Alveolar and airway sites of nitric oxide inflammation in treated asthma.
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.
Gelb
Arthur F
AF
Department of Pharmacy Services, Lakewood Regional Medical Center, Lakewood, California, USA. afgelb@msn.com
Taylor
Colleen Flynn
CF
Nussbaum
Eliezer
E
Gutierrez
Carlos
C
Schein
Aaron
A
Shinar
Chris M
CM
Schein
Mark J
MJ
Epstein
Joel D
JD
Zamel
Noe
N
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
D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D015415:Biomarkers; D009569:Nitric Oxide; D000420:Albuterol; D011241:Prednisone