Exhaled nitric oxide rather than lung function distinguishes preschool children with probable asthma

• Published in: Thorax Vol. 58; no. 6; pp. 494 - 499
• Main Authors: Malmberg, L P, Pelkonen, A S, Haahtela, T, Turpeinen, M
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Thoracic Society 01.06.2003; BMJ; BMJ Publishing Group Ltd; BMJ Publishing Group LTD; BMJ Group
• Subjects: Age; Airway management; Airway Resistance - physiology; Analysis of Variance; Asthma; Asthma - diagnosis; Asthma in children; Biological and medical sciences; Biomarkers - analysis; Breath Tests; Bronchial Provocation Tests; Bronchodilator Agents; Child; Child, Preschool; Diagnosis; Evaluation; Families & family life; Family medical history; Female; Humans; Inflammation; Investigative techniques of respiratory function; Investigative techniques, diagnostic techniques (general aspects); lung function tests; Male; Medical sciences; Methods; Nitric oxide; Nitric Oxide - analysis; Physiological aspects; Physiology; Preschool children; Prognosis; Respiratory Function Tests; Respiratory Physiological Phenomena; ROC Curve; Sensitivity and Specificity; Skin; Studies; Values; Finland; Human; Preschool age; Respiratory disease; Expiration; Exploration; Asthma; Lung function; Nitric oxide; Obstructive pulmonary disease; Diagnosis; Technique; Child; Comparative study
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thorax.58.6.494

Background: Respiratory function and airway inflammation can be evaluated in preschool children with special techniques, but their relative power in identifying young children with asthma has not been studied. This study was undertaken to compare the value of exhaled nitric oxide (FENO), baseline lung function, and bronchodilator responsiveness in identifying children with newly detected probable asthma. Methods: Ninety six preschool children (age 3.8–7.5 years) with asthmatic symptoms or history and 62 age matched healthy non-atopic controls were studied. FENO was measured with the standard online single exhalation technique, and baseline lung function and bronchodilator responsiveness were measured using impulse oscillometry (IOS). Results: Children with probable asthma (n=21), characterised by recent recurrent wheeze, had a significantly higher mean (SE) concentration of FENO than controls (22.1 (3.4) ppb v 5.3 (0.4) ppb; mean difference 16.8 ppb, 95% CI 12.0 to 21.5) and also had higher baseline respiratory resistance, lower reactance, and larger bronchodilator responses expressed as the change in resistance after inhalation of salbutamol. Children with chronic cough only (n=46) also had significantly raised mean FENO (9.2 (1.5) ppb; mean difference 3.9 ppb, 95% CI 0.8 to 7.0) but their lung function was not significantly reduced. Children on inhaled steroids due to previously diagnosed asthma (n=29) differed from the controls only in their baseline lung function. The analysis of receiver operating characteristics (ROC) showed that FENO provided the best power for discriminating between children with probable asthma and healthy controls, with a sensitivity of 86% and specificity of 92% at the cut off level of 1.5 SD above predicted. Conclusions: FENO is superior to baseline respiratory function and bronchodilator responsiveness in identifying preschool children with probable asthma. The results emphasise the presence of airway inflammation in the early stages of asthma, even in young children.