Clinical correlates and determinants of airway inflammation in pediatric asthma.
BACKGROUND
Airway inflammation is a key component in the pathophysiology of asthma. However, neither its role in the clinical features of asthma nor the factors affecting the degree of inflammation have been fully defined.


METHODS
We determined the fractional exhaled nitric oxide concentration (FE(NO)) using a portable device (NIOX-MINO, Aerocrine, Solna, Sweden) in a consecutive sample of 149 asthmatic children aged 6 to 14 years. In order to establish an association with FE(NO), we analyzed symptoms, spirometric parameters before and after a bronchodilator test, and the impact of asthma on quality of life during the previous 4 weeks. We also investigated how clinical variables that regulate inflammation affected FE(NO).


RESULTS
In patients not treated with inhaled corticosteroids (ICs), FE(NO) was higher when specific symptoms (wheeze and cough) had been present during the previous 4 weeks; however, we were unable to establish a relationship with symptom frequency, bronchodilator use, asthma crises, hospital admissions, limitation of daily activities, or spirometry results. In patients treated with ICs, FE(NO) was not related to the clinical expression of asthma, except for a reduced ratio of forced expiratory volume in 1 second to forced vital capacity, both before and after bronchodilation. The main determinant of FE level in untreated patients was sensitization to house dust mite. In patients treated with ICs, FE(NO) was only associated with adherence to therapy.


CONCLUSIONS
Airway inflammation, as determined by FE(NO), is only weakly associated with the clinical expression of asthma and spirometry results. Adherence to treatment is the main determinant of the degree of inflammation in patients taking ICs.
Cano-Garcinuño
A
A
Centro de Salud Villamuriel de Cerrato, Palencia, Spain. acanog@saludcastillayleon.es
Carvajal-Urueña
I
I
Díaz-Vázquez
C A
CA
Domínguez-Aurrecoechea
B
B
García-Merino
A
A
de Rodas
P Mola-Caballero
PM
Mora-Gandarillas
I
I
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D039741:Antigens, Dermatophagoides / Q000276:immunology; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000503:physiopathology*; D002648:Child; D003371:Cough; D005260:Female; D006801:Humans; D007114:Immunization; D008297:Male; D055118:Medication Adherence; D009569:Nitric Oxide / Q000378:metabolism*; D011014:Pneumonia; D012135:Respiratory Sounds; D013147:Spirometry
D000305:Adrenal Cortex Hormones; D039741:Antigens, Dermatophagoides; D009569:Nitric Oxide