat, MD

      Affiliations

    • Swiss Pediatric Respiratory Research Group and Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland
    • ,
  • Joanne Brooks-Wildhaber, MPH

      Affiliations

    • Alpine Children's Hospital, Davos, Switzerland
    • ,
  • Graham L. Hall, PhD

      Affiliations

    • Department of Respiratory Medicine, Princess Margaret Hospital for Children and School of Pediatrics and Child Health, University of Western Australia, Perth, Australia
    • ,
  • Johannes H. Wildhaber, MD, PhD

      Affiliations

    • Swiss Pediatric Respiratory Research Group and Division of Respiratory Medicine, University Children's Hospital Zurich, Zurich, Switzerland

Received 6 May 2007; received in revised form 30 October 2007; accepted 1 November 2007. published online 21 January 2008.

Background

Respiratory symptoms are common in early childhood. The clinical characterization of disease presentation and hence its likely disease progression has so far been proven difficult.

Objective

To investigate whether exhaled nitric oxide (NO) could be helpful to distinguish between subgroups of nonwheezy and wheezy young children less than 4 years of age.

Methods

Exhaled NO was measured in 391 children (age 3-47 months) with nonwheezy and wheezy respiratory symptoms. Children were divided into 3 groups: children with recurrent cough but no history of wheeze (group 1), with early recurrent wheeze and a loose index for the prediction of asthma at school age (group 2), and with frequent recurrent wheeze and a stringent index for the prediction of asthma at school age (group 3).

Results

Children from group 3 showed significantly higher median (interquartile range) fractional exhaled NO (FeNO) levels (11.7 [11.85]) than children from groups 1 (6.5 [5.5]; P < .001) and 2 (6.4 [6.5]; P < .001). No difference in FeNO levels was found between children from groups 1 and 2 (P = .91).

Conclusion

Wheezy young children less than 4 years of age with a stringent index for the prediction of asthma at school age have elevated levels of FeNO compared with children with recurrent wheeze and a loose index for the prediction of asthma at school age or children with recurrent cough.

Key words: Exhaled nitric oxide, early childhood asthma, infants, young children

Abbreviations used: AR, Airway responsiveness, FeNO, Fractional exhaled nitric oxide, ICS, Inhaled corticosteroid, NO, Nitric oxide

 

 Supported by an unrestricted grant by GlaxoSmithKline Switzerland.

 Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest.

PII: S0091-6749(07)02219-1

doi:10.1016/j.jaci.2007.11.008

The Journal of Allergy and Clinical Immunology
Volume 121, Issue 3 , Pages 705-709, March 2008