title: The role of exhaled nitric oxide in evaluation of acute asthma in a pediatric emergency department.
abstract: OBJECTIVE
  Fractional excretion of nitric oxide (FE(NO)) has been used as a noninvasive marker to assess and manage chronic asthma in adults and children. The aim of this study was to determine the feasibility of obtaining FE(NO) concentrations in children treated in the emergency department (ED) for acute asthma exacerbation and to examine the association between FE(NO) concentrations and other measures of acute asthma severity.
  
  
  METHODS
  This was a cross-sectional study of a convenience sample of children 2-18 years old who were seen in an urban ED for acute asthma exacerbation. Using a tidal breathing method with real-time display, the authors measured FE(NO) concentrations before and 1 hour after the administration of corticosteroids and at discharge from the ED. Outcome measures included pulmonary index score (PIS), hospital admission, and short-term outcomes (e.g., missed days of school).
  
  
  RESULTS
  A total of 133 subjects were enrolled. Sixty-eight percent (95% confidence interval [CI] = 60% to 76%) of the subjects provided adequate breaths for FE(NO) measurement. There was no difference in the median initial FE(NO) concentration among subjects, regardless of the severity of their acute asthma. Most subjects showed no change in their FE(NO) concentrations from the start to the end of treatment. FE(NO) concentrations were not significantly associated with other short-term outcomes.
  
  
  CONCLUSIONS
  Measurement of FE(NO) is difficult for a large proportion of children with acute asthma exacerbation. FE(NO) concentration during an asthma exacerbation does not correlate with other measures of acute severity and has limited utility in the ED management of acute asthma in children.
authors.affiliation: Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA. myk2102@columbia.edu
authors.forename: Maria Y
authors.initials: MY
authors.lastname: Kwok
authors.forename: Christine M
authors.initials: CM
authors.lastname: Walsh-Kelly
authors.forename: Marc H
authors.initials: MH
authors.lastname: Gorelick
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001249:Asthma / Q000145:classification / Q000175:diagnosis*; D015415:Biomarkers / Q000032:analysis; D001944:Breath Tests; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D009569:Nitric Oxide / Q000032:analysis*; D010366:Peak Expiratory Flow Rate; D012372:ROC Curve; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D009569:Nitric Oxide