The effect of inhaled nitric oxide in pediatric asthma.
Nitric oxide (NO) appears to play an important role in regulating several biologic functions in the lung, including modulation of pulmonary arterial and bronchial smooth muscle tone. Recent studies have shown that relatively high concentrations of inhaled NO reduce the bronchoconstrictor effect of methacholine in animal models. This raises the possibility that NO inhalation might have therapeutic potential as an alternative bronchodilator. Although investigation of this potential in adults with airway reactivity or bronchial asthma has been reported, data are lacking on the role of NO in the pediatric asthma population. We therefore performed spirometry on 12 children with asthma (mean age 11.1 yrs) at baseline (B), immediately after inhaling 40 ppm NO (NO-1), 10 min after inhaling NO (NO-10), and after inhalation of a standard beta 2-agonist, albuterol (A). Baseline pulmonary functions (% predicted +/- SEM) were FVC of 103.2 +/- 5.6, FEV1 of 82.2 +/- 3.3, FEF-max of 97.0 +/- 3.6, and FEF25-75% of 53.5 +/- 3.3. There were no statistically significant differences between baseline and NO-1 or NO-10 between any of the four pulmonary function parameters measured. Inhaled albuterol, however, resulted in significant improvement (% predicted +/- SEM) in FVC to 109.8 +/- 3.5, FEV1 to 99.7 +/- 2.9, FEFmax to 106.5 +/- 5.1, and FEF25-75% to 84.4 +/- 6.4 compared with the baseline and NO inhalation groups. We conclude that NO inhaled at 40 ppm has no apparent bronchodilatory effect in pediatric subjects with asthma and mild airways disease. The clinical application of this gas as a therapeutic modality under these conditions is questionable.
Pfeffer
K D
KD
Department of Pediatrics, University of Utah Medical Center, Salt Lake City 84132, USA.
Ellison
G
G
Robertson
D
D
Day
R W
RW
D000280:Administration, Inhalation; D000293:Adolescent; D001249:Asthma / Q000188:drug therapy / Q000503:physiopathology*; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005540:Forced Expiratory Flow Rates / Q000187:drug effects; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008297:Male; D009569:Nitric Oxide / Q000008:administration & dosage* / Q000494:pharmacology; D013147:Spirometry; D014797:Vital Capacity / Q000187:drug effects
D001993:Bronchodilator Agents; D009569:Nitric Oxide