title: Exhaled nitric oxide is increased in active fibrosing alveolitis.
abstract: OBJECTIVE
  Interstitial inflammation is a major aggravating factor in fibrosing lung disease associated with scleroderma (FASSc) and cryptogenic fibrosing alveolitis (CFA). Exhaled nitric oxide (NO) production is increased in asthma and bronchiectasis and reflects the degree of inflammation. We investigated whether measuring levels of exhaled NO is valuable in assessing disease activity in patients with CFA and patients with FASSc.
  
  
  RESULTS
  NO levels were measured in 11 patients with CFA (mean age +/- SEM, 58 +/- 12 years old; 5 were male) and 17 patients with FASSc (mean age, 48 +/- 9 years old; 5 were male), and they were compared to BAL cell counts and lung function. Patients with CFA and FASSe had elevated NO levels (11.2 +/-1.0 parts per billion [ppb] and 9.8 +/- 1.0 ppb, respectively; p > 0.05), whereas in a group of 13 nonsmoking normal subjects, the NO levels were not elevated (6.9 +/- 0.5 ppb; p < 0.05). Patients with FASSc (n = 8) who had active BAL (defined as either lymphocytes > 14%, neutrophils > 4%, or eosinophils > 3%) had significantly higher NO levels (13.2 +/- 1.8 ppb), and neutrophil (16.5 +/- 4.0%) and lymphocyte (26.8 +/- 3.4%) BAL cell counts than did patients with FASSc who had inactive BAL (6.7 +/- 1.2 ppb; 1.3 +/- 1.0% and 7.5 +/- 1.3%, respectively; p < 0.05). There was a significant correlation between exhaled NO and lymphocyte cell count in patients with FASSc (r = 0.58; p < 0.05). All patients with CFA had active BAL; however, those treated with corticosteroids (12.9 +/- 1.0% ppb, p < 0.05) had lower NO levels (9.0 +/- 1 ppb) and higher BAL lymphocyte cell couits (16.6 +/- 2.0%) than did those not treated with corticosteroids (7.2 +/- 1.7%; p < 0.05).
  
  
  CONCLUSIONS
  We conclude that exhaled NO may be a useful addition to BAL cell counts in disease monitoring.
authors.affiliation: Department of Thoracic Medicine, Imperial College School of Medicine at the National Heart and Lung Institute, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Paredi
authors.forename: S A
authors.initials: SA
authors.lastname: Kharitonov
authors.forename: S
authors.initials: S
authors.lastname: Loukides
authors.forename: P
authors.initials: P
authors.lastname: Pantelidis
authors.forename: R M
authors.initials: RM
authors.lastname: du Bois
authors.forename: P J
authors.initials: PJ
authors.lastname: Barnes
mesh_terms: D001944:Breath Tests; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D002452:Cell Count; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000032:analysis*; D011653:Pulmonary Diffusing Capacity; D011658:Pulmonary Fibrosis / Q000150:complications / Q000175:diagnosis / Q000378:metabolism* / Q000503:physiopathology; D012595:Scleroderma, Systemic / Q000150:complications; D014109:Total Lung Capacity; D014797:Vital Capacity
chemical_list: D009569:Nitric Oxide