Offline exhaled nitric oxide in emergency department and subsequent acute asthma control.
BACKGROUND
Few studies have evaluated exhaled NO measurement during acute asthma.


OBJECTIVE
To evaluate exhaled NO fraction (FE(NO)) and peak expiratory flow (PEF) time-courses during acute asthma treatment (beta 2-agonist plus systemic steroid) and to assess whether FE(NO) time-course predicts subsequent asthma control.


METHODS
Sixty-five asthmatic patients (mean +/- SD, 34 +/- 10 years) were prospectively enrolled in three Emergency Departments.


RESULTS
Sixteen patients were excluded (failure of offline FE(NO) measurement at 100 mL/s [FE(NO 0.1)], n = 4, and early discharge). The 49 remaining patients performed FE(NO 0.1) and PEF on admission, at the 2nd (H2) and 6th hour (H6). Follow-up using an Asthma Control Diary was obtained in 27 of 49 patients, whether they were hospitalized (n = 9) or discharged (n = 18). All but 2 patients had elevated FE(NO) on admission (median [interquartile], 49 [26-78] ppb). Unlike PEF, mean FE(NO 0.1) of our sample was not significantly modified by treatment. No significant relationship was evidenced between exhaled NO and PEF variations. The variation of FE(NO 0.1) [H0 minus H6] was different in patients who were hospitalized (decrease of 8 +/- 20 ppb) versus discharged (increase of 5 +/- 20 ppb, p = 0.04). This variation of FE(NO 0.1) was correlated with the Diary score (control of subsequent week), an initial increase in FE(NO 0.1) being associated with better asthma control. Nevertheless, neither exhaled NO nor PEFR were good predictors of asthma control.


CONCLUSIONS
An increase in FE(NO) is observed in almost all patients with acute asthma, and its subsequent increase within 6 hours is associated with a better degree of asthma control in the subsequent week.
Delclaux
Christophe
C
Department of Physiology, Assistance Publique, Hopitaux de Paris, Universite Paris Descartes, Paris, France. christophe.delclaux@egp.aphp.fr
Sembach
Nicole
N
Claessens
Yann-Erick
YE
Dolbeau
Guillaume
G
Chevalier-Bidaud
Brigitte
B
Renaud
Bertrand
B
Allo
Jean-Christophe
JC
Zerah-Lancner
Francoise
F
Davido
Alain
A
Dinh-Xuan
Anh-Tuan
AT
D000208:Acute Disease; D000328:Adult; D001249:Asthma / Q000378:metabolism / Q000503:physiopathology* / Q000517:prevention & control*; D001944:Breath Tests; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D009569:Nitric Oxide / Q000032:analysis*; D011446:Prospective Studies; D012129:Respiratory Function Tests
D009569:Nitric Oxide