title: Alveolar and airway sites of nitric oxide inflammation in treated asthma.
abstract: The goal of this study was to identify airway and alveolar site(s) of inflammation using exhaled nitric oxide (NO) as a marker in treated patients with asthma, including response to oral corticosteroids, and correlate these sites with expiratory airflow limitation. In 53 (24 male) patients with asthma, age 43 +/- 23 years (mean +/- SD) and all on inhaled corticosteroids, post 180 microg aerosolized albuterol, FEV(1) was 74 +/- 23% predicted and FEV(1)/FVC was 68 +/- 11%. Exhaled NO at 100 ml/second was 27 +/- 23 ppb (p < 0.001 compared with normal, 12 +/- 15 ppb). Bronchial NO maximal flux was 2.4 +/- 3.1 nl/second (p < 0.001 compared with normal, 0.85 +/- 0.55). Alveolar NO concentration was 7.0 +/- 7.4 ppb (p = 0.01 compared with the normal value, 3.2 +/- 2.0 ppb). There was no significant correlation between FEV(1) % predicted or lung elastic recoil and NO bronchial flux or alveolar concentration. However, there was a weak but significant correlation between NO bronchial flux and alveolar concentration (Spearman r = 0.50, p < 0.001). In 10 subjects with asthma on inhaled corticosteroids, 5 days of 30 mg prednisone resulted in isolated significant decreases in NO alveolar concentration, from 13 +/- 10 to 4 +/- 4 ppb (p = 0.002). Despite treatment, including inhaled corticosteroids, patients with asthma may have ongoing separate airway and alveolar sites of NO inflammation, the latter responsive to oral corticosteroids.
authors.affiliation: Department of Pharmacy Services, Lakewood Regional Medical Center, Lakewood, California, USA. afgelb@msn.com
authors.forename: Arthur F
authors.initials: AF
authors.lastname: Gelb
authors.forename: Colleen Flynn
authors.initials: CF
authors.lastname: Taylor
authors.forename: Eliezer
authors.initials: E
authors.lastname: Nussbaum
authors.forename: Carlos
authors.initials: C
authors.lastname: Gutierrez
authors.forename: Aaron
authors.initials: A
authors.lastname: Schein
authors.forename: Chris M
authors.initials: CM
authors.lastname: Shinar
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Schein
authors.forename: Joel D
authors.initials: JD
authors.lastname: Epstein
authors.forename: Noe
authors.initials: N
authors.lastname: Zamel
mesh_terms: D000280:Administration, Inhalation; D000284:Administration, Oral; D000328:Adult; D000420:Albuterol / Q000276:immunology / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000276:immunology / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000276:immunology / Q000627:therapeutic use; D001249:Asthma / Q000145:classification / Q000188:drug therapy* / Q000276:immunology* / Q000378:metabolism; D015415:Biomarkers / Q000032:analysis; D001944:Breath Tests / Q000379:methods; D001980:Bronchi / Q000187:drug effects / Q000276:immunology; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000032:analysis / Q000276:immunology; D011237:Predictive Value of Tests; D011241:Prednisone / Q000276:immunology / Q000627:therapeutic use; D011446:Prospective Studies; D011650:Pulmonary Alveoli / Q000187:drug effects / Q000276:immunology; D011659:Pulmonary Gas Exchange / Q000187:drug effects / Q000276:immunology; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014797:Vital Capacity
chemical_list: D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D009569:Nitric Oxide; D000420:Albuterol; D011241:Prednisone