NDLI: Exhaled nitric oxide levels in asthma: Personal best versus reference values.

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Exhaled nitric oxide levels in asthma: Personal best versus reference values.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Smith, Andrew D. Cowan, Jan O. Taylor, D. Robin
Description	Country affiliation: New Zealand Author Affiliation: Smith AD ( Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.)
Abstract	BACKGROUND: Factors affecting the fraction of nitric oxide in exhaled air (FE(NO)) are multiple. Interpreting values when assessing airways disease may be problematic. Clinically optimum levels have not been defined. OBJECTIVES: We aimed to establish the relationship between predicted values for FE(NO) obtained from equations by Olin et al, Travers et al, and Dressel et al, and normalized levels after oral prednisone. We also compared postprednisone FE(NO) levels with those obtained during optimized treatment with inhaled fluticasone. METHODS: Data were obtained before and after a trial of oral prednisone (30mg/d for 14 days), and also from a previously published study in which patients had their dose of inhaled corticosteroid adjusted using either FE(NO) or symptoms/lung function to optimize treatment. RESULTS: Seventy-three patients completed the study. The geometric mean FE(NO) after prednisone (17.7 parts per billion [ppb]; 95% CI, 15.5-20.2) was significantly lower than mean FE(NO) at the optimized fluticasone dose (20.2 ppb; 95% CI, 17.1-23.8; P=.04) and at loss of control (27.6 ppb; 95% CI, 22.8-33.4; P < .001). FE(NO) levels after prednisone did not differ significantly from the predicted values of Olin et al (16.8 ppb, 95% CI, 16.0-17.5; P=.44), but were significantly lower than values of Travers et al (predicted, 21.5 ppb; 95% CI, 20.9-22.2; P=.005) and Dressel et al (predicted, 27.8 ppb; 95% CI, 26.7-28.9; P < .001). CONCLUSIONS: Optimum FE(NO) levels are best established by using oral rather than inhaled steroid treatment, and these approximate to predicted values from the reference equation by Olin et al. However, at optimized doses of inhaled corticosteroid, although FE(NO) levels were higher than predicted, asthma was well controlled. Targeting FE(NO) on reference values is not justified.
File Format	HTM / HTML
ISSN	00916749
e-ISSN	10976825
Journal	Journal of Allergy and Clinical Immunology
Issue Number	4
Volume Number	124
Language	English
Publisher	Elsevier
Publisher Date	2009-10-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Immunology Androstadienes Therapeutic Use Asthma Drug Therapy Nitric Oxide Prednisone Administration, Inhalation Administration, Oral Adolescent Administration & Dosage Diagnosis Immunology Breath Tests Exhalation Drug Effects Physiology Fluticasone Reference Values Randomized Controlled Trial Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Immunology and Allergy Immunology

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