title: Exhaled nitric oxide rather than lung function distinguishes preschool children with probable asthma.
abstract: BACKGROUND
  Respiratory function and airway inflammation can be evaluated in preschool children with special techniques, but their relative power in identifying young children with asthma has not been studied. This study was undertaken to compare the value of exhaled nitric oxide (FE(NO)), baseline lung function, and bronchodilator responsiveness in identifying children with newly detected probable asthma.
  
  
  METHODS
  Ninety six preschool children (age 3.8-7.5 years) with asthmatic symptoms or history and 62 age matched healthy non-atopic controls were studied. FE(NO) was measured with the standard online single exhalation technique, and baseline lung function and bronchodilator responsiveness were measured using impulse oscillometry (IOS).
  
  
  RESULTS
  Children with probable asthma (n=21), characterised by recent recurrent wheeze, had a significantly higher mean (SE) concentration of FE(NO) than controls (22.1 (3.4) ppb v 5.3 (0.4) ppb; mean difference 16.8 ppb, 95% CI 12.0 to 21.5) and also had higher baseline respiratory resistance, lower reactance, and larger bronchodilator responses expressed as the change in resistance after inhalation of salbutamol. Children with chronic cough only (n=46) also had significantly raised mean FE(NO) (9.2 (1.5) ppb; mean difference 3.9 ppb, 95% CI 0.8 to 7.0) but their lung function was not significantly reduced. Children on inhaled steroids due to previously diagnosed asthma (n=29) differed from the controls only in their baseline lung function. The analysis of receiver operating characteristics (ROC) showed that FE(NO) provided the best power for discriminating between children with probable asthma and healthy controls, with a sensitivity of 86% and specificity of 92% at the cut off level of 1.5 SD above predicted.
  
  
  CONCLUSIONS
  FE(NO) is superior to baseline respiratory function and bronchodilator responsiveness in identifying preschool children with probable asthma. The results emphasise the presence of airway inflammation in the early stages of asthma, even in young children.
authors.affiliation: Division of Allergy, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland. pekka.malmberg@hus.fi
authors.forename: L P
authors.initials: LP
authors.lastname: Malmberg
authors.forename: A S
authors.initials: AS
authors.lastname: Pelkonen
authors.forename: T
authors.initials: T
authors.lastname: Haahtela
authors.forename: M
authors.initials: M
authors.lastname: Turpeinen
mesh_terms: D000403:Airway Resistance / Q000502:physiology*; D000704:Analysis of Variance; D001249:Asthma / Q000175:diagnosis*; D015415:Biomarkers / Q000032:analysis; D001944:Breath Tests; D001985:Bronchial Provocation Tests; D001993:Bronchodilator Agents; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009569:Nitric Oxide / Q000032:analysis*; D012372:ROC Curve; D012129:Respiratory Function Tests; D012143:Respiratory Physiological Phenomena; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D001993:Bronchodilator Agents; D009569:Nitric Oxide