Small airway function, exhaled NO and airway hyper-responsiveness in paediatric asthma
Asthma is a chronic inflammatory airway disorder known to involve the peripheral airways. Current guidelines state that diagnosis and treatment should be guided by symptoms and spirometry. FEV 1 is, however, a poor marker of small airway function and correlates poorly with asthma control and airway...
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| Published in | Respiratory medicine Vol. 105; no. 10; pp. 1476 - 1484 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | English |
| Published |
Kidlington
Elsevier Ltd
01.10.2011
Elsevier Elsevier Limited |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0954-6111 1532-3064 1532-3064 |
| DOI | 10.1016/j.rmed.2011.04.004 |
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| Abstract | Asthma is a chronic inflammatory airway disorder known to involve the peripheral airways. Current guidelines state that diagnosis and treatment should be guided by symptoms and spirometry. FEV
1 is, however, a poor marker of small airway function and correlates poorly with asthma control and airway inflammation.
To assess the contribution of small airway dysfunction and inflammation in paediatric asthma. A secondary aim was to study the associations between small airway dysfunction, airway inflammation and airway hyper-responsiveness (AHR).
Small airway function was measured as LCI, S
cond and S
acin, evaluated with the SF
6 multiple breath inert gas washout (MBW) technique, in 47 asthmatic children and 74 healthy controls. Exhaled NO at multiple exhalation flow rates including 50 mL/s (FENO
50) was assessed to calculate alveolar NO and bronchial NO flux (a surrogate for airway inflammation). AHR was evaluated with isocapnoic dry air hyperventilation challenge in the asthmatic children.
S
cond was elevated in 31 (66%) and S
acin in 18 (38%) of the asthmatic subjects. LCI was increased and FEV
1 decreased in 7 (15%) of the subjects with asthma. Individuals with AHR had higher S
cond (
p = 0.001) and FENO
50 (
p < 0.0001) than those without AHR. The levels of FENO
50 and bronchial NO flux were elevated in asthmatic subjects compared with healthy controls. In asthma, S
cond correlated with FENO
50 (
r
s = 0.42,
p = 0.003) and alveolar NO (
r
s = 0.40,
p = 0.011), and S
acin correlated with alveolar NO (
r
s = 0.40,
p = 0.015).
Dysfunction of small conducting airways is associated with airway inflammation and hyper-responsiveness in paediatric asthma. |
|---|---|
| AbstractList | Asthma is a chronic inflammatory airway disorder known to involve the peripheral airways. Current guidelines state that diagnosis and treatment should be guided by symptoms and spirometry. FEV
1 is, however, a poor marker of small airway function and correlates poorly with asthma control and airway inflammation.
To assess the contribution of small airway dysfunction and inflammation in paediatric asthma. A secondary aim was to study the associations between small airway dysfunction, airway inflammation and airway hyper-responsiveness (AHR).
Small airway function was measured as LCI, S
cond and S
acin, evaluated with the SF
6 multiple breath inert gas washout (MBW) technique, in 47 asthmatic children and 74 healthy controls. Exhaled NO at multiple exhalation flow rates including 50 mL/s (FENO
50) was assessed to calculate alveolar NO and bronchial NO flux (a surrogate for airway inflammation). AHR was evaluated with isocapnoic dry air hyperventilation challenge in the asthmatic children.
S
cond was elevated in 31 (66%) and S
acin in 18 (38%) of the asthmatic subjects. LCI was increased and FEV
1 decreased in 7 (15%) of the subjects with asthma. Individuals with AHR had higher S
cond (
p = 0.001) and FENO
50 (
p < 0.0001) than those without AHR. The levels of FENO
50 and bronchial NO flux were elevated in asthmatic subjects compared with healthy controls. In asthma, S
cond correlated with FENO
50 (
r
s = 0.42,
p = 0.003) and alveolar NO (
r
s = 0.40,
p = 0.011), and S
acin correlated with alveolar NO (
r
s = 0.40,
p = 0.015).
Dysfunction of small conducting airways is associated with airway inflammation and hyper-responsiveness in paediatric asthma. Asthma is a chronic inflammatory airway disorder known to involve the peripheral airways. Current guidelines state that diagnosis and treatment should be guided by symptoms and spirometry. FEV1 is, however, a poor marker of small airway function and correlates poorly with asthma control and airway inflammation. To assess the contribution of small airway dysfunction and inflammation in paediatric asthma. A secondary aim was to study the associations between small airway dysfunction, airway inflammation and airway hyper-responsiveness (AHR). Small airway function was measured as LCI, Scond and Sacin, evaluated with the SF6 multiple breath inert gas washout (MBW) technique, in 47 asthmatic children and 74 healthy controls. Exhaled NO at multiple exhalation flow rates including 50 mL/s (FENO50) was assessed to calculate alveolar NO and bronchial NO flux (a surrogate for airway inflammation). AHR was evaluated with isocapnoic dry air hyperventilation challenge in the asthmatic children. Scond was elevated in 31 (66%) and Sacin in 18 (38%) of the asthmatic subjects. LCI was increased and FEV1 decreased in 7 (15%) of the subjects with asthma. Individuals with AHR had higher Scond (p = 0.001) and FENO50 (p < 0.0001) than those without AHR. The levels of FENO50 and bronchial NO flux were elevated in asthmatic subjects compared with healthy controls. In asthma, Scond correlated with FENO50 (r s = 0.42, p = 0.003) and alveolar NO (r s = 0.40, p = 0.011), and Sacin correlated with alveolar NO (r s = 0.40, p = 0.015). Dysfunction of small conducting airways is associated with airway inflammation and hyper-responsiveness in paediatric asthma. 37 references Asthma is a chronic inflammatory airway disorder known to involve the peripheral airways. Current guidelines state that diagnosis and treatment should be guided by symptoms and spirometry. FEV(1) is, however, a poor marker of small airway function and correlates poorly with asthma control and airway inflammation.BACKGROUNDAsthma is a chronic inflammatory airway disorder known to involve the peripheral airways. Current guidelines state that diagnosis and treatment should be guided by symptoms and spirometry. FEV(1) is, however, a poor marker of small airway function and correlates poorly with asthma control and airway inflammation.To assess the contribution of small airway dysfunction and inflammation in paediatric asthma. A secondary aim was to study the associations between small airway dysfunction, airway inflammation and airway hyper-responsiveness (AHR).AIMSTo assess the contribution of small airway dysfunction and inflammation in paediatric asthma. A secondary aim was to study the associations between small airway dysfunction, airway inflammation and airway hyper-responsiveness (AHR).Small airway function was measured as LCI, S(cond) and S(acin), evaluated with the SF(6) multiple breath inert gas washout (MBW) technique, in 47 asthmatic children and 74 healthy controls. Exhaled NO at multiple exhalation flow rates including 50 mL/s (FENO(50)) was assessed to calculate alveolar NO and bronchial NO flux (a surrogate for airway inflammation). AHR was evaluated with isocapnoic dry air hyperventilation challenge in the asthmatic children.METHODSSmall airway function was measured as LCI, S(cond) and S(acin), evaluated with the SF(6) multiple breath inert gas washout (MBW) technique, in 47 asthmatic children and 74 healthy controls. Exhaled NO at multiple exhalation flow rates including 50 mL/s (FENO(50)) was assessed to calculate alveolar NO and bronchial NO flux (a surrogate for airway inflammation). AHR was evaluated with isocapnoic dry air hyperventilation challenge in the asthmatic children.S(cond) was elevated in 31 (66%) and S(acin) in 18 (38%) of the asthmatic subjects. LCI was increased and FEV(1) decreased in 7 (15%) of the subjects with asthma. Individuals with AHR had higher S(cond) (p = 0.001) and FENO(50) (p < 0.0001) than those without AHR. The levels of FENO(50) and bronchial NO flux were elevated in asthmatic subjects compared with healthy controls. In asthma, S(cond) correlated with FENO(50) (r(s) = 0.42, p = 0.003) and alveolar NO (r(s) = 0.40, p = 0.011), and S(acin) correlated with alveolar NO (r(s) = 0.40, p = 0.015).RESULTSS(cond) was elevated in 31 (66%) and S(acin) in 18 (38%) of the asthmatic subjects. LCI was increased and FEV(1) decreased in 7 (15%) of the subjects with asthma. Individuals with AHR had higher S(cond) (p = 0.001) and FENO(50) (p < 0.0001) than those without AHR. The levels of FENO(50) and bronchial NO flux were elevated in asthmatic subjects compared with healthy controls. In asthma, S(cond) correlated with FENO(50) (r(s) = 0.42, p = 0.003) and alveolar NO (r(s) = 0.40, p = 0.011), and S(acin) correlated with alveolar NO (r(s) = 0.40, p = 0.015).Dysfunction of small conducting airways is associated with airway inflammation and hyper-responsiveness in paediatric asthma.CONCLUSIONDysfunction of small conducting airways is associated with airway inflammation and hyper-responsiveness in paediatric asthma. Summary Background Asthma is a chronic inflammatory airway disorder known to involve the peripheral airways. Current guidelines state that diagnosis and treatment should be guided by symptoms and spirometry. FEV1 is, however, a poor marker of small airway function and correlates poorly with asthma control and airway inflammation. Aims To assess the contribution of small airway dysfunction and inflammation in paediatric asthma. A secondary aim was to study the associations between small airway dysfunction, airway inflammation and airway hyper-responsiveness (AHR). Methods Small airway function was measured as LCI, Scond and Sacin , evaluated with the SF6 multiple breath inert gas washout (MBW) technique, in 47 asthmatic children and 74 healthy controls. Exhaled NO at multiple exhalation flow rates including 50 mL/s (FENO50 ) was assessed to calculate alveolar NO and bronchial NO flux (a surrogate for airway inflammation). AHR was evaluated with isocapnoic dry air hyperventilation challenge in the asthmatic children. Results Scond was elevated in 31 (66%) and Sacin in 18 (38%) of the asthmatic subjects. LCI was increased and FEV1 decreased in 7 (15%) of the subjects with asthma. Individuals with AHR had higher Scond ( p = 0.001) and FENO50 ( p < 0.0001) than those without AHR. The levels of FENO50 and bronchial NO flux were elevated in asthmatic subjects compared with healthy controls. In asthma, Scond correlated with FENO50 ( rs = 0.42, p = 0.003) and alveolar NO ( rs = 0.40, p = 0.011), and Sacin correlated with alveolar NO ( rs = 0.40, p = 0.015). Conclusion Dysfunction of small conducting airways is associated with airway inflammation and hyper-responsiveness in paediatric asthma. Asthma is a chronic inflammatory airway disorder known to involve the peripheral airways. Current guidelines state that diagnosis and treatment should be guided by symptoms and spirometry. FEV1 is, however, a poor marker of small airway function and correlates poorly with asthma control and airway inflammation. To assess the contribution of small airway dysfunction and inflammation in paediatric asthma. A secondary aim was to study the associations between small airway dysfunction, airway inflammation and airway hyper-responsiveness (AHR). Small airway function was measured as LCI, Scond and Sacin, evaluated with the SF6 multiple breath inert gas washout (MBW) technique, in 47 asthmatic children and 74 healthy controls. Exhaled NO at multiple exhalation flow rates including 50 mL/s (FENO50) was assessed to calculate alveolar NO and bronchial NO flux (a surrogate for airway inflammation). AHR was evaluated with isocapnoic dry air hyperventilation challenge in the asthmatic children. Scond was elevated in 31 (66%) and Sacin in 18 (38%) of the asthmatic subjects. LCI was increased and FEV1 decreased in 7 (15%) of the subjects with asthma. Individuals with AHR had higher Scond (p = 0.001) and FENO50 (p < 0.0001) than those without AHR. The levels of FENO50 and bronchial NO flux were elevated in asthmatic subjects compared with healthy controls. In asthma, Scond correlated with FENO50 (r s = 0.42, p = 0.003) and alveolar NO (r s = 0.40, p = 0.011), and Sacin correlated with alveolar NO (r s = 0.40, p = 0.015). Dysfunction of small conducting airways is associated with airway inflammation and hyper-responsiveness in paediatric asthma. BACKGROUND: Asthma is a chronic inflammatory airway disorder known to involve the peripheral airways. Current guidelines state that diagnosis and treatment should be guided by symptoms and spirometry. FEV(1) is, however, a poor marker of small airway function and correlates poorly with asthma control and airway inflammation. AIMS: To assess the contribution of small airway dysfunction and inflammation in paediatric asthma. A secondary aim was to study the associations between small airway dysfunction, airway inflammation and airway hyper-responsiveness (AHR). METHODS: Small airway function was measured as LCI, S(cond) and S(acin), evaluated with the SF(6) multiple breath inert gas washout (MBW) technique, in 47 asthmatic children and 74 healthy controls. Exhaled NO at multiple exhalation flow rates including 50mL/s (FENO(50)) was assessed to calculate alveolar NO and bronchial NO flux (a surrogate for airway inflammation). AHR was evaluated with isocapnoic dry air hyperventilation challenge in the asthmatic children. RESULTS: S(cond) was elevated in 31 (66%) and S(acin) in 18 (38%) of the asthmatic subjects. LCI was increased and FEV(1) decreased in 7 (15%) of the subjects with asthma. Individuals with AHR had higher S(cond) (p=0.001) and FENO(50) (p<0.0001) than those without AHR. The levels of FENO(50) and bronchial NO flux were elevated in asthmatic subjects compared with healthy controls. In asthma, S(cond) correlated with FENO(50) (r(s)=0.42, p=0.003) and alveolar NO (r(s)=0.40, p=0.011), and S(acin) correlated with alveolar NO (r(s)=0.40, p=0.015). CONCLUSION: Dysfunction of small conducting airways is associated with airway inflammation and hyper-responsiveness in paediatric asthma. Asthma is a chronic inflammatory airway disorder known to involve the peripheral airways. Current guidelines state that diagnosis and treatment should be guided by symptoms and spirometry. FEV(1) is, however, a poor marker of small airway function and correlates poorly with asthma control and airway inflammation. To assess the contribution of small airway dysfunction and inflammation in paediatric asthma. A secondary aim was to study the associations between small airway dysfunction, airway inflammation and airway hyper-responsiveness (AHR). Small airway function was measured as LCI, S(cond) and S(acin), evaluated with the SF(6) multiple breath inert gas washout (MBW) technique, in 47 asthmatic children and 74 healthy controls. Exhaled NO at multiple exhalation flow rates including 50 mL/s (FENO(50)) was assessed to calculate alveolar NO and bronchial NO flux (a surrogate for airway inflammation). AHR was evaluated with isocapnoic dry air hyperventilation challenge in the asthmatic children. S(cond) was elevated in 31 (66%) and S(acin) in 18 (38%) of the asthmatic subjects. LCI was increased and FEV(1) decreased in 7 (15%) of the subjects with asthma. Individuals with AHR had higher S(cond) (p = 0.001) and FENO(50) (p < 0.0001) than those without AHR. The levels of FENO(50) and bronchial NO flux were elevated in asthmatic subjects compared with healthy controls. In asthma, S(cond) correlated with FENO(50) (r(s) = 0.42, p = 0.003) and alveolar NO (r(s) = 0.40, p = 0.011), and S(acin) correlated with alveolar NO (r(s) = 0.40, p = 0.015). Dysfunction of small conducting airways is associated with airway inflammation and hyper-responsiveness in paediatric asthma. |
| Author | Gustafsson, Per Olin, Anna-Carin Wennergren, Göran Keen, Christina |
| Author_xml | – sequence: 1 givenname: Christina surname: Keen fullname: Keen, Christina email: christina.keen@telia.com organization: Department of Paediatrics, University of Gothenburg, Queen Silvia Children’s Hospital, SE-416 85 Gothenburg, Sweden – sequence: 2 givenname: Anna-Carin surname: Olin fullname: Olin, Anna-Carin organization: Department of Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden – sequence: 3 givenname: Göran surname: Wennergren fullname: Wennergren, Göran organization: Department of Paediatrics, University of Gothenburg, Queen Silvia Children’s Hospital, SE-416 85 Gothenburg, Sweden – sequence: 4 givenname: Per surname: Gustafsson fullname: Gustafsson, Per organization: Department of Paediatrics, University of Gothenburg, Queen Silvia Children’s Hospital, SE-416 85 Gothenburg, Sweden |
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| Keywords | ATS FENO NO cACT D NO RSD MBW S acin ERS Multiple breath inert gas washout AHR ACT FVC FEV 1 LCI MMEFexpiratory flow ULN PNT SF 6ur hexafluoride Flow-independent exhaled nitric oxide C W S cond Lung clearance index forced vital capacity sulph residual standard deviation childhood Asthma Control Test European Respiratory Society bronchial NO diffusion capacity forced expiratory volume in 1 second Asthma Control Test nitric oxide contribution to MBW phase III slope generated in the acinar lung zone bronchial wall NO concentration maximum mid fraction of exhaled nitric oxide pneumotachometer American Thoracic Society upper limit of normal airway hyper-responsiveness contribution to MBW phase III slope generated in the conducting airway zone Lung disease Multiple Respiratory disease Lung Clearance Asthma Nitric oxide Bronchus disease Obstructive pulmonary disease Pneumology |
| Language | English |
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| Snippet | Asthma is a chronic inflammatory airway disorder known to involve the peripheral airways. Current guidelines state that diagnosis and treatment should be... Summary Background Asthma is a chronic inflammatory airway disorder known to involve the peripheral airways. Current guidelines state that diagnosis and... BACKGROUND: Asthma is a chronic inflammatory airway disorder known to involve the peripheral airways. Current guidelines state that diagnosis and treatment... |
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| SubjectTerms | Adolescent Airway management Allergies Asthma Asthma - diagnosis Asthma - drug therapy Asthma - physiopathology Biological and medical sciences Bronchial Hyperreactivity - diagnosis Bronchial Hyperreactivity - physiopathology Child Chronic obstructive pulmonary disease, asthma Cross-Sectional Studies Exhalation Female Flow-independent exhaled nitric oxide Humans Lung clearance index Lungs Male Mathematical models Medical sciences Multiple breath inert gas washout Nitric oxide Nitric Oxide - metabolism Pediatrics Pediatrik Pneumology Practice Guidelines as Topic Pulmonary/Respiratory Reproducibility of Results Spirometry - methods Treatment Outcome Ventilation |
| Title | Small airway function, exhaled NO and airway hyper-responsiveness in paediatric asthma |
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