Relations between exhaled nitric oxide and measures of disease activity among children with mild-to-moderate asthma.
OBJECTIVE
Exhaled nitric oxide (FE(NO)) was evaluated in children with asthma after 4 to 6 years of treatment with budesonide, nedocromil, or albuterol as needed.


METHODS
FE(NO), spirometry, total eosinophil count, and serum eosinophil cationic protein levels were obtained from 118 children at the Denver site of the Childhood Asthma Management Program upon completion of treatment and after a 2- to 4-month washout.


RESULTS
Budesonide-treated patients had significantly lower median (1st, 3rd quartile) FE(NO) (21.5 [13.2, 84.4] vs 62.5 [26.2, 115.0] ppb, P <.01) and eosinophil cationic protein levels (17.4 [10.1, 24.3] vs 24.0 [15.4, 33.9] mg/dL, P =.05) compared with placebo, whereas no differences were noted between nedocromil and placebo groups. After washout, FE(NO) levels were similar between the three treatments. FE(NO) levels significantly correlated with degree of bronchial hyperresponsiveness, bronchodilator reversibility, allergen skin prick tests, serum IgE, and total eosinophil count. FE(NO) levels were also higher in patients with nocturnal symptoms and in patients requiring beta-agonist use at least once weekly.


CONCLUSIONS
Budesonide therapy was more effective than nedocromil in reducing FE(NO). Unfortunately, the effects of long-term budesonide were not sustained after its discontinuation. FE(NO) may be a complementary tool to current practice guidelines in assessing asthma control and medication response.
Covar
Ronina A
RA
Ira J. and Jacqueline Neimark Laboratory of Clinical Pharmacology and the Division of Allergy-Clinical Immunology, Department of Pediatrics, Denver, Colorado, USA. covarr@njc.org
Szefler
Stanley J
SJ
Martin
Richard J
RJ
Sundstrom
D A
DA
Silkoff
Philip E
PE
Murphy
James
J
Young
David A
DA
Spahn
Joseph D
JD
D018927:Anti-Asthmatic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism*; D001798:Blood Proteins / Q000378:metabolism; D016085:Bronchoconstrictor Agents; D019819:Budesonide / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D047091:Eosinophil Granule Proteins; D004804:Eosinophils; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects*; D006801:Humans; D006967:Hypersensitivity / Q000150:complications / Q000175:diagnosis; D007073:Immunoglobulin E / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D016210:Methacholine Chloride; D017835:Nedocromil / Q000494:pharmacology / Q000627:therapeutic use*; D009569:Nitric Oxide / Q000378:metabolism*; D012119:Respiration; D012129:Respiratory Function Tests; D012260:Ribonucleases; D012720:Severity of Illness Index; D012882:Skin Tests; D013147:Spirometry / Q000379:methods; D018709:Statistics, Nonparametric
D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D001798:Blood Proteins; D016085:Bronchoconstrictor Agents; D047091:Eosinophil Granule Proteins; D017835:Nedocromil; D016210:Methacholine Chloride; D009569:Nitric Oxide; D007073:Immunoglobulin E; D019819:Budesonide; D012260:Ribonucleases