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Bojahr J, Jörres RA, Kronseder A, Weber F, Ledderhos C, Roiu I, Karrasch S, Nowak D, Teupser D, Königer C. Effects of training flights of combat jet pilots on parameters of airway function, diffusing capacity and systemic oxidative stress, and their association with flight parameters. Eur J Med Res 2024; 29:100. [PMID: 38317201 PMCID: PMC10840181 DOI: 10.1186/s40001-024-01668-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 01/12/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Fighter aircraft pilots are regularly exposed to physiological challenges from high acceleration (Gz) forces, as well as increased breathing pressure and oxygen supply in the support systems. We studied whether effects on the lung and systemic oxidative stress were detectable after real training flights comprising of a wide variety of exposure conditions, and their combinations. METHODS Thirty-five pilots of the German Air Force performed 145 flights with the Eurofighter Typhoon. Prior to and after flight lung diffusing capacity for carbon monoxide (DLCO) and nitric oxide (DLNO), alveolar volume (VA), and diffusing capacities per volume (KCO, KNO) were assessed. In addition, the fractional concentration of exhaled nitric oxide (FeNO) was determined, and urine samples for the analysis of molecular species related to 8-hydroxy-2'-deoxyguanosine (8-OHdG) were taken. For statistical analysis, mixed ANOVA models were used. RESULTS DLNO, DLCO, KNO, KCO and VA were reduced (p < 0.001) after flights, mean ± SD changes being 2.9 ± 5.0, 3.2 ± 5.2, 1.5 ± 3.7, 1.9 ± 3.7 and 1.4 ± 3.1%, respectively, while FeNO decreased by 11.1% and the ratio of 8-OHdG to creatinine increased by 15.7 ± 37.8%. The reductions of DLNO (DLCO) were smaller (p < 0.001) than those of KNO (KCO). In repeated flights on different days, baseline values were restored. Amongst various flight parameters comprising Gz-forces and/or being indicative of positive pressure breathing and oxygenation support, the combination of long flight duration and high altitude appeared to be linked to greater changes in DLNO and DLCO. CONCLUSIONS The pattern of reductions in diffusing capacities suggests effects arising from atelectasis and increased diffusion barrier, without changes in capillary blood volume. The decrease in exhaled endogenous NO suggests bronchial mucosal irritation and/or local oxidative stress, and the increase in urinary oxidized guanosine species suggests systemic oxidative stress. Although changes were small and not clinically relevant, their presence demonstrated physiological effects of real training flights in a modern 4th generation fighter jet.
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Affiliation(s)
- Janina Bojahr
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany.
- Federal Armed Forces Hospital, Lesserstr. 180, 22049, Hamburg, Germany.
- Air Force Centre of Aerospace Medicine, Fuerstenfeldbruck, Cologne, Germany.
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Angelika Kronseder
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Frank Weber
- Air Force Centre of Aerospace Medicine, Fuerstenfeldbruck, Cologne, Germany
| | - Carla Ledderhos
- Air Force Centre of Aerospace Medicine, Fuerstenfeldbruck, Cologne, Germany
| | - Immanuel Roiu
- 74th Tactical Air Wing of the German Air Force, Neuburg, Germany
| | - Stefan Karrasch
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), University Hospital, LMU Munich, Munich, Germany
| | - Daniel Teupser
- Institute for Laboratory Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Christian Königer
- Air Force Centre of Aerospace Medicine, Fuerstenfeldbruck, Cologne, Germany
- Occupational Medicine Department, Medical Support Center Munich, Munich, Germany
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2
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Wisseman BL, Edwards ES, Akers JD, Kurti SP. The Effect of Varying Fatty Acid Composition on Postprandial Airway Inflammation, Pulmonary Function, and Airway Resistance in Healthy, Young Adults. J Am Nutr Assoc 2024; 43:131-138. [PMID: 37399335 DOI: 10.1080/27697061.2023.2229877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 06/08/2023] [Accepted: 06/21/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To examine the effect of varying fatty acid composition in a HFM on eNO, pulmonary function, and airway resistance. METHODS Fifteen individuals [6 M/9 F; 21.9 ± 1.5 years old] each completed three HFM conditions {SF, O6FA, and O3FA; 12 kcal/kg body weight, 63% total fat, and 0.72 g/kg sugar smoothies} in random order separated by at least 48 h. Airway inflammation assessed via eNO, pulmonary function measured using the maximum flow volume loop (MFVL) and airway resistance measured using impulse oscillometry (iOS) were taken at baseline, 2h and 4h postprandially. RESULTS There was no difference in eNO or iOS across time in any condition or between conditions (p > 0.05). There was a significant time by condition effect for FEV1 post-HFM in the SF and O6FA conditions (p < 0.05). CONCLUSION Different fatty acid compositions do not increase eNO or iOS in healthy, college-aged participants after consumption of a HFM, though the minimally processed meals with fruit added may contribute to these findings.
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Affiliation(s)
- Breanna L Wisseman
- Department of Kinesiology, Human Performance Laboratory, James Madison University, Harrisonburg, VA, USA
- Department of Kinesiology, Human Performance Laboratory, East Carolina University, Greenville, NC, USA
| | - Elizabeth S Edwards
- Department of Kinesiology, Human Performance Laboratory, James Madison University, Harrisonburg, VA, USA
| | - Jeremy D Akers
- Department of Kinesiology, Human Performance Laboratory, James Madison University, Harrisonburg, VA, USA
- Department of Health Professions, Integrated Nutrition and Physiology Laboratory, James Madison University, Harrisonburg, VA, USA
| | - Stephanie P Kurti
- Department of Kinesiology, Human Performance Laboratory, James Madison University, Harrisonburg, VA, USA
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3
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Schleich F, Moermans C, Gerday S, Ziant S, Louis G, Bougard N, Paulus V, Guissard F, Henket M, Bachert C, Louis R. Patients With Asthma Only Sensitized to Staphylococcus aureus Enterotoxins Have More Exacerbations, Airflow Limitation, and Higher Levels of Sputum IL-5 and IgE. J Allergy Clin Immunol Pract 2023; 11:3055-3061.e4. [PMID: 37301436 DOI: 10.1016/j.jaip.2023.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Staphylococcus aureus enterotoxins (SE) may act as superantigens and induce an intense T-cell activation, causing local production of polyclonal IgE and resultant eosinophil activation. OBJECTIVE To assess whether asthma with sensitization to SE but not to common aeroallergens (AAs) displays different inflammatory characteristics. METHODS We conducted a prospective study on a series of 110 consecutive patients with asthma recruited from the University Asthma Clinic of Liège. We compared clinical, functional, and inflammatory characteristics of this general population of patients with asthma categorized into 4 groups according to sensitization to AAs and/or SE. We also compared sputum supernatant cytokines in patients sensitized to SE or not. RESULTS Patients with asthma sensitized only to AAs represented 30%, while 29% were sensitized to both AAs and SE. One-fifth of the population had no specific IgE. Sensitization to SE but not to AA (21%) was associated with later onset of disease, higher rate of exacerbations, nasal polyps, and more severe airway obstruction. As for airway type 2 biomarkers, patients presenting with specific IgE against SE displayed higher fractional exhaled nitric oxide, sputum IgE, and sputum IL-5 levels but not IL-4. We confirm that the presence of specific IgE against SE is associated with elevated serum IgE to levels well above those observed in patients sensitized only to AAs. CONCLUSIONS Our study suggests that asthma specialists should measure specific IgE against SE during the phenotyping process because it may allow the identification of a subgroup of patients with more asthma exacerbations, more nasal polyposis and chronic sinusitis, lower lung function, and more intense type 2 inflammation.
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Affiliation(s)
- Florence Schleich
- CHU Liège Sart-Tilman, University of Liège, GIGA I(3), Liège, Belgium.
| | | | - Sara Gerday
- CHU Liège Sart-Tilman, University of Liège, GIGA I(3), Liège, Belgium
| | - Stéphanie Ziant
- CHU Liège Sart-Tilman, University of Liège, GIGA I(3), Liège, Belgium
| | - Gilles Louis
- CHU Liège Sart-Tilman, University of Liège, GIGA I(3), Liège, Belgium
| | - Nicolas Bougard
- CHU Liège Sart-Tilman, University of Liège, GIGA I(3), Liège, Belgium
| | - Virginie Paulus
- CHU Liège Sart-Tilman, University of Liège, GIGA I(3), Liège, Belgium
| | | | - Monique Henket
- CHU Liège Sart-Tilman, University of Liège, GIGA I(3), Liège, Belgium
| | - Claus Bachert
- ENT-Clinic, University Hospital of Münster, Münster, Germany; Division of ENT Diseases, CLINTEC, Karolinska Institute, Stockholm, Sweden; Upper Airway Research Laboratory, Ghent University, Ghent, Belgium
| | - Renaud Louis
- CHU Liège Sart-Tilman, University of Liège, GIGA I(3), Liège, Belgium
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Khomich M, Lin H, Malinovschi A, Brix S, Cestelli L, Peddada S, Johannessen A, Eriksen C, Real FG, Svanes C, Bertelsen RJ. Association between lipid-A-producing oral bacteria of different potency and fractional exhaled nitric oxide in a Norwegian population-based adult cohort. J Transl Med 2023; 21:354. [PMID: 37246224 DOI: 10.1186/s12967-023-04199-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/14/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Lipid A is the primary immunostimulatory part of the lipopolysaccharide (LPS) molecule. The inflammatory response of LPS varies and depends upon the number of acyl chains and phosphate groups in lipid A which is specific for a bacterial species or strain. Traditional LPS quantification assays cannot distinguish between the acylation degree of lipid A molecules, and therefore little is known about how bacteria with different inflammation-inducing potencies affect fractional exhaled nitric oxide (FeNO). We aimed to explore the association between pro-inflammatory hexa- and less inflammatory penta-acylated LPS-producing oral bacteria and FeNO as a marker of airway inflammation. METHODS We used data from a population-based adult cohort from Norway (n = 477), a study center of the RHINESSA multi-center generation study. We applied statistical methods on the bacterial community- (prediction with MiRKAT) and genus-level (differential abundance analysis with ANCOM-BC) to investigate the association between the oral microbiota composition and FeNO. RESULTS We found the overall composition to be significantly associated with increasing FeNO levels independent of covariate adjustment, and abundances of 27 bacterial genera to differ in individuals with high FeNO vs. low FeNO levels. Hexa- and penta-acylated LPS producers made up 2.4% and 40.8% of the oral bacterial genera, respectively. The Bray-Curtis dissimilarity within hexa- and penta-acylated LPS-producing oral bacteria was associated with increasing FeNO levels independent of covariate adjustment. A few single penta-acylated LPS producers were more abundant in individuals with low FeNO vs. high FeNO, while hexa-acylated LPS producers were found not to be enriched. CONCLUSIONS In a population-based adult cohort, FeNO was observed to be associated with the overall oral bacterial community composition. The effect of hexa- and penta-acylated LPS-producing oral bacteria was overall significant when focusing on Bray-Curtis dissimilarity within each of the two communities and FeNO levels, but only penta-acylated LPS producers appeared to be reduced or absent in individuals with high FeNO. It is likely that the pro-inflammatory effect of hexa-acylated LPS producers is counteracted by the dominance of the more abundant penta-acylated LPS producers in this population-based adult cohort involving mainly healthy individuals.
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Affiliation(s)
- Maryia Khomich
- Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Huang Lin
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences (NIEHS), NIH, Research Triangle Park, Durham, NC, USA
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Susanne Brix
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Lucia Cestelli
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Shyamal Peddada
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences (NIEHS), NIH, Research Triangle Park, Durham, NC, USA
| | - Ane Johannessen
- Department of Global Public Health and Primary Care, Center for International Health, University of Bergen, Bergen, Norway
| | - Carsten Eriksen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
- Center for Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Francisco Gomez Real
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Cecilie Svanes
- Department of Global Public Health and Primary Care, Center for International Health, University of Bergen, Bergen, Norway
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Randi Jacobsen Bertelsen
- Department of Clinical Science, University of Bergen, Bergen, Norway.
- Oral Health Center of Expertise in Western Norway, Bergen, Norway.
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5
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Kerget B, Araz Ö, Akgün M. The role of exhaled nitric oxide (FeNO) in the evaluation of lung parenchymal involvement in COVID-19 patients. Intern Emerg Med 2022; 17:1951-1958. [PMID: 35809151 PMCID: PMC9521553 DOI: 10.1007/s11739-022-03035-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/16/2022] [Indexed: 01/13/2023]
Abstract
The inflammatory balance is an important factor in the clinical course of COVID-19 (SARS-CoV-2) infection, which has affected over 300 million people globally since its appearance in December 2019. This study aimed to evaluate the correlation between exhaled nitric oxide (FeNO) level and parenchymal involvement in COVID-19. The study included 106 patients with the delta variant of COVID-19 identified by real-time PCR as well as 40 healthy control groups between October 2021 and March 2022. The patients were analyzed in three groups: moderate COVID-19 (group 1), severe COVID-19 without macrophage activation syndrome (MAS) (group 2), and severe COVID-19 with MAS (group 3). FeNO and CT scores were significantly higher in groups 2 and 3 at admission and discharge compared to group 1 (p = 0.001 for all). In addition, CT score at admission and CT score and FeNO level at discharge were higher in group 3 than in group 2 (p = 0.001 for all). It was found that the FeNO levels were higher in Groups 2 and 3 than in the control group (p = 0.001) during the admission. FeNO and CT scores showed strong positive correlation at admission and discharge (r = 0.917, p = 0.001; r = 0.790, p = 0.001). In receiver operating characteristic curve analysis for prediction of MAS, FeNO at a cut-off of 10.5 ppb had 66% sensitivity and 71% specificity. COVID-19 causes more severe lung involvement than other viral lower respiratory tract infections, leading to the frequent use of chest CT in these patients. FeNO assessment is a practical and noninvasive method that may be useful in evaluating for parenchymal infiltration in the diagnosis and follow-up of COVID-19 patients.
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Affiliation(s)
- Buğra Kerget
- Department of Pulmonary Diseases, Ataturk University School of Medicine, 25240, Yakutiye, Erzurum, Turkey.
| | - Ömer Araz
- Department of Pulmonary Diseases, Ataturk University School of Medicine, 25240, Yakutiye, Erzurum, Turkey
| | - Metin Akgün
- Department of Pulmonary Diseases, Ataturk University School of Medicine, 25240, Yakutiye, Erzurum, Turkey
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Bertolini F, Sprio AE, Baroso A, Riccardi E, Pizzimenti S, Carriero V, Arrigo E, Di Stefano A, Ricciardolo FLM. Predictors of Low and High Exhaled Nitric Oxide Values in Asthma: A Real-World Study. Respiration 2022; 101:746-756. [PMID: 35512642 DOI: 10.1159/000524498] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 03/29/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In asthma, exhaled nitric oxide (FENO) is a clinically established biomarker of airway T2 inflammation and an indicator for anti-inflammatory therapy. OBJECTIVES The aim of the study was to identify, in an observational real-world cross-sectional study, the main characteristics of patients with asthma as classified by their FENO level. METHOD We stratified 398 patients with stable mild-to-severe asthma according to FENO level as low (≤25 ppb) versus elevated (>25 ppb), subdividing the latter into two subgroups: moderately elevated (26-50 ppb) versus very high FENO (>50 ppb). Clinical, functional, and blood parameters were extrapolated from patients' chart data and compared with the FENO stratification. Predictors of low and elevated FENO asthma were detected by logistic regression model. RESULTS Low BMI, higher blood eosinophilia, allergen poly-sensitization, the severest airflow obstruction (FEV1/FVC), and anti-leukotriene use are predictors of elevated FENO values in asthma, as well as persistent rhinitis and chronic rhinosinusitis with or without nasal polyps. Beyond these, younger age, more than 2 asthma exacerbations/year, higher airflow reversibility (post-bronchodilator ∆FEV1), and oral corticosteroid dependence are predictors of very high FENO values. In contrast, obesity, obstructive sleep apnoea syndrome, gastroesophageal reflux disease, arterial hypertension, and myocardial infarction are predictors of low FENO asthma. In our population, FENO correlated with blood eosinophils, airflow obstruction, and reversibility and negatively correlated with age and BMI. CONCLUSIONS Stratifying patients by FENO level can identify specific asthma phenotypes with distinct clinical features and predictors useful in clinical practice to tailor treatment and improve asthmatic patients' outcomes.
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Affiliation(s)
- Francesca Bertolini
- Department of Clinical and Biological Sciences, Rare Lung Disease Unit and Severe Asthma Centre, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | - Andrea E Sprio
- Department of Clinical and Biological Sciences, Rare Lung Disease Unit and Severe Asthma Centre, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy.,Department of Research, ASOMI College of Sciences, Marsa, Malta
| | - Andrea Baroso
- Department of Clinical and Biological Sciences, Rare Lung Disease Unit and Severe Asthma Centre, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | - Elisa Riccardi
- Department of Clinical and Biological Sciences, Rare Lung Disease Unit and Severe Asthma Centre, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | - Stefano Pizzimenti
- Rare Lung Disease Unit and Severe Asthma Centre, San Luigi Gonzaga University Hospital, Turin, Italy
| | - Vitina Carriero
- Department of Clinical and Biological Sciences, Rare Lung Disease Unit and Severe Asthma Centre, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | - Elisa Arrigo
- Department of Clinical and Biological Sciences, Rare Lung Disease Unit and Severe Asthma Centre, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
| | - Antonino Di Stefano
- Division of Pneumology and Laboratory of Cytoimmunopathology of the Heart and Lung, Istituti Clinici Scientifici Maugeri, IRCCS, Novara, Italy
| | - Fabio L M Ricciardolo
- Department of Clinical and Biological Sciences, Rare Lung Disease Unit and Severe Asthma Centre, San Luigi Gonzaga University Hospital, University of Turin, Turin, Italy
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Rydell N, Nagao M, Movérare R, Ekoff H, Sjölander A, Borres MP, Fujisawa T. Serum Eosinophilic Cationic Protein Is a Reliable Biomarker for Childhood Asthma. Int Arch Allergy Immunol 2022; 183:744-752. [PMID: 35144256 DOI: 10.1159/000521890] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/03/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Eosinophilic cationic protein (ECP) is associated with airway inflammation and asthma. However, the clinical value of measuring ECP in childhood asthma is not fully known. We aimed to study the diagnostic performance of serum ECP and other common asthma biomarkers, individually and in combinations. METHODS In a cross-sectional study, 5-16-year-old children with current asthma (CA) (n = 37), transient asthma (TA) (n = 43), (previous history of wheezing/asthma), and healthy children (HC) (n = 86) were investigated for ECP, blood eosinophil count (B-Eos), fractional exhaled nitric oxide (FeNO), and lung function, i.e., spirometry (forced expiratory volume during the first second [FEV1]/forced vital capacity [FVC] ratio). RESULTS Both ECP and B-Eos were higher in CA compared to TA (p < 0.01) and HC (p < 0.0001). ECP and B-Eos were also higher in TA compared to HC (p < 0.05 and p < 0.001, respectively). FeNO was higher in CA (p < 0.0001) and TA (p < 0.01) compared to HC but similar between the asthma groups. The FEV1/FVC ratio was lower in CA compared to TA and HC (both p < 0.01) but similar between TA and HC. The best diagnostic performance regarding CA was found for ECP and B-Eos with receiver operating characteristics area under curve (AUC) of 0.801 and 0.810, respectively. The optimal cutoff for ECP (29 μg/L) yielded a sensitivity and specificity of 70.3% and 81.4%. The corresponding AUCs for FeNO and FEV1/FVC were 0.732 and 0.670, respectively. ECP and B-Eos showed the highest AUCs (0.669 and 0.673) for differentiation between CA and TA. Combining ECP with FeNO and FEV1/FVC increased the odds ratio (OR) for having CA from OR 3.97-10.3 for the single biomarkers to OR 20.2 (95% confidence interval: 5.76-68.6). CONCLUSION Our results show that serum ECP is a reliable biomarker in the diagnosis of childhood asthma, with additional value in combination with FeNO and FEV1/FVC, and that ECP can be an alternative to B-Eos.
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Affiliation(s)
| | - Mizuho Nagao
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Robert Movérare
- Thermo Fisher Scientific, Uppsala, Sweden.,Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | | | | | - Magnus P Borres
- Thermo Fisher Scientific, Uppsala, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Takao Fujisawa
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
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8
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Matsumoto H. Bronchiectasis in severe asthma and asthmatic components in bronchiectasis. Respir Investig 2021; 60:187-196. [PMID: 34924307 DOI: 10.1016/j.resinv.2021.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/19/2021] [Accepted: 11/05/2021] [Indexed: 12/15/2022]
Abstract
Asthma and bronchiectasis are different diseases; however, differentiating them can be difficult because they share several symptomatic and physiological similarities. Approximately 20% of patients with bronchiectasis have eosinophilic inflammation, 34% show wheezing, and 7-46% have comorbid asthma, although comorbidity with severe asthma may be limited as shown in 3.3% of cases of bronchiectasis. Meanwhile, 25-68% of patients with severe asthma have comorbid bronchiectasis, and at least two phenotypes are present in the accompanying bronchiectasis: eosinophilic bronchiectasis and chronic infectious bronchiolitis/bronchiectasis. Recent studies show that type-2-targeted biologics are effective for eosinophilic bronchiectasis and theoretically effective for some of the remaining cases when used before oral corticosteroids. Further studies are needed to identify treatment strategies for severe asthma with comorbid bronchiectasis and vice versa.
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Affiliation(s)
- Hisako Matsumoto
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, 377-2, Ohno-higashi, Osakasayama City, Osaka, 589-8511, Japan.
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9
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Betancor D, Valverde-Mongue M, Gomez-Lopez A, Barroso B, Ruete L, Olaguibel JM, Sastre J. Evaluation of fractional exhaled nitric oxide during SARS-CoV-2 infection. J Investig Allergol Clin Immunol 2021; 32:301-303. [PMID: 34755657 DOI: 10.18176/jiaci.0762] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- D Betancor
- Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - M Valverde-Mongue
- Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - A Gomez-Lopez
- Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - B Barroso
- Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - L Ruete
- Eversens, Pamplona, Navarra, Spain
| | - J M Olaguibel
- Allergy Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - J Sastre
- Allergy Department, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain.,CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
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10
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Villalobos-Violan V, Betancor D, Mahíllo-Fernández I, Sastre J. Nonasthmatic Eosinophilic Bronchitis and Asthma Development: analysis of biomarkers. J Investig Allergol Clin Immunol 2021; 32:216-217. [PMID: 34661536 DOI: 10.18176/jiaci.0738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- V Villalobos-Violan
- Allergology Service. Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid and Instituto de Investigación Sanitaria (IIS) Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES)
| | - D Betancor
- 1Allergology Service. Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid and Instituto de Investigación Sanitaria (IIS) Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES)
| | - I Mahíllo-Fernández
- Department of Biostatistics and Epidemiology, IIS-Fundación Jimenez Diaz UAM, Madrid, Spain
| | - J Sastre
- Allergology Service. Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid and Instituto de Investigación Sanitaria (IIS) Fundación Jiménez Díaz, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES)
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11
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Vinnikov D, Tulekov Z, Blanc PD. Fractional exhaled NO in a metalworking occupational cohort. Int Arch Occup Environ Health 2021; 95:701-708. [PMID: 34626220 DOI: 10.1007/s00420-021-01801-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/22/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Secondary metalworking carries exposure to relatively heavy levels of respirable particulate. We investigated the extent to which metalworking is associated with increased exhaled nitric oxide (FeNO), an established inflammatory biomarker. METHODS We studied 80 metalworking factory employees in Kazakhstan. Informed by industrial hygiene data, we categorized them into three groups: (1) machine operators (41%); (2) welders or assemblers (33%); and (3) all others, including administrative and ancillary staff (26%). Participants completed questionnaires covering occupational history, smoking, home particulate sources, respiratory symptoms, and comorbidities. We measured exhaled carbon monoxide (CO), exhaled fractional nitric oxide (FeNO), and spirometric function. We used mixed-effects modeling to test the associations of occupational group with FeNO, adjusted for covariates. RESULTS The median age was 51.5 (interquartile range 20.5) years; 7% were women. Occupational group (p < 0.01), daily current cigarette smoking intensity (p < 0.05), and age (p < 0.05), each was statistically associated with FeNO. Welders, or assemblers (Group 2), who had intermediate particulate exposure, manifested significantly higher exhaled FeNO compared to machinists (Group 1, with the highest particulate exposure) and all others (Groups 3, the lowest particulate): adjusted Group 2 mean 44.8 ppb (95% confidence interval (CI) 33.8-55.9) vs. Group 1 24.6 ppb (95% 20.5-28.7) and Group 3, 24.3 ppb (95% CI 17.7-30.9). Secondhand smoking and height were not associated with FeNO. CONCLUSION In a metalworking industrial cohort, welders/assemblers manifested significantly higher levels of FeNO. This may reflect respiratory tract inflammation associated with airborne exposures specific to this group.
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Affiliation(s)
- Denis Vinnikov
- Al-Farabi Kazakh National University, 71 al-Farabi avenue, 050040, Almaty, Kazakhstan. .,Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation.
| | - Zhangir Tulekov
- Al-Farabi Kazakh National University, 71 al-Farabi avenue, 050040, Almaty, Kazakhstan
| | - Paul D Blanc
- University of California San Francisco, San Francisco, CA, USA
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12
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Madrid WA, Guzmán-Valderrábano C, Martínez-Briseño D, Torre-Bouscoulet L, Juan DHRS, Gochicoa-Rangel L. Offline exhaled nitric oxide in children: chemiluminescence vs. electrochemical devices. Bol Med Hosp Infant Mex 2021; 78:404-410. [PMID: 34571514 DOI: 10.24875/bmhim.20000345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Exhaled nitric oxide (eNO) is a noninvasive marker of airway inflammation that has been used in children, using the "offline" technique. To the extent of our knowledge, no article reported in literature compares the concordance and correlation between the two different technologies used to measure eNO at tidal volume offline. This study aimed to report the concordance and correlation of the eNO measured "offline" at tidal volume, using chemioluminiscence (cl) vs electrochemical devices (eq). Methods A cross-sectional, observational, and prospective study was conducted in the National Institute of Respiratory Diseases (Instituto Nacional de Enfermedades Respiratorias), Mexico City. Healthy children and those with a lung disease between 1 and 11 years of age were included. The exhaled air sample at tidal volume was obtained by attaching a mask connected to a Mylar® bag. Results We studied 36 children. The mean ± standard deviation (SD) age of the study population was 6 ± 2.6 years; 25% of the subjects included were healthy, and the rest had a lung disease. The concordance correlation coefficient between the two measuring devices was 0.98 (p < 0.001), with a mean difference of 1.46 ± 3.5 ppb and 95% limits of agreement from -5.3 ppb to 8.3 ppb. The linear regression model equation for the estimation of eNO was eNOcl = (eNOeq·1.0718) - 0.1343 (r2 = 0.97). Conclusions The measurement of eNO at tidal volume by the offline method can be analyzed by electrochemical devices, and the results are interchangeable with those analyzed by chemiluminescence technology.
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Affiliation(s)
- Wilmer A Madrid
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas. Mexico City, Mexico
| | - Carlos Guzmán-Valderrábano
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas. Mexico City, Mexico.,Departmento de Pulmonología, Pedia-Hero. Mexico City, Mexico
| | - David Martínez-Briseño
- Departmento de Epidemiología y Estadística, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas. Mexico City, Mexico
| | - Luis Torre-Bouscoulet
- Laboratorio de Función Pulmonar, Instituto de Desarrollo e Innovación en Fisiología Respiratoria S de RL. Mexico City, Mexico
| | - David H Ramírez-San Juan
- Laboratorio de Función Pulmonar, Instituto de Desarrollo e Innovación en Fisiología Respiratoria S de RL. Mexico City, Mexico
| | - Laura Gochicoa-Rangel
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas. Mexico City, Mexico.,Laboratorio de Función Pulmonar, Instituto de Desarrollo e Innovación en Fisiología Respiratoria S de RL. Mexico City, Mexico
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13
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Liu Y, Chang X, Liang L, Hou Z, Lu Y. A comparative study of the RuiBreath and NIOX VERO analyzers for detecting fractional exhaled nitric oxide. J Thorac Dis 2021; 13:4418-4426. [PMID: 34422368 PMCID: PMC8339745 DOI: 10.21037/jtd-21-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/23/2021] [Indexed: 11/26/2022]
Abstract
Background Fractional exhaled nitric oxide (FeNO) measurement is a reliable, noninvasive marker of airway inflammation. Portable FeNO analyzers facilitate the assessment of airway inflammation in primary care. Differences between analyzers from different manufacturers are not comparable. Here, we aimed to compare the FeNO values obtained by a new portable device (RuiBreath, Guangzhou Ruipu Medical Technology Co., Ltd, Guangzhou, China) to those obtained by the widely used NIOX VERO portable analyzer (Aerocrine AB, Solna, Sweden) in patients with asthma. Methods This prospective validation study enrolled patients (≥14 years old) with asthma over a 2-month period (July and August 2019) at the Beijing Chao-Yang Hospital. At least one valid FeNO measurement was obtained using each analyzer for all the participants. Results There were 197 participants in this study. The FeNONIOX and FeNORuiBreath values significantly differed (P=0.016). After log-transformation, a difference was found only when the FeNONIOX was <25 ppb (P<0.001). The FeNONIOX and FeNORuiBreath values had a significant correlation (r=0.938, P<0.001), which was confirmed by the Altman-Bland plot. Using a receiver-operating characteristic curve analysis, when using 49 ppb as the cut-off point for the two devices in identifying patients with symptomatic asthma symptoms, the sensitivity and specificity were 0.42 and 0.88, respectively, by NIOX, and 0.40 and 0.89, respectively, by RuiBreath. Conclusions This is the first report of FeNO values obtained by the new portable RuiBreath FeNO analyzer. The FeNORuiBreath values are reliable and directly comparable with the FeNONIOX values.
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Affiliation(s)
- Yalan Liu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaohong Chang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Lirong Liang
- Clinical Epidemiology and Tobacco Dependence Treatment Research Department, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhaoshen Hou
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yong Lu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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14
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Li JH, Han R, Wang YB, Cheng M, Chen HY, Lei WH, Li L, Gao C, Zhao NN, Nie NF, Li ZY, Yin GQ, Huang S, He Y. Diagnostic possibility of the combination of exhaled nitric oxide and blood eosinophil count for eosinophilic asthma. BMC Pulm Med 2021; 21:259. [PMID: 34372824 PMCID: PMC8351446 DOI: 10.1186/s12890-021-01626-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 08/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tests to identify reversible airflow limitation are important in asthma diagnosis, but they are time-consuming and it may be difficult for patients to cooperate. We aimed to evaluate whether the combination of fractional exhaled nitric oxide (FeNO) and blood eosinophil (B-Eos) can be used to distinguish some asthma patients who could avoid objective tests. METHODS We conducted a retrospective cohort study on 7463 suspected asthma cases between January 2014 and December 2019 in Chongqing, China, and identified 2349 patients with complete FeNO, B-Eos count, and spirometry data. Asthma was diagnosed by clinicians by the criteria of recurrent respiratory symptoms and a positive bronchial-provocation or bronchodilation test (BPT, BPD). We evaluated the diagnostic accuracy of FeNO or B-Eos alone or both in combination for asthma using receiver operating characteristic (ROC) curve analysis. RESULTS In this study, 824 patients were diagnosed with asthma. When FeNO and B-Eos counts were used in combination, the area under the ROC curve (AUC) for diagnosing asthma increased slightly (0.768 vs. 0.745 [FeNO] or 0.728 [B-Eos]; both P < 0.001). The odds ratio for having asthma increased progressively with a gradual increase in FeNO or B-Eos count (both P < 0.001; assessed using the Cochran-Armitage trend test). Further analysis of in-series combinations of different threshold values for these biomarkers indicated that moderately elevated biomarker levels (FeNO > 40 ppb and B-Eos > 300 cells/μl) support a diagnosis of asthma because diagnostic specificity was > 95% and the positive likelihood ratio (PLR) was > 10. This conclusion was verified when selecting the 2017-2019 data as the internal validation dataset. CONCLUSION FeNO or B-Eos count alone is insufficient to accurately diagnose asthma. Patients with moderately elevated biomarkers (FeNO > 40 ppb and B-Eos > 300 cells/μl) could be diagnosed with asthma and avoid objective tests when such tests are not feasible.
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Affiliation(s)
| | - Rui Han
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Yu-Bo Wang
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Min Cheng
- Department of Cardiology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Heng-Yi Chen
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Wen-Hui Lei
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Li Li
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Chen Gao
- Department of Clinical Laboratory Medicine, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Na-Na Zhao
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Nai-Fu Nie
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Zhong-Yan Li
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Guo-Qing Yin
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Shuai Huang
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China
| | - Yong He
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, 10# Changjiang Branch Road, Chongqing, 400042, China.
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15
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Songnuy T, Petchuay P, Chutiyon W, Nurak A. Correlation between fractional exhaled nitric oxide level and clinical outcomes among childhood asthmatic patients: community hospital-based perspective. Heliyon 2021; 7:e06925. [PMID: 34007928 PMCID: PMC8111257 DOI: 10.1016/j.heliyon.2021.e06925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/02/2021] [Accepted: 04/22/2021] [Indexed: 11/17/2022] Open
Abstract
A fractional exhaled nitric oxide (FeNO) device has been developed for the evaluation of clinical control in asthmatic patients, instead of for uses in only analyzing clinical data and spirometry. The implementation of the FeNO device in daily practice has demonstrated both positive and negative results. Community hospital settings in Thailand have never used this method for the evaluation of disease control in asthmatics. The aim of this study was to assess the correlation between FeNO levels and asthma control, as determined by physicians. We recruited asthmatic patients aged from 4-15-years-old (after informed consent approval was obtained from their guardians) from May 15, 2018, to July 20, 2019. All of the patients had already been diagnosed as having asthma by physicians and had been prescribed inhaled corticosteroid medications. After routine visits, skin prick tests with 8 aeroallergens were performed. If a positive result was shown for at least 1 allergen, then the FeNO device was applied for the assessment of the level of inflammation. Data were analyzed by using SPSS Statistics version 21.0. Agreement index and Kruskal Wallis tests were used to measure the correlations. From 178 asthmatic patients, the mean age was 94.9 ± 36.75 months, and 59% of them were male. The educational levels of the guardians of the patients mostly consisted of primary school, and the household income was less than 333 US dollars per month. Inhaled corticosteroids were prescribed among the patients for disease control. The correlation between the FeNO level and the control level demonstrated a high agreement (accuracy index: 91.57%). The medians of the mean wheal diameters of Dermatophagoids pteronyssinus, Dermatophagoids farinae and Cladosporium spp. were significantly related to the FeNO level (with p-values of 0.024, 0.003 and 0.045, respectively). Conversely, a number of positive skin responses to aeroallergens were not related with the FeNO level. In conclusion, a lower level of FeNO correlates with good asthma control level in pediatric allergic asthma. The medians of the mean wheal diameters of Dermatophagoids pteronyssinus, Dermatophagoids farinae and Cladosporium spp. correlated with higher FeNO levels. A device assessing FeNO seems beneficial for evaluating the level of disease control among childhood asthmatic patients in a primary care setting.
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Affiliation(s)
- Theerapan Songnuy
- Department of Clinical Medical Sciences, Walailak University, School of Medicine, Nakhon Si Thammarat, 80160, Thailand
| | - Prachyapan Petchuay
- Department of Clinical Medical Sciences, Walailak University, School of Medicine, Nakhon Si Thammarat, 80160, Thailand
| | - Wongwat Chutiyon
- Division of Pediatrics, Thasala Hospital, Nakhon Si Thammarat, 80160, Thailand
| | - Awirut Nurak
- Division of Pediatrics, Thasala Hospital, Nakhon Si Thammarat, 80160, Thailand
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16
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Goth FEM, Schmidt BJ, Agertoft L, Jørgensen IM. Exhaled nitric oxide in premature and mature infants during the first months of life. Nitric Oxide 2021; 113-114:7-12. [PMID: 33866006 DOI: 10.1016/j.niox.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 02/02/2021] [Accepted: 04/13/2021] [Indexed: 10/21/2022]
Abstract
AIM In this review, we aim to describe how exhaled Nitric Oxide(NO) changes during the first months of life in premature and mature infants. METHOD Review of the literature up to August 2020, on online, tidal breathing NO measurements in unsedated infants. The association between Fractional exhaled NO(FeNO) values, postnatal age, and prematurity was analysed using linear mixed modeling and Spearman's rank correlation. RESULTS Median FeNO during the first months of life was 5.9 and 8.5 ppb in premature and mature infants, respectively. The linear mixed model analysis showed a significant effect of postnatal age on FeNO (p = 0.007). CONCLUSION Our study suggests that FeNO is higher in mature infants than premature infants, and FeNO increased with postnatal age at approximately the same pace in both groups.
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Affiliation(s)
- Fanny E M Goth
- Department of Pediatrics and Adolescence Medicine, Nordsjællands Hospital, Capital Region of Denmark, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark.
| | - Birgitte J Schmidt
- Department of Pediatrics, Hvidovre Hospital, Capital Region of Denmark, Denmark
| | - Lone Agertoft
- Department of Pediatrics, H.C. Andersen Children's Hospital, Odense University Hospital, University of Southern Denmark, Denmark
| | - Inger Merete Jørgensen
- Department of Pediatrics and Adolescence Medicine, Nordsjællands Hospital, Capital Region of Denmark, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
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17
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Olaguibel A, Oleaga M, Iraola A, Cortaberría R, Corcuera A, Alvarez-Puebla MJ, Tabar A, Ruete L, Botas A, Olaguibel JM. Exhaled Nitric Oxide (eNO) Measurements With the New evernoa Device Are Valid and Reproducible Through an Extended Range of eNO Levels. J Investig Allergol Clin Immunol 2021; 30:147-149. [PMID: 32327404 DOI: 10.18176/jiaci.0465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- A Olaguibel
- NavarraBioMed, Gobierno de Navarra, Navarra, Spain
| | - M Oleaga
- NavarraBioMed, Gobierno de Navarra, Navarra, Spain
| | - A Iraola
- NavarraBioMed, Gobierno de Navarra, Navarra, Spain.,Unidad de Asma Grave, Servicio de Alergología, Complejo Hospitalario de Navarra, Navarra, Spain
| | - R Cortaberría
- NavarraBioMed, Gobierno de Navarra, Navarra, Spain.,Unidad de Asma Grave, Servicio de Alergología, Complejo Hospitalario de Navarra, Navarra, Spain
| | - A Corcuera
- Unidad de Asma Grave, Servicio de Alergología, Complejo Hospitalario de Navarra, Navarra, Spain
| | - M J Alvarez-Puebla
- NavarraBioMed, Gobierno de Navarra, Navarra, Spain.,Unidad de Asma Grave, Servicio de Alergología, Complejo Hospitalario de Navarra, Navarra, Spain.,CIBER Respiratorio
| | - A Tabar
- NavarraBioMed, Gobierno de Navarra, Navarra, Spain.,Unidad de Asma Grave, Servicio de Alergología, Complejo Hospitalario de Navarra, Navarra, Spain
| | - L Ruete
- Eversens, Pamplona, Navarra, Spain
| | - A Botas
- Eversens, Pamplona, Navarra, Spain
| | - J M Olaguibel
- NavarraBioMed, Gobierno de Navarra, Navarra, Spain.,Unidad de Asma Grave, Servicio de Alergología, Complejo Hospitalario de Navarra, Navarra, Spain.,CIBER Respiratorio
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18
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Ji N, Fang M, Baptista A, Cepeda C, Greenberg M, Mincey IC, Ohman-Strickland P, Haynes F, Fiedler N, Kipen HM, Laumbach RJ. Exposure to traffic-related air pollution and changes in exhaled nitric oxide and DNA methylation in arginase and nitric oxide synthase in children with asthma. Environ Health 2021; 20:12. [PMID: 33573660 PMCID: PMC7879528 DOI: 10.1186/s12940-020-00678-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/13/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Traffic-related air pollution (TRAP) has been associated with increased risk of airway inflammation in children with asthma. While epigenetic changes could potentially modulate TRAP-induced inflammatory responses, few studies have assessed the temporal pattern of exposure to TRAP, epigenetic changes and inflammation in children with asthma. Our goal was to test the time-lag patterns of personal exposure to TRAP, airway inflammation (measured as fractional exhaled nitric oxide, FeNO), and DNA methylation in the promoter regions of genes involved in nitric oxide synthesis among children with asthma. METHODS We measured personal exposure to black carbon (BC) and FeNO for up to 30 days in a panel of children with asthma. We collected 90 buccal cell samples for DNA methylation analysis from 18 children (5 per child). Methylation in promoter regions of nitric oxide synthase (NOS1, NOS2A, NOS3) and arginase (ARG1, ARG2) was assessed by bisulfite pyrosequencing. Linear-mixed effect models were used to test the associations of BC at different lag periods, percent DNA methylation at each site and FeNO level. RESULTS Exposure to BC was positively associated with FeNO, and negatively associated with DNA methylation in NOS3. We found strongest association between FeNO and BC at lag 0-6 h while strongest associations between methylation at positions 1 and 2 in NOS3 and BC were at lag 13-24 h and lag 0-24 h, respectively. The strengths of associations were attenuated at longer lag periods. No significant associations between exposure to TRAP and methylation levels in other NOS and ARG isoforms were observed. CONCLUSIONS Exposure to TRAP was associated with higher levels of FeNO and lower levels of DNA methylation in the promoter regions of the NOS3 gene, indicating that DNA methylation of the NOS3 gene could be an important epigenetic mechanism in physiological responses to TRAP in children with asthma.
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Affiliation(s)
- N Ji
- Rutgers, The State University of New Jersey, 170 Frelinghuysen Rd, Room 204, Piscataway, NJ, 08854, USA
| | - M Fang
- Rutgers, The State University of New Jersey, 170 Frelinghuysen Rd, Room 204, Piscataway, NJ, 08854, USA
| | | | - C Cepeda
- Rutgers, The State University of New Jersey, 170 Frelinghuysen Rd, Room 204, Piscataway, NJ, 08854, USA
| | | | | | - P Ohman-Strickland
- Rutgers, The State University of New Jersey, 170 Frelinghuysen Rd, Room 204, Piscataway, NJ, 08854, USA
| | - F Haynes
- Rutgers, The State University of New Jersey, 170 Frelinghuysen Rd, Room 204, Piscataway, NJ, 08854, USA
| | - N Fiedler
- Rutgers, The State University of New Jersey, 170 Frelinghuysen Rd, Room 204, Piscataway, NJ, 08854, USA
| | - H M Kipen
- Rutgers, The State University of New Jersey, 170 Frelinghuysen Rd, Room 204, Piscataway, NJ, 08854, USA
| | - R J Laumbach
- Rutgers, The State University of New Jersey, 170 Frelinghuysen Rd, Room 204, Piscataway, NJ, 08854, USA.
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19
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Carvalho-Oliveira R, Amato-Lourenço LF, Almeida PS, Garcia BBM, Vieira WKM, Santana A, Motta Godinho-Netto MC, Carretero ME, Nascimento Saldiva PH, Mauad T. Effects of long-standing exposure to heavy-duty diesel vehicle traffic on respiratory symptoms and airway inflammation in older adults. Environ Pollut 2021; 268:115893. [PMID: 33126158 DOI: 10.1016/j.envpol.2020.115893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/06/2020] [Accepted: 10/15/2020] [Indexed: 06/11/2023]
Abstract
In the present study, we evaluated the effects of chronic exposure to traffic from a heavy-duty diesel-fueled vehicle area on respiratory symptoms and airway inflammation in a nonsmoking adult and elderly population. Respiratory symptoms were evaluated by the ISAAC questionnaire (International Study of Asthma and Allergies questionnaire), and airway inflammation was assessed by fractional exhaled nitric oxide (FeNO). Forty volunteers were selected from the 112 volunteers who completed the ISAAC questionnaire for the measurement of FeNO. The FeNO population comprised seven men (six aged ≥ 64 years old, four aged ≥ 75 years old) and 32 women (27 aged ≥ 64 years old, nine aged ≥ 75 years old). FeNO levels were tracked for six months, from November 2014 to June 2015. Results: Twenty-four percent of the volunteers reported having had wheezing in the chest in the last 12 months. However, only 2.7% of the volunteers reported doctor-diagnosed asthma. There was a positive association between FeNO and pollutants in most of the study months. An increase of 1 μg m-3 in NO2 was associated with a mean increase of 1.08 ppb in FeNO, and an increase of 1 μg m-3 in O3 was associated with a mean increase of 1.06 ppb in FeNO. The relative risk for NO2 ranged from 1.009 to 1.32 and that for O3 ranged from 1.014 to 1.020. Conclusion: The frequency of respiratory symptoms was much higher than the previously described levels of 6% in the Brazilian adult population. In summary, a high frequency of respiratory symptoms and high levels of FeNO were described in an underdiagnosed adult population living very close to a heavy-duty diesel-traffic area. Older elderly adults presented greater susceptibility to airway inflammation than younger adults.
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Affiliation(s)
- Regiani Carvalho-Oliveira
- Pathology Department, School of Medicine at Sao Paulo University (FMUSP), Brazil; National Institute for Integrated Analysis of Environmental Risk (INAIRA), Brazil.
| | | | - Pâmela S Almeida
- Pathology Department, School of Medicine at Sao Paulo University (FMUSP), Brazil; Instituto Federal de Educação, Ciência e Tecnologia de São Paulo (IFSP), Brazil
| | - Bianca B M Garcia
- Pathology Department, School of Medicine at Sao Paulo University (FMUSP), Brazil; Instituto Federal de Educação, Ciência e Tecnologia de São Paulo (IFSP), Brazil
| | - William K M Vieira
- Instituto Federal de Educação, Ciência e Tecnologia de São Paulo (IFSP), Brazil
| | - Ariane Santana
- Instituto Federal de Educação, Ciência e Tecnologia de São Paulo (IFSP), Brazil
| | | | - Maria E Carretero
- Pathology Department, School of Medicine at Sao Paulo University (FMUSP), Brazil
| | - Paulo H Nascimento Saldiva
- Pathology Department, School of Medicine at Sao Paulo University (FMUSP), Brazil; National Institute for Integrated Analysis of Environmental Risk (INAIRA), Brazil
| | - Thais Mauad
- Pathology Department, School of Medicine at Sao Paulo University (FMUSP), Brazil; National Institute for Integrated Analysis of Environmental Risk (INAIRA), Brazil
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20
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Dreßler M, Fussbroich D, Böhler L, Herrmann E, Benker N, Tytyk M, Schulze J, Schubert R, Beermann C, Zielen S. Oil supplementation with a special combination of n-3 and n-6 long-chain polyunsaturated fatty acids does not protect for exercise induced asthma: a double-blind placebo-controlled trial. Lipids Health Dis 2020; 19:167. [PMID: 32660564 PMCID: PMC7359229 DOI: 10.1186/s12944-020-01343-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 07/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many patients suffering from exercise-induced asthma (EIA) have normal lung function at rest and show symptoms and a decline in FEV1 when they do sports or during exercise-challenge. It has been described that long-chain polyunsaturated fatty acids (LCPUFA) could exert a protective effect on EIA. METHODS In this study the protective effect of supplementation with a special combination of n-3 and n-6 LCPUFA (sc-LCPUFA) (total 1.19 g/ day) were investigated in an EIA cold air provocation model. PRIMARY OUTCOME MEASURE Decrease in FEV1 after exercise challenge and secondary outcome measure: anti-inflammatory effects monitored by exhaled NO (eNO) before and after sc-LCPUFA supplementation versus placebo. RESULTS Ninety-nine patients with exercise-induced symptoms aged 10 to 45 were screened by a standardized exercise challenge in a cold air chamber at 4 °C. Seventy-three patients fulfilled the inclusion criteria of a FEV1 decrease > 15% and were treated double-blind placebo-controlled for 4 weeks either with sc-LCPUFA or placebo. Thirty-two patients in each group completed the study. Mean FEV1 decrease after cold air exercise challenge and eNO were unchanged after 4 weeks sc-LCPUFA supplementation. CONCLUSION Supplementation with sc-LCPUFA at a dose of 1.19 g/d did not have any broncho-protective and anti-inflammatory effects on EIA. TRIAL REGISTRATION Clinical trial registration number: NCT02410096. Registered 7 February 2015 at Clinicaltrial.gov.
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Affiliation(s)
- M Dreßler
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe-University, Frankfurt/Main, Germany
| | - D Fussbroich
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe-University, Frankfurt/Main, Germany.,Department of Food Technology, University of Applied Science, Fulda, Germany.,Faculty of Biological Sciences, Goethe-University, Frankfurt/Main, Germany
| | - L Böhler
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe-University, Frankfurt/Main, Germany
| | - E Herrmann
- Institute of Biostatistics and Mathematical Modelling, Goethe-University, Frankfurt/Main, Germany
| | - N Benker
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe-University, Frankfurt/Main, Germany
| | - M Tytyk
- Department of Food Technology, University of Applied Science, Fulda, Germany
| | - J Schulze
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe-University, Frankfurt/Main, Germany
| | - R Schubert
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe-University, Frankfurt/Main, Germany
| | - C Beermann
- Department of Food Technology, University of Applied Science, Fulda, Germany
| | - S Zielen
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic fibrosis, Goethe-University, Frankfurt/Main, Germany.
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21
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Saranz R, Lozano A, Lozano NA, Alegre G, Sasia LV, Cóncari E, Robredo P, Ponzio M, Cruz Á. [Comparative analysis of exhaled nitric oxide in children and teenagers with allergic and non-allergic rhinitis]. ACTA ACUST UNITED AC 2020; 66:272-281. [PMID: 31606010 DOI: 10.29262/ram.v66i3.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is subclinical bronchial inflammation in patients with allergic rhinitis (AR). There is less evidence of inflammation of the lower airway in non-allergic rhinitis (NAR). OBJECTIVE To investigate the inflammation of the lower airway by exhaled nitric oxide (FeNO) in patients with AR and NAR without asthma and its link to lung function, the severity of rhinitis, and biomarkers of atopy. METHODS A cross-sectional study of patients aged 6 to 18 years, with AR or NAR without asthma. Spirometry, serum IgE, blood eosinophil count and FeNO were carried out. Rhinitis was classified according to the ARIA guide. RESULTS Forty patients were included; 28 with AR and 12 with NAR. Patients with AR showed higher FeNO levels (medium 36.5 ppb; range 5-114) than those with NAR (medium 7 ppb; range 5-24) (p = 0.0011). Elevated FeNO was linked to spirometric abnormalities [OR= 7.14 (95 % CI 1.04-49.04), p = 0.049)]. In AR, there was correlation between FeNO and blood eosinophils (r = 0.41, p = 0-33). CONCLUSIONS Both children and teenagers with AR showed higher FeNO than patients with NAR, which was correlated with blood eosinophilia and altered lung function.
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Affiliation(s)
- Ricardo Saranz
- Universidad Católica de Córdoba, Clínica Universitaria Reina Fabiola, Servicio de Alergia e Inmunología, Córdoba, Argentina.
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22
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Hoffmeyer F, Beine A, Lehnert M, Berresheim H, Taeger D, van Kampen V, Sander I, Zahradnik E, Brüning T, Raulf M. The Pattern of Sensitization Influences Exhaled and Nasal Nitric Oxide Levels in Young Adults. Adv Exp Med Biol 2020; 1279:15-26. [PMID: 32193864 DOI: 10.1007/5584_2020_509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Nitric oxide (NO) from upper (nasal NO, nNO) or lower airways (fractional exhaled NO, FeNO) is considered a surrogate marker for Th2-type inflammation, which is influenced by atopy. The aim of this study was to analyze nNO and FeNO in regard to qualitative and quantitative aspects of sensitization. We evaluated 244 non-smoking young adults. All of them were first-year students recruited for a longitudinal study. An inhalation allergy screening tool was used for atopy definition (specific immunoglobulin E (sIgE) to sx1 ≥ 0.35 kU/L), and also sIgE response to three inhalant perennial allergens, house dust mite (HDM, d1), cat (e1), and dog (e5), was determined in the non-pollen season. With respect to sx1, 100 subjects could be classified as atopic. Sensitization to one, two, or three perennial allergens could be demonstrated in 46, 10, and 16 students, respectively. The subjects with positive IgE response to sx1, but not sensitized to HDM, cat, and/or dog, had FeNO levels comparable to those of non-atopic subjects (13.5 vs. 13.0 ppb, respectively; p = 0.485). These levels were significantly lower compared to atopic subjects being sensitized to any perennial allergen (19.0 ppb; p = 0.0003). After grouping the atopic subjects for perennial sensitization patterns, significantly higher FeNO could be detected in subjects with poly-sensitization (n = 26; 26.0 ppb) compared to the mono-sensitized ones (n = 46; 18.0 ppb; p = 0.023). Regarding nNO, no differences could be observed. Applying a two-way ANOVA, we could reveal a significant correlation of specific HDM-IgE CAP-class with FeNO (p < 0.0001) and nNO levels (p = 0.007). Finally, a significant relationship was found between nNO and FeNO for the whole cohort (p < 0.0001). In summary, our findings support the argument that atopy and perennial sensitization should be considered for the interpretation of NO.
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23
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Kang MG, Yoon SA, Sim JH, Woo SI. Fractional exhaled nitric oxide and forced expiratory volume in 1 second/forced vital capacity have predictive value of asthma exacerbation in Korean school children. Asia Pac Allergy 2020; 10:e7. [PMID: 32099829 PMCID: PMC7016316 DOI: 10.5415/apallergy.2020.10.e7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/23/2020] [Indexed: 12/11/2022] Open
Abstract
Background The incidence of asthma exacerbation (AE) and the predictive value of spirometry and fractional exhaled nitric oxide (FeNO) in school children have not been evaluated. Objective We sought to evaluate the efficacy of spirometry measurement and FeNO monitoring for predicting AE in school children in the Cheongju area in Korea. Methods With parental agreement, we studied 170 students aged 7–12 years. Children were evaluated by an asthma specialist using baseline spirometry, skin prick test, seasonal FeNO measurement, and asthma control test. The study participants underwent a physical examination and their medical history was also evaluated by the specialist. They were assessed for asthma control status during regular doctor visits for 1 year. Results In total, 160 children (94.1%) completed follow-up and FeNO monitoring. Of which, 26 children (16.3%) had AE. AE was associated with male children and children with allergic rhinitis (p < 0.05). While, children with AE tended to have higher FeNO than those without AE, no significant difference was found. The maximum value of FeNO ≥35 ppb was associated with AE (p < 0.05). Children with AE had a significantly decreased baseline forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC), %predicted, forced expiratory flow at 25%–75% of FVC (FEF25%–75%). FEV1/FVC < 80% was associated with AE in children regardless of inhalant allergen sensitization (all p < 0.05). Conclusion Baseline spirometry had a predictive value of AE in school children. Sensitive spirometric parameters such as FEV1/FVC and FEF25%–75% can be used as prognostic factors to predict future childhood AE. FeNO value ≥ 35 ppb during monitoring was associated with AE in school children.
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Affiliation(s)
- Min-Gyu Kang
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Shin-Ae Yoon
- Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ju-Han Sim
- Oksan and Gangnae Elementary School, Chungbuk, Cheongju, Korea
| | - Sung-Il Woo
- Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
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24
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Al Badri FM, Baatjies R, Jeebhay MF. Assessing the health impact of interventions for baker's allergy and asthma in supermarket bakeries: a group randomised trial. Int Arch Occup Environ Health 2020; 93:589-599. [PMID: 31927662 DOI: 10.1007/s00420-019-01511-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/24/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE To assess the impact of an intervention for baker's allergy and asthma in supermarket bakeries. METHODS A group randomised trial conducted in 31 bakeries (n = 337 bakers) that were randomly assigned to one of two intervention groups (n = 244 bakers) and a control group (n = 93 bakers). Health data collected prior to and 1-year after the intervention included information obtained from an ECRHS questionnaire; tests for atopy and serum-specific IgE to cereal flours; fractional exhaled nitric oxide (FeNO). Data from the two intervention groups were combined to form one intervention group for purposes of the statistical analysis. RESULTS At 1 year of follow-up, the incidence and level of decline of work-related ocular-nasal and chest symptoms, sensitisation status and elevated FeNO (FeNO > 25 ppb) was similar in both intervention and control groups. The mean FeNO difference was also similar across both groups (2.2 ppb vs 1.7 ppb, p = 0.86). In those with FeNO > 25 ppb at baseline, the decline was greater in the intervention compared to control group (16.9 ppb vs 7.7 ppb, p = 0.24). Multivariate logistic regression models (adjusting for smoking, baseline sensitisation to cereal flour, baseline FeNO > 25 ppb) did not demonstrate an appreciable FeNO decline (≥ 10%) in the intervention compared to control group. However, stratification by the presence of work-related ocular-nasal symptoms in bakers at baseline demonstrated a significant FeNO decline (≥ 10%) in the intervention compared to the control group (OR 3.73, CI 1.22-11.42). CONCLUSION This study demonstrates some evidence of an intervention effect on FeNO 1 year after an intervention, particularly in bakers with work-related ocular-nasal symptoms.
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Affiliation(s)
- F M Al Badri
- Occupational Medicine Division and Centre for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Room 4. 45, Fourth Level, Falmouth Building, Anzio Road, Observatory, Cape Town, 7925, South Africa.,Occupational Medicine Department, Armed Forces Medical Services, Muscat, Oman
| | - R Baatjies
- Occupational Medicine Division and Centre for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Room 4. 45, Fourth Level, Falmouth Building, Anzio Road, Observatory, Cape Town, 7925, South Africa.,Department of Environmental and Occupational Studies, Cape Peninsula University of Technology (CPUT), Cape Town, South Africa
| | - Mohamed F Jeebhay
- Occupational Medicine Division and Centre for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Room 4. 45, Fourth Level, Falmouth Building, Anzio Road, Observatory, Cape Town, 7925, South Africa.
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25
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Abstract
Severe asthma is heterogeneous in its clinical presentation, underlying pathophysiology, course and response to therapy. Clinical and physiological assessment of severe asthma is often inadequate in predicting underlying disease mechanisms and or response to medications. With the emergence of novel targeted therapies in severe asthma, the need for reproducible, easily measured biomarkers became obvious but only few are currently available for clinical use. These biomarkers along with the clinical presentation of the patient play an important role in identifying phenotypes and endotypes, predicting the clinical course and prognosis and improving the precision therapeutic approach to asthma.
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Affiliation(s)
- Dharani Narendra
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - John Blixt
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, United States.
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26
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Malekmohammad M, Folkerts G, Kashani BS, Naghan PA, Dastenae ZH, Khoundabi B, Garssen J, Mortaz E, Adcock IM. Exhaled nitric oxide is not a biomarker for idiopathic pulmonary arterial hypertension or for treatment efficacy. BMC Pulm Med 2019; 19:188. [PMID: 31664957 PMCID: PMC6819396 DOI: 10.1186/s12890-019-0954-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 10/09/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Idiopathic pulmonary arterial hypertension (IPAH) is a fatal illness. Despite many improvements in the treatment of these patients, there is no unique prognostic variable available to track these patients. The aim of this study was to evaluate the association between fractional exhaled nitric oxide (FeNO) levels, as a noninvasive biomarker, with disease severity and treatment outcome. METHODS Thirty-six patients (29 women and 7 men, mean age 38.4 ± 11.3 years) with IPAH referred to the outpatient's clinic of Masih Daneshvari Hospital, Tehran, Iran, were enrolled into this pilot observational study. Echocardiography, six-minute walking test (6MWT), FeNO, brain natriuretic peptide (BNP) levels and the functional class of patients was assessed before patients started treatment. Assessments were repeated after three months. 30 healthy non-IPAH subjects were recruited as control subjects. RESULTS There was no significant difference in FeNO levels at baseline between patients with IPAH and subjects in the control group. There was also no significant increase in FeNO levels during the three months of treatment and levels did not correlate with other disease measures. In contrast, other markers of disease severity were correlated with treatment effect over the three months. CONCLUSION FeNO levels are a poor non-invasive measure of IPAH severity and of treatment response in patients in this pilot study.
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Affiliation(s)
- Majid Malekmohammad
- Tracheal Disease Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gert Folkerts
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands
| | - Babak Sharif Kashani
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parisa Adimi Naghan
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Habibi Dastenae
- Tracheal Disease Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Batoutl Khoundabi
- Helal-e-Iran Applied Science Higher Education Institute Red crescents society of Iran, Tehran, Iran
| | - Johan Garssen
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands
| | - Esmaeil Mortaz
- Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ian M. Adcock
- Cell and Molecular Biology Group, Airways Disease Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
- Priority Research Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW Australia
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27
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Zhang Q, Wang W, Niu Y, Xia Y, Lei X, Huo J, Zhao Q, Zhang Y, Duan Y, Cai J, Ying Z, Li W, Chen R, Fu Q, Kan H. The effects of fine particulate matter constituents on exhaled nitric oxide and DNA methylation in the arginase-nitric oxide synthase pathway. Environ Int 2019; 131:105019. [PMID: 31330363 DOI: 10.1016/j.envint.2019.105019] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/13/2019] [Accepted: 07/13/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Fine particulate matter (PM2.5) has been widely associated with airway inflammation represented by increased fractional concentration of exhaled nitric oxide (FeNO). However, it remains unclear whether various PM2.5 constituents have different impacts on FeNO and its production process from the arginase (ARG)-nitric oxide synthase (NOS) pathway. OBJECTIVES To investigate the acute effects of PM2.5 constituents on FeNO and DNA methylation of genes involved. METHODS We conducted a longitudinal panel study among 43 young adults in Shanghai, China from May to October in 2016. We monitored the concentrations of 25 constituents of PM2.5. We applied the linear mixed-effect model to evaluate the associations of PM2.5 constituents with FeNO and DNA methylation of the ARG2 and NOS2A genes. RESULTS Following PM2.5 exposure, NOS2A methylation decreased and ARG2 methylation increased only on the concurrent day, whereas FeNO increased most prominently on the second day. Nine constituents (OC, EC, K, Fe, Zn, Ba, Cr, Se, and Pb) showed consistent associations with elevated FeNO and decreased NOS2A methylation or increased ARG2 methylation in single-constituent models and models adjusting for PM2.5 total mass and collinearity. An interquartile range increase of these constituents was associated with respective decrements of 0.27-1.20 in NOS2A methylation (%5mC); increments of 0.48-1.56 in ARG2 methylation (%5mC); and increments of 7.12%-17.54% in FeNO. CONCLUSIONS Our results suggested that OC, EC, and some metallic elements may be mainly responsible for the development and epigenetic regulation of airway inflammatory response induced by short-term PM2.5 exposure.
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Affiliation(s)
- Qingli Zhang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Weidong Wang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Yue Niu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Yongjie Xia
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Xiaoning Lei
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Juntao Huo
- Shanghai Environmental Monitoring Center, Shanghai 200235, China
| | - Qianbiao Zhao
- Shanghai Environmental Monitoring Center, Shanghai 200235, China
| | - Yihua Zhang
- Shanghai Environmental Monitoring Center, Shanghai 200235, China
| | - Yusen Duan
- Shanghai Environmental Monitoring Center, Shanghai 200235, China
| | - Jing Cai
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Zhekang Ying
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China
| | - Weihua Li
- Key Laboratory of Reproduction Regulation of National Population and Family Planning Commission, Shanghai Institute of Planned Parenthood Research, Institute of Reproduction and Development, Fudan University, Shanghai 200032, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China; Shanghai Key Laboratory of Meteorology and Health, Shanghai 200030, China.
| | - Qingyan Fu
- Shanghai Environmental Monitoring Center, Shanghai 200235, China.
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai 200032, China; Key Laboratory of Reproduction Regulation of National Population and Family Planning Commission, Shanghai Institute of Planned Parenthood Research, Institute of Reproduction and Development, Fudan University, Shanghai 200032, China.
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28
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Saito J, Kikuchi M, Fukuhara A, Sato S, Rikimaru M, Suzuki Y, Uematsu M, Fukuhara N, Kawamata T, Umeda T, Togawa R, Sato Y, Koizumi T, Hirai K, Minemura H, Nikaido T, Kanazawa K, Tanino Y, Shibata Y, Munakata M. Comparison of fractional exhaled nitric oxide levels measured by different analyzers produced by different manufacturers. J Asthma 2019; 57:1216-1226. [PMID: 31288573 DOI: 10.1080/02770903.2019.1642351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Fractional exhaled nitric oxide (FeNO) is widely used as a biomarker of allergic airway inflammation. At present, both stationary chemiluminescence and portable electrochemical analyzers produced by different manufacturers are available. However, it remains debatable whether those analyzers are comparable to each other. We compare FeNO levels obtained by different analyzers.Methods: For the first study, 153 subjects were enrolled to compare differences in FeNO levels measured using three analyzers (NA623NP®, NObreath®, and NIOX MINO®) which were produced by different manufacturers. For the second study, 30 subjects were recruited to compare FeNO levels obtained by the two analyzers (NIOX MINO® and NIOX VERO®) produced by the same manufacturer. FeNO was measured twice using each analyzer in random order.Results: FeNO levels obtained using the NIOX MINO® and NObreath® were more variable than those measured using the NA623NP®. There were strong positive correlations in FeNO levels measured by the NA623NP®, NIOX MINO®, and NObreath® (p < 0.001). The NA623NP® and NIOX MINO® provided the highest and lowest FeNO levels, respectively; whereas, those obtained by NObreath® were intermediate. No significant differences were observed in FeNO levels obtained using the NIOX MINO® and NIOX VERO®.Conclusions: FeNO levels measured by the NIOX MINO® and NIOX VERO®, both of which were produced by the same manufacturer, have comparability. However, significant differences in FeNO levels exist when measured by analyzers manufactured by different manufacturers. This should be taken into account for FeNO measurement.
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Affiliation(s)
- Junpei Saito
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Masami Kikuchi
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Atsuro Fukuhara
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Suguru Sato
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Mami Rikimaru
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuhito Suzuki
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Manabu Uematsu
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Naoko Fukuhara
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takaya Kawamata
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takeshi Umeda
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Ryuichi Togawa
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yuki Sato
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Tatsuhiko Koizumi
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kenichiro Hirai
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Hiroyuki Minemura
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Takefumi Nikaido
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Kenya Kanazawa
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yoshinori Tanino
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yoko Shibata
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Mitsuru Munakata
- Department of Pulmonary Medicine, School of Medicine, Fukushima Medical University, Fukushima, Japan
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29
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Protopapas AA, Vradelis S, Karampitsakos T, Steiropoulos P, Chatzimichael A, Paraskakis E. Elevated Levels of Alveolar Nitric Oxide May Indicate Presence of Small Airway Inflammation in Patients with Inflammatory Bowel Disease. Lung 2019; 197:663-670. [PMID: 31317255 DOI: 10.1007/s00408-019-00253-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 07/09/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Pulmonary manifestations of inflammatory bowel disease (IBD), albeit not rare, are largely overlooked in clinical practice. The role of exhaled nitric oxide (eNO) as an established biological marker of airway inflammation compels us to use it as a tool to investigate the exact nature of these manifestations. METHODS Fractional eNO (FeNO) was measured in multiple flows, and with the use of a mathematical model, alveolar concentration of NO (CANO) and bronchial flux of NO (JawNO) were assessed in 27 patients with IBD [17 with Crohn's disease (CD) and 10 with ulcerative colitis (UC)] and in 39 healthy controls. Carefully selected criteria were used to exclude patients or healthy controls that presented factors considered to be correlated with eNO measurements. Disease activity was measured in Crohn's patients using the CD activity index (CDAI) score and in UC using the partial Mayo score. RESULTS CANO was significantly higher in the IBD group, compared to the control group (p < 0.0001). FeNO was significantly increased in patients with IBD (p = 0.023), while there was no statistical significance found regarding levels of JawNO in patients with IBD (p = 0.106), both compared to controls. There was no significant correlation between any eNO component and markers of disease activity. CONCLUSIONS Alveolar concentration of NO is elevated in patients with IBD, regardless of disease activity. This may suggest that subclinical small airway inflammation is present in patients with IBD, even those with mild or inactive disease.
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Affiliation(s)
- Adonis A Protopapas
- Department of Pediatrics, University Hospital of Alexandroupolis, Democritus University of Thrace, 68100, Alexandroupolis, Greece.
| | - Stergios Vradelis
- Second Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Theodoros Karampitsakos
- Department of Pediatrics, University Hospital of Alexandroupolis, Democritus University of Thrace, 68100, Alexandroupolis, Greece
| | - Paschalis Steiropoulos
- Department of Pneumonology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Athanasios Chatzimichael
- Department of Pediatrics, University Hospital of Alexandroupolis, Democritus University of Thrace, 68100, Alexandroupolis, Greece
| | - Emmanouil Paraskakis
- Department of Pediatrics, University Hospital of Alexandroupolis, Democritus University of Thrace, 68100, Alexandroupolis, Greece
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Murphy VE, Jensen ME, Robijn AL, Wright TK, Mattes J, Collison A, Gibson PG. How Maternal BMI Modifies the Impact of Personalized Asthma Management in Pregnancy. J Allergy Clin Immunol Pract 2019; 8:219-228.e3. [PMID: 31299352 DOI: 10.1016/j.jaip.2019.06.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/06/2019] [Accepted: 06/18/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Maternal asthma is associated with perinatal complications and respiratory illness in offspring. Obesity increases asthma exacerbation risk in pregnancy and risk of wheeze in offspring. OBJECTIVES In this secondary analysis of a randomized controlled trial, we investigated the influence of maternal body mass index, gestational weight gain (GWG), and fractional exhaled nitric oxide (FENO)-based management on asthma exacerbations in pregnancy and offspring wheeze. METHODS A total of 220 women were randomized to asthma treatment adjustment according to symptoms (control group), or FENO and symptoms (FENO group). Exacerbations were recorded prospectively. Height and weight were measured at baseline, and in late pregnancy. GWG was categorized according to Institute of Medicine guidelines. A validated parent-completed questionnaire assessed infant wheeze-related outcomes. RESULTS FENO-based management was associated with a significantly lower incidence rate ratio for maternal exacerbations in nonobese mothers (0.52, 95% confidence interval [CI], 0.31-0.88, P = .015, n = 129), and women with GWG within recommendations (0.35, 95% CI, 0.12-0.96, P = .042, n = 43), but not for obese mothers (0.59, 95% CI, 0.32-1.08, P = .089, n = 88), or women with excess GWG (0.58, 95% CI, 0.32-1.04, P = .07, n = 104). Recurrent bronchiolitis occurred in 5.3% (n = 1) of infants born to non-overweight mothers, 16.7% (n = 3) of infants of overweight mothers, and 21.7% (n = 5) of infants of obese mothers in the control group. In the FENO group, 2 infants of obese mothers had recurrent bronchiolitis (7.1%, P = .031). CONCLUSIONS The benefits of FENO-based management are attenuated among obese mothers and those with excess GWG, indicating the importance of weight management in contributing to improved asthma management in pregnancy.
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Affiliation(s)
- Vanessa E Murphy
- Priority Research Centre GrowUpWell(TM) and Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.
| | - Megan E Jensen
- Priority Research Centre GrowUpWell(TM) and Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Annelies L Robijn
- Priority Research Centre GrowUpWell(TM) and Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Thomas K Wright
- Priority Research Centre for Healthy Lungs and Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Joerg Mattes
- Priority Research Centre GrowUpWell(TM) and Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia; Department of Paediatric Respiratory and Sleep Medicine, John Hunter Children's Hospital, Newcastle, NSW, Australia
| | - Adam Collison
- Priority Research Centre GrowUpWell(TM) and Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Peter G Gibson
- Priority Research Centre for Healthy Lungs and Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
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Hoffmeyer F, Sucker K, Berresheim H, Monsé C, Jettkant B, Beine A, Raulf M, Bünger J, Brüning T. Impact of Internal and External Factors on EBC-pH and FeNO Changes in Humans Following Challenge with Ethyl Acrylate. Adv Exp Med Biol 2019; 1020:7-16. [PMID: 28236121 DOI: 10.1007/5584_2017_1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Acute effects of ethyl acrylate exposure at 5 ppm for 4 h include changes of pH in exhaled breath condensate (EBC-pH) and exhaled nitric oxide (FeNO). So far, few data have been reported for atopic persons or the impact of the exposure conditions on biomarkers, e.g., constant versus variable application of irritants. Nine atopic and eighteen healthy volunteers without bronchial hyperresponsiveness were exposed for 4 h to ethyl acrylate concentrations of 0.05 ppm (sham), 5 ppm (constant concentration), and 0-10 ppm (variable, mean concentration of 5 ppm) in an exposure laboratory. A positive atopic status was defined according to specific IgE concentrations to common inhalant allergens (sx1 ≥ 0.35 kU/L). Biomarker levels were assessed before and after challenge and adjusted for levels after sham exposure (net response). Ethyl acrylate at constant, but not at variable concentrations induced a significant change in the net responses of EBC-pH and FeNO. Concerning FeNO, this could be observed only for atopic persons. The changes of biomarker levels were related to their baseline values. Biomarker responses to challenge with ethyl acrylate may be influenced by the patterns of application as well as baseline airway inflammation and atopic status of the volunteers.
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Affiliation(s)
- F Hoffmeyer
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany.
| | - K Sucker
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | - H Berresheim
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | - C Monsé
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | - B Jettkant
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | - A Beine
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | - M Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | - J Bünger
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | - T Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
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Kalicki B, Wawrzyniak A, Lipińska-Opałka A, Lewicki S, Zdanowski R. Influence of Vitamin D and Cotinine on T-Regulatory Cells and Asthma Severity in Children. Adv Exp Med Biol 2019; 1021:27-36. [PMID: 28730377 DOI: 10.1007/5584_2017_27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Asthma is a common chronic respiratory diseases in children. Understanding the immune mechanisms of epigenetic factors may contribute to a better control of asthma. This study seeks to determine the effects of serum vitamin D and urine cotinine on asthma severity and on T regulatory cells (Tregs) and other immune-related factors such as CD3, CD4, CD8, CD19, CD16/56, and anti-CD3 HLA-DR3. The study involved 34 children with asthma. Disease severity was assessed with the Asthma Control Test, spirometry, and the fractional exhaled nitric oxide (FeNO). The control group consisted of 18 healthy children. We found a significantly lower proportion of Tregs in the serum of asthmatic children compared with the control group (p < 0.002). There were no significant differences in the other immunological factors investigated. Nor was there any appreciable association between vitamin D or cotinine and the course of asthma, FeNO, Tregs, and the other immune factors. However, the percentage of Tregs was positively associated with the level of FeNO (p < 0.02). In conclusion, the study shows a role of T regulatory cells in the pathogenesis of asthma in children, but fails to show any influence of serum vitamin D or urine cotinine on disease course.
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Affiliation(s)
- Bolesław Kalicki
- Department of Pediatrics, Nephrology and Allergology, Military Institute of Medicine, 128 Szaserow Street, 04-141, Warsaw, Poland
| | - Agata Wawrzyniak
- Department of Pediatrics, Nephrology and Allergology, Military Institute of Medicine, 128 Szaserow Street, 04-141, Warsaw, Poland.
| | - Agnieszka Lipińska-Opałka
- Department of Pediatrics, Nephrology and Allergology, Military Institute of Medicine, 128 Szaserow Street, 04-141, Warsaw, Poland
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Li T, Wang Y, Hou J, Zheng D, Wang G, Hu C, Xu T, Cheng J, Yin W, Mao X, Wang L, He Z, Yuan J. Associations between inhaled doses of PM 2.5-bound polycyclic aromatic hydrocarbons and fractional exhaled nitric oxide. Chemosphere 2019; 218:992-1001. [PMID: 30609505 DOI: 10.1016/j.chemosphere.2018.11.196] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 11/20/2018] [Accepted: 11/28/2018] [Indexed: 06/09/2023]
Abstract
Exposure to fine particulate matter (PM2.5) is linked to various respiratory outcomes. However, the associations of concentrations of PM2.5-bound polycyclic aromatic hydrocarbons (PM2.5-bound PAHs) with airway inflammatory indices remains unclear. To assess effects of short-term exposure to PM2.5-bound PAHs on fractional exhaled nitric oxide (FeNO), we conducted a pilot study with repeated measures. We recruited 20 postgraduate students in Wuhan city, China, and repeatedly measured outdoor and indoor (including dormitories, offices and laboratories) PM2.5-bound PAHs concentrations, urinary monohydroxy polycyclic aromatic hydrocarbons (OH-PAHs) and FeNO levels in the four seasons. Subsequently, we estimated inhaled doses of PM2.5-bound PAHs based on the micro-environmental PM2.5-bound PAHs concentrations, time-activity patterns and referred inhalation rates. We assessed the association of inhaled doses of PM2.5-bound PAHs with FeNO using linear mixed-effects regression models. We found the positive associations of urinary ∑OH-PAHs levels with inhaled doses of indoor PM2.5-bound PAHs (including dormitories and offices) (all p < 0.05). A one-unit increase in inhaled doses of PM2.5-bound PAHs or in urinary concentrations of ∑OH-PAHs was corresponded to a maximum FeNO increase of 13.5% (95% CI: 5.4, 22.2) at lag2 day or of 6.8% (95% CI: 3.4, 10.2) at lag1 day. Inhaled doses of PM2.5-bound PAHs or urinary OH-PAHs was positively related to increased FeNO, they may be accepted as a short-term biomarker of exposure to PAHs in air. Exposure to PM2.5-bound PAHs in indoor air may contribute more to the body burden of PAHs than outdoor air, and exhibited stronger effect on increased FeNO rather than urinary OH-PAHs.
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Affiliation(s)
- Tian Li
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China
| | - Yao Wang
- Wuhan Center for Disease Prevention and Control, Department of Environmental Health and Food Safety, Wuhan 430022, Hubei, PR China
| | - Jian Hou
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China
| | - Dan Zheng
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China
| | - Guiyang Wang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China
| | - Chen Hu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China
| | - Tian Xu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China
| | - Juan Cheng
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China
| | - Wenjun Yin
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China
| | - Xiang Mao
- Wuhan Center for Disease Prevention and Control, Department of Environmental Health and Food Safety, Wuhan 430022, Hubei, PR China
| | - Lin Wang
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China
| | - Zhenyu He
- Wuhan Center for Disease Prevention and Control, Department of Environmental Health and Food Safety, Wuhan 430022, Hubei, PR China
| | - Jing Yuan
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China; Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hangkong Road 13, Wuhan 430030, Hubei, PR China.
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Guo H, Yang W, Jiang L, Lyu Y, Cheng T, Gao B, Li X. Association of short-term exposure to ambient air pollutants with exhaled nitric oxide in hospitalized patients with respiratory-system diseases. Ecotoxicol Environ Saf 2019; 168:394-400. [PMID: 30396136 DOI: 10.1016/j.ecoenv.2018.10.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/21/2018] [Accepted: 10/24/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Previous studies have suggested that exposure to ambient air pollutants may adversely affect human health. However, few studies have examined the health effects of exposure to ambient air pollutants in hospitalized patients. OBJECTIVES To evaluate the association between short-term exposure to ambient air pollutants and exhaled nitric oxide fraction (FeNO) in a large cohort of hospitalized patients. METHODS FeNO was detected for 2986 hospitalized patients (ages 18-88 years). Daily average concentrations of SO2, NO2, O3, CO, PM2.5 and PM10 in 2014 and 2015 were obtained from nine fixed-site monitoring stations. Multiple linear regression models were chosen to assess the associations of exposure to ambient air pollutants with FeNO while adjusting for confounding variables. Lagged variable models were selected to determine the association between FeNO and ambient air pollutants concentrations with lags of up to 7 days prior to FeNO testing. RESULTS Interquartile-range (IQR) increases in the daily average SO2 (8.00 μg/m3) and PM2.5 (37.0 μg/m3) were strongly associated with increases in FeNO, with increases of 3.41% [95% confidence interval (CI), 0.94-5.93%] and 2.72% (95%CI, -0.09% to 5.61%), respectively. However, FeNO levels were not statistically associated with PM10, NO2, O3 or CO. In the two-pollutant models, the maximum correlation was for ambient SO2. We also found that FeNO was associated with IQR increases in daily average ambient concentrations of SO2 up to 3 and 4 days after the exposure events. CONCLUSIONS Short-term exposure to SO2 and PM2.5 were positively correlated with FeNO levels in hospitalized patients in Shanghai.
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Affiliation(s)
- Huibin Guo
- Department of Environmental Science & Engineering, Fudan University, Shanghai 200438, PR China
| | - Wenlan Yang
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Li Jiang
- Department of Environmental Science & Engineering, Fudan University, Shanghai 200438, PR China
| | - Yan Lyu
- Department of Environmental Science & Engineering, Fudan University, Shanghai 200438, PR China
| | - Tiantao Cheng
- Department of Environmental Science & Engineering, Fudan University, Shanghai 200438, PR China
| | - Beilan Gao
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Xiang Li
- Department of Environmental Science & Engineering, Fudan University, Shanghai 200438, PR China; Shanghai Institute of Pollution Control and Ecological Security, Shanghai 200092, PR China.
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Ritz T, Werchan CA, Kroll JL, Rosenfield D. Beetroot juice supplementation for the prevention of cold symptoms associated with stress: A proof-of-concept study. Physiol Behav 2019; 202:45-51. [PMID: 30682333 DOI: 10.1016/j.physbeh.2019.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/24/2018] [Accepted: 01/21/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Psychological stress has been linked to common cold symptoms. Nitric oxide (NO) is part of the first line of epithelial defense against pathogens, and beetroot juice is a source of dietary nitrate that increases NO availability. We therefore tested whether beetroot juice protects against cold symptoms in a period of sustained acute stress. DESIGN Seventy-six students, 16 of these with asthma, were randomly assigned to seven daily doses of beetroot juice or no supplementation control during their final exams. METHODS Participants completed stress ratings, a cold symptom questionnaire, and exhaled NO measurements at a low-stress period and two periods during their final exams, with one questionnaire follow-up assessment seven days after finals. RESULTS Beetroot juice was associated with reduced symptoms of cold and sickness during and following finals. Those with asthma showed the greatest benefits. Higher exhaled NO was concurrently and prospectively associated with reduced symptomatology. CONCLUSION Beetroot juice during periods of psychological stress protects against cold symptoms. Preliminary evidence suggests particular benefits in asthma, which could translate into reduced asthma exacerbations due to respiratory infections. Clinical Trial ID: NCT03159273.
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Affiliation(s)
- Thomas Ritz
- Department of Psychology, Southern Methodist University, Dallas, TX, USA.
| | - Chelsey A Werchan
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - Juliet L Kroll
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, TX, USA
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Dales RE, Cakmak S. Is residential ambient air limonene associated with asthma? Findings from the Canadian Health Measures Survey. Environ Pollut 2019; 244:966-970. [PMID: 30469291 DOI: 10.1016/j.envpol.2018.10.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 06/09/2023]
Abstract
Asthma is a common chronic disease. Exposure to limonene is commonplace because it may be used in the manufacture of personal care products and household cleaners. We investigated the influence of limonene on asthma in a population-based sample of approximately 3000 Canadians. During the Canada Health Measures Survey, carried out between 2012 and 2013, participants were asked if they wheezed or had a diagnosis of asthma, and underwent spirometry and measurement of the fraction of exhaled nitric oxide (FeNO). These variables were tested for an association with limonene concentrations measured in their household air samples, using linear regression analysis A 100% increase in air limonene concentration was associated with an approximate 17% adjusted relative increase wheezing with an odds ratio of 1.17 (95%CI 1.16, 1.18). The percent change in FeNO for a 100% increase in limonene was twice as large for children, 2.89% (95% CI 1.88, 4.43) compared to adults, 1.44% (95%CI 1.16, 1.79). Among boys, the odds ratio was 1.50 (95%CI 1.48, 1.52) between a 100% increase in limonene and a diagnosis of asthma. This study provides evidence that household exposure to limonene may increase the prevalence of asthma in the general population.
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Affiliation(s)
- Robert E Dales
- Population Studies Division, Health Canada, Ottawa Hospital Research Institute and University Or Ottawa, Floor 1, Room A-128, Finance Building, 101 Tunney's Pasture Driveway, Ottawa, ON, K1A 0K9, Canada
| | - Sabit Cakmak
- Population Studies Division, Health Canada, Floor 1, Room A-152, Finance Building, 101 Tunney's Pasture Driveway, Ottawa, ON, K1A 0K9, Canada.
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Zhang D, Xiao Y, Luo J, Wang X, Qiao Y, Huang R, Wu W. Measurement of fractional exhaled nitric oxide and nasal nitric oxide in male patients with obstructive sleep apnea. Sleep Breath 2018; 23:785-793. [PMID: 30542936 PMCID: PMC6700235 DOI: 10.1007/s11325-018-1760-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/29/2018] [Accepted: 11/15/2018] [Indexed: 11/30/2022]
Abstract
Objective Airway inflammation plays an important role in obstructive sleep apnea (OSA); exhaled nitric oxide is regarded as a noninvasive marker of airway inflammation. The aim of this study was to evaluate fractional exhaled nitric oxide (FeNO) and nasal nitric oxide (nNO) in patients with OSA. Methods Seventy-five patients with OSA and 30 health controls were enrolled in this study. FeNO and nNO were measured before and after sleep. Nasal lavage was performed in 31 non-smoking individuals immediately after NO measurement in the morning. The sample of nasal lavage was taken for cell classification and analyzing interleukin 6 (IL-6) and interleukin 8 (IL-8). Results Both FeNO and nNO were significantly higher in OSA (before sleep FeNO 21.08 ± 8.79 ppb vs.16.90 ± 6.86 ppb, p = 0.022; after sleep FeNO 25.57 ± 15.58 ppb vs.18.07 ± 6.25 ppb, p = 0.003; before sleep nNO 487.03 ± 115.83 ppb vs. 413.37 ± 73.10 ppb, p = 0.001; after sleep nNO 550.07 ± 130.24 ppb vs. 460.43 ± 109.77 ppb, p < 0.001). Furthermore, in non-smoking OSA, nNO levels were positively correlated with apnea hypopnea index (AHI) and average decrease of pulse arterial oxygen saturation (SpO2); after sleep, nNO was also positively associated to recording time with SpO2 < 90% and negatively associated to minimum SpO2. Both before and after sleep nNO levels were positively correlated with the percentage of neutrophils in nasal lavage (r = 0.528, p = 0.014; r = 0.702, p < 0.001, respectively). Additionally, before sleep nNO was also positively associated with IL-6 (r = 0.586, p = 0.005) and IL-8 (r = 0.520, p = 0.016) concentration. Conclusion This study sustains the presence of airway inflammation in OSA patients with the increase of FeNO and nNO. The data suggests nNO might have greater value than FeNO since it positively correlated with OSA severity, and nNO is a potential bio-marker of nasal inflammation in non-smoking OSA patients. Electronic supplementary material The online version of this article (10.1007/s11325-018-1760-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dongmei Zhang
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yi Xiao
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Jinmei Luo
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaona Wang
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yixian Qiao
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Rong Huang
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wei Wu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Zhou J, Zhao X, Zhang X, Yu X, Wang Y, Jiang W, Huang L, Hao C, Zhang L. Values of fractional exhaled nitric oxide for cough-variant asthma in children with chronic cough. J Thorac Dis 2018; 10:6616-6623. [PMID: 30746207 PMCID: PMC6344719 DOI: 10.21037/jtd.2018.11.137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/09/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chronic cough is a common symptom in children. We wished to explore the value of fractional exhaled nitric oxide (FeNO) for cough-variant asthma (CVA) in children with chronic cough. METHODS This prospective cohort study was conducted in the Children's Hospital of Soochow University from January 2012 to December 2014. Children aged 6-14 years with a cough of duration >4 weeks were enrolled. They underwent FeNO measurement, sputum cytology and pulmonary function tests. RESULTS A total of 115 patients and 25 healthy controls were evaluated. For the diagnosis of CVA, the optimal FeNO cutoff value was 25 ppb with a sensitivity of 84.0%, specificity of 97.1%, positive predictive value of 97.5%, and negative predictive of being 81.4%. The FeNO level had a significant correlation with eosinophil count in sputum (P<0.05). FeNO level in CVA was decreased significantly after treatment (P=0.001). CONCLUSIONS In children, FeNO measurement might be an excellent method for diagnosing CVA with high sensitivity and specificity.
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Affiliation(s)
- Jing Zhou
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou 215003, China
| | - Xianhong Zhao
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou 215003, China
| | - Xu Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100000, China
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing 100000, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Xingmei Yu
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou 215003, China
| | - Yuqing Wang
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou 215003, China
| | - Wujun Jiang
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou 215003, China
| | - Li Huang
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou 215003, China
| | - Chuangli Hao
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou 215003, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100000, China
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing 100000, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
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Zeng J, Chen Z, Hu Y, Hu Q, Zhong S, Liao W. Asthma control in preschool children with small airway function as measured by IOS and fractional exhaled nitric oxide. Respir Med 2018; 145:8-13. [PMID: 30509720 DOI: 10.1016/j.rmed.2018.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/04/2018] [Accepted: 10/10/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study investigated the accuracy of impulse oscillometry (IOS) combined with fractional exhaled nitric oxide (FeNO) to assess asthma control among preschool children. METHODS A total of 79 preschool children(3-6 year old) with asthma and 25 healthy preschool children who visited a paediatrician were enrolled in this study. All of the children were tested for allergens, respiratory system resistance (at 5 and 20 Hz [R5, R20]), respiratory system reactance (at 5 Hz [X5]), the resonant frequency of reactance (Fres), and the area under the reactance curve (between 5 Hz and Fres (reactance area [AX]) using IOS and FeNO. A paediatric respiratory specialist who was unaware of the IOS and FeNO results assigned children with asthma to either the asthma-controlled group (n = 27) or the asthma-uncontrolled group (n = 52) based on the Global Initiative for Asthma (GINA) criteria. A healthy control group (n = 25) was also included. The relationships between the FeNO and IOS values as well as the asthma control of the three groups were analysed, and the areas under the curve (AUCs) were calculated for each measure. RESULTS (1) During the controlled group, means±standard deviations of AX, R5-20, R5, X5 and FeNO were 26.15 ± 7.534, 3.52 ± 1.311,9.97 ± 1.576,-3.85 ± 0.572,-3.85 ± 0.572. During the uncontrolled group, means±standard deviations of AX,R5-20,R5,X5 and FeNO were 38.34 ± 13.563,5.36 ± 1.545,11.41 ± 2.029,-5.07 ± 1.554,36.40 ± 21.07. Among preschool children, significant differences were observed between the controlled and uncontrolled group with regard to the small airway functional parameters (AX, R5-20, R5, and X5) and FeNO(P <0.05).(2) A receiver operating characteristic (ROC) analysis showed that the AUCs were 0.786 for FeNO alone, 0.751 for X5 alone, and 0.866 for X5 combined with FeNO (cut-off value: 27 ppb). CONCLUSION FeNO combined with the small airway function parameter X5 accurately assessed asthma control among preschool children.
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Abstract
Fractional concentration of exhaled nitric oxide (FENO) is a biomarker used to identify allergic airway inflammation. Because it is noninvasive and easy to obtain, its utility has been studied in the diagnosis and management of several respiratory diseases. Much of the research has been done in asthma, and many studies support the use of FENO in aiding diagnosing asthma, predicting steroid responsiveness, and preventing exacerbations by guiding medication dosage and assessing adherence.
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Affiliation(s)
- Flavia C L Hoyte
- Division of Allergy and Immunology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA.
| | - Lara M Gross
- Division of Allergy and Immunology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA; Division of Allergy and Clinical Immunology, Department of Medicine, University of Colorado, 13001 E 17th Place, Aurora, CO 80045, USA
| | - Rohit K Katial
- Division of Allergy and Immunology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
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Coumou H, Westerhof GA, de Nijs SB, Amelink M, Bel EH. Diagnosing persistent blood eosinophilia in asthma with single blood eosinophil or exhaled nitric oxide level. Respir Med 2018; 141:81-6. [PMID: 30053977 DOI: 10.1016/j.rmed.2018.06.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 06/20/2018] [Accepted: 06/27/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Eosinophilic asthma is characterized by persistently elevated blood eosinophils, adult-onset asthma and corticosteroid resistance. For stratified medicine purposes one single measurement of blood eosinophils or exhaled nitric oxide (FeNO) is commonly used. The aim of this study was to investigate in patients with new-onset asthma whether persistent blood eosinophilia can be predicted with one single measurement of these biomarkers. METHODS Blood eosinophils and exhaled nitric oxide levels were measured at yearly intervals over 5 years in 114 adults with new-onset asthma on inhaled corticosteroid treatment. Two definitions of persistent blood eosinophilia were used (1); blood eosinophils at every visit ≥0.30 × 109/L, or (2) ≥0.40 × 109/L. Receiver operating characteristic analyses were performed. Diagnostic cut-off values were defined at a positive predictive value of 95% (or the highest achievable). RESULTS Using definition 1 (blood eosinophils ≥0.30 × 109/L) the cut-off value for a single measurement of blood eosinophils was 0.47 × 109/L. For definition 2 (≥0.40 × 109/L) the cut-off value was 0.49 × 109/L. Cut-off values for persistently low blood eosinophils were 0.17 × 109/L for definition (1) and 0.21 × 109/L for definition (2), respectively. For FeNO no cut-off values with sufficient accuracy could be defined. CONCLUSION We showed that by using high and low cut-off values, one single measurement of blood eosinophils, but not FeNO in the initial phase of new-onset asthma in adults can be used to predict persistence or absence of blood eosinophilia in asthma.
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Jalota L, Allison DR, Prajapati V, Vempilly JJ, Jain VV. Ability of Exhaled Nitric Oxide to Discriminate for Airflow Obstruction Among Frequent Exacerbators of Clinically Diagnosed Asthma. Lung 2018; 196:455-462. [PMID: 29916097 DOI: 10.1007/s00408-018-0132-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/11/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Fraction of exhaled nitric oxide (FENO) has been proposed as a non-invasive biomarker for allergic inflammation seen in asthma. Many asthmatics in clinical practice have never had spirometry and recent data report misdiagnoses in patients with physician diagnosed (PD) asthma. The aim of this study was to assess the ability of FENO to discriminate between those with and without airflow obstruction (AO) among patients with PD-asthma. METHODS Frequent exacerbators of PD-asthma (with 2 or more asthma exacerbations leading to emergency room visit or hospitalization within last 12 months) were enrolled. All patients underwent diagnostic evaluations including spirometry, FENO testing and serum immunoglobulin (IgE) and eosinophils. Serial spirometry and methacholine challenge testing (MCT) were performed as indicated. AO was defined by a decreased FEV1/FVC ratio (< 70% and/or < LLN), or a positive MCT. RESULTS Of the 222 patients with PD-asthma, AO was found in 136 (vs. 86 without AO). 81.6% of patients with AO and 66.2% without AO completed FENO testing. There was no significant difference in the mean FENO levels among patients with or without AO (40.8 vs. 30.4 ppb, P = 0.10). Likewise, there was no difference in the serum IgE levels and serum eosinophils. CONCLUSIONS Our analyses suggest that FENO levels do not help discriminate between those with and without AO in patients with PD-asthma. Patients who experience symptoms of asthma may have elevated FENO levels above the suggested cut points of 20-25 ppb. Objective confirmation of AO should be considered in all patients with PD-asthma, irrespective of FENO levels.
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Affiliation(s)
- Leena Jalota
- Division of Pulmonary and Critical Care, University of California, San Francisco-Fresno, 155 N Fresno St, Fresno, CA, 93701, USA
- Department of Internal Medicine, University of California, San Francisco-Fresno, 155 N Fresno St, Fresno, CA, 93701, USA
| | - D Richard Allison
- Division of Pulmonary and Critical Care, University of California, San Francisco-Fresno, 155 N Fresno St, Fresno, CA, 93701, USA
- Department of Internal Medicine, University of California, San Francisco-Fresno, 155 N Fresno St, Fresno, CA, 93701, USA
- Community Regional Medical Center, Fresno, CA, USA
| | - Vinisha Prajapati
- Division of Pulmonary and Critical Care, University of California, San Francisco-Fresno, 155 N Fresno St, Fresno, CA, 93701, USA
- Department of Internal Medicine, University of California, San Francisco-Fresno, 155 N Fresno St, Fresno, CA, 93701, USA
| | - Jose J Vempilly
- Division of Pulmonary and Critical Care, University of California, San Francisco-Fresno, 155 N Fresno St, Fresno, CA, 93701, USA
- Department of Internal Medicine, University of California, San Francisco-Fresno, 155 N Fresno St, Fresno, CA, 93701, USA
| | - Vipul V Jain
- Division of Pulmonary and Critical Care, University of California, San Francisco-Fresno, 155 N Fresno St, Fresno, CA, 93701, USA.
- Department of Internal Medicine, University of California, San Francisco-Fresno, 155 N Fresno St, Fresno, CA, 93701, USA.
- Community Regional Medical Center, Fresno, CA, USA.
- Chronic Lung Disease Program, University of California, San Francisco, Fresno, 2823, Fresno St, Suite A, Fresno, CA, 93721, USA.
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Shang J, Khuzestani RB, Huang W, An J, Schauer JJ, Fang D, Cai T, Tian J, Yang S, Guo B, Zhang Y. Acute changes in a respiratory inflammation marker in guards following Beijing air pollution controls. Sci Total Environ 2018; 624:1539-1549. [PMID: 29929263 DOI: 10.1016/j.scitotenv.2017.12.109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 05/21/2023]
Abstract
The adverse respiratory health effects of PM2.5 have been studied. However, the epidemiological evidence for the association of specific PM2.5 sources with health outcomes is still limited. This study investigated the association between PM2.5 components and sources with a biomarker of acute respiratory inflammation (FeNO) in guards. Personal exposure was estimated by microenvironment samplers and FeNO measurements were carried out before, during and after the Victory Day Military Parade in Beijing. Four sources were determined by factor analysis, including urban pollution, dust, alloy steel abrasion and toxic metals. A mixed-effect model was used to estimate the associations of FeNO with PM2.5 sources and chemical constituents, controlling for age, BMI, smoke activity, physical activity, waist circumference, temperature and relative humidity. In summary, large concentration decreases in PM2.5 concentration and PM2.5 chemical constituents were observed in both roadside and indoor environments during the air control periods, immediately followed by statistically significant decreases in FeNO of roadside guards and patrol guards. Besides, statistically significant increases in FeNO were found to be associated with interquartile range (IQR) increases in some pollutants, with an increase of 1.45ppb (95% CI: 0.69, 2.20), 0.65ppb (95% CI: 0.13, 1.17), 1.48ppb (95% CI: 0.60, 2.35), 0.82ppb (95% CI: 0.44, 1.20), 0.77ppb (95% CI: 0.42, 1.11) in FeNO for mass, sulfate, BC, Ca2+ and Sm, respectively. In addition, compared to alloy steel abrasion and toxic metals, urban pollution and dust factors were more associated with acute airway inflammation for highly-exposed populations.
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Affiliation(s)
- Jing Shang
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Reza Bashiri Khuzestani
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Wei Huang
- Institute for Environmental Reference Materials of Ministry of Environmental Protection, Beijing, China
| | - Jianxiong An
- Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University, Beijing 100012, China
| | - James J Schauer
- Environmental Chemistry and Technology Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Dongqing Fang
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Tianqi Cai
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jingyu Tian
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Shujian Yang
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Bo Guo
- Shandong Key Laboratory of Water Pollution Control and Resource Reuse, School of Environmental Science and Engineering, Shandong University, Shandong 250100, China
| | - Yuanxun Zhang
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China; CAS Center for Excellence in Regional Atmospheric Environment, Chinese Academy of Sciences, Xiamen, 361021, China; Huairou Eco-Environmental Observatory, Chinese Academy of Sciences, Beijing, 101408, China.
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Tonacci A, Sansone F, Pala AP, Conte R. Exhaled breath analysis in evaluation of psychological stress: A short literature review. Int J Psychol 2018; 54:589-597. [PMID: 29761475 DOI: 10.1002/ijop.12494] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 03/24/2018] [Indexed: 01/01/2023]
Abstract
Physiological stress is pervasive in today's society. Its detection is normally performed through several unobtrusive methods, driving both caregivers and patients to take measures to reduce the burden of this condition on human health. Among the methods for assessing stress, exhaled breath analysis represents a non-invasive, real-time alternative to classic laboratory tests. Therefore, a literature review was performed to assess the presence of altered parameters, related to psychological stress, in exhaled breath. Most studies in our review measured nitric oxide (NO), whose concentration was often correlated, either positively or negatively, with psychological stress, with reasonable scientific support. Other compounds (isoprene, terpene and so on) were rarely studied and with mixed evidence. Further investigations are needed to elucidate the involvement and the pathophysiological role of NO in stress, possibly including a greater number of individuals, as sample size actually represents the main limitation of the work published to date.
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Affiliation(s)
- Alessandro Tonacci
- Clinical Physiology Institute, National Research Council of Italy (IFC-CNR), Pisa, Italy
| | - Francesco Sansone
- Clinical Physiology Institute, National Research Council of Italy (IFC-CNR), Pisa, Italy
| | - Anna Paola Pala
- Clinical Physiology Institute, National Research Council of Italy (IFC-CNR), Pisa, Italy
| | - Raffaele Conte
- Clinical Physiology Institute, National Research Council of Italy (IFC-CNR), Pisa, Italy
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Garg Y, Kakria N, Katoch CDS, Bhattacharyya D. Exhaled nitric oxide as a guiding tool for bronchial asthma: A randomised controlled trial. Med J Armed Forces India 2020; 76:17-22. [PMID: 32020963 DOI: 10.1016/j.mjafi.2018.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 02/01/2018] [Indexed: 11/22/2022] Open
Abstract
Background Evidence regarding the role of non-invasive marker of airway inflammation, fractional exhaled nitric oxide (FeNO) to guide asthma treatment is equivocal. We aimed to evaluate if the use of FeNO to adjust inhaled corticosteroid treatment resulted in reduced daily corticosteroid use and lesser exacerbations. Methods 100 patients of bronchial asthma in the age group of 12-70 years were randomised to receive inhaled corticosteroids based on either FeNO measurements (n = 50) or as per Global Initiative for Asthma (GINA) guidelines. Follow up was done every 2 months for period of 12 months. Results were compared in terms of mean daily inhaled corticosteroid use and number of exacerbations. Results After the follow up period of 12 months, mean daily dose of ICS (SD) required in FeNO group was 267.5 μg (126.29), as opposed to control group in which mean daily dose of steroid was 320.00 μg (138.69). However this observed difference in steroid dose was statistically insignificant (p value = 0.061). The estimated mean (SD) rate of asthma exacerbation experienced in follow up period of 12 months in FeNO group was 0.3 episodes (0.54) per patient per year (95% confidence interval, 0.145-455) and 0.4 episodes (0.61) per patient per year in control group (95% confidence interval, 0.228-572). However this difference in rate of exacerbations between the two study groups was not statistically significant (p = 0.387). Conclusion FeNO guided management strategy for asthma did not result in statistically significant reduction in dose of inhaled corticosteroids or number of asthma exacerbations.
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Abstract
PURPOSE Physical activity is an important part of life, and exercise-induced asthma (EIA) can reduce the quality of life. A standardized exercise challenge is needed to diagnose EIA, but this is a time consuming, effortful and expensive method. Exhaled nitric oxide (eNO) as a marker of eosinophil inflammation is determined rapidly and easily. The aim of this study was to investigate eNO as surrogate marker for predicting a positive reaction in an exercise challenge in a cold chamber (ECC). METHODS A total of 143 subjects aged 6-45 years with suspected EIA were recruited for the study. The subjects underwent an eNO measurement, an ECC and a skin prick test (SPT). To define the sensitivity and specificity of eNO as predictor, a receiver-operating characteristic (ROC) curve was plotted. The individual probability of the occurrence of a positive reaction after ECC based on an eNO value was calculated using a logistic regression model. RESULTS An eNO cut-off value of 18.5 ppb (area under the curve (AUC) 0.71, p < 0.001) showed the best combination of sensitivity and specificity for a positive reaction (forced expiratory volume in 1 s (FEV1) decrease ≥ 10% after ECC) for the whole group. An eNO cut-off value of 46.0 ppb had a specificity of 100.0% to predict a significant FEV1 decrease and may save exercise testing in 22.4% of patients. A negative predictive level with a high sensitivity and negative predictive value (NPV) could not be defined. In the subgroup that was house dust might (HDM) allergy positive (HDM pos; n = 68, 45.5% of all subjects), an eNO cut-off value of 35.5 ppb (AUC 0.79, p < 0.01) showed the best combination of sensitivity and specificity for a positive reaction after the ECC with a specificity 100.0% and may save exercise testing in 45.6% of HDM pos patients. Using logistic regression, a 95% probability for a positive FEV1 decrease after ECC was estimated at 53 ppb for the whole group and at 47 ppb for the HDM pos subgroup. CONCLUSIONS Exhaled NO measurement is a screening tool for EIA, especially in HDM pos subjects. In a real-life setting, a cut-off value of 46.0 ppb detects EIA at 100% in all suspected patients, and a cut-off level of 35.5 ppb is valuable marker of EIA in patients with an HDM allergy. These levels can save time and costs in a large proportion of patients and will be helpful for clinicians.
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Affiliation(s)
- Melanie Dreßler
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, Goethe University Hospital, Frankfurt, Germany.
| | - Emilia Salzmann-Manrique
- Institute of Biostatistics and Mathematical Modeling, Department of Medicine, Goethe University, Frankfurt, Germany.
| | - Stefan Zielen
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, Goethe University Hospital, Frankfurt, Germany.
| | - Johannes Schulze
- Department for Children and Adolescents, Division of Allergology, Pulmonology and Cystic Fibrosis, Goethe University Hospital, Frankfurt, Germany.
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Thornadtsson A, Lind A, Weitoft T, Högman M. Altered levels of exhaled nitric oxide in rheumatoid arthritis. Nitric Oxide 2018; 76:1-5. [PMID: 29486306 DOI: 10.1016/j.niox.2018.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 01/18/2018] [Accepted: 02/23/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is an autoimmune disorder characterized by bone and joint destruction, but other organ systems can also be involved. Recent studies have suggested that the disease may start in the lungs. Exhaled nitric oxide (FENO) is a marker of inflammation. The aims of the study were to compare the NO parameters between subjects with RA and healthy control subjects, and to examine whether the NO parameters correlated with lung function and disease activity in the subjects with RA. METHODS Subjects with RA (n = 35) were recruited during their regular outpatient visits to the rheumatology department. The nitric oxide (NO) parameters: alveolar NO concentration (CANO), airway compartment diffusing capacity of NO (DawNO), and tissue concentration of NO in the airway wall (CawNO), were algorithmically estimated. Healthy subjects (n = 35) matched by age, gender and height were used as controls. Data are given in median, (quartile 25, 75). Wilcoxon Matched Pairs test was used for group comparisons. Mann-Whitney U test was used to make comparisons between any two groups and for pairwise comparisons. Correlations were tested with Spearman rank order correlation. RESULTS CANO was significantly lower in the RA subjects compared with healthy subjects; 1.1 (0.5, 1.8) ppb versus 2.4 (2.0, 3.0) ppb, (p < 0.001). CawNO was significantly lower in the RA subjects with 51 (22, 87) ppb versus 120 (76, 162) ppb in the control group. DawNO was significantly higher at 25 (15, 36) mL/s in the RA group versus the control group's 7.7 (5.3, 10.7) mL/s. CONCLUSIONS There are significant differences between subjects with RA and matched healthy control subjects regarding the exhaled NO parameters. It is unclear if this can be explained by the pathogenesis of RA, consequences of long-term disease, and/or due to drug treatment.
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Affiliation(s)
- Alexandra Thornadtsson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden; Section of Rheumatology, Centre for Research and Development, Uppsala University/Region Gävleborg, Sweden.
| | - Anders Lind
- Section of Rheumatology, Centre for Research and Development, Uppsala University/Region Gävleborg, Sweden
| | - Tomas Weitoft
- Section of Rheumatology, Centre for Research and Development, Uppsala University/Region Gävleborg, Sweden
| | - Marieann Högman
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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Xu X, Hu H, Kearney GD, Kan H, Carrillo G, Chen X. A population-based study of smoking, serum cotinine and exhaled nitric oxide among asthmatics and a healthy population in the USA. Inhal Toxicol 2017; 28:724-730. [PMID: 27973944 DOI: 10.1080/08958378.2016.1264502] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Fractional concentration of exhaled nitric oxide (FeNO) is recommended by the American Thoracic Society (ATS) as a noninvasive biomarker of airway inflammation. In addition to inflammation, many factors may be associated with FeNO, particularly tobacco exposure; however, only age has been included as an influential factor for children below 12 years. Numerous studies have demonstrated negative associations between tobacco exposure and FeNO levels with self-reported data, but few with an objective assessment of smoking. METHODS Data from the National Health and Nutrition Examination Survey (NHANES) 2007-2012 were analyzed to examine the association between FeNO and active/passive tobacco. Exposure was assessed by both self-report and serum cotinine levels among 11,160 subjects aged 6-79 years old with asthma, or without any respiratory disease. RESULTS Study results indicated 28.8% lower FeNO, 95% CI [25.2%, 32.3%] and 38.1% lower FeNO, 95% CI: [28.1, 46.2] was observed among healthy and asthmatic participants with serum cotinine in the highest quartile compared to those in the lowest quartile, respectively. Self-reported smoking status and recent tobacco use were also associated with decreased FeNO. Self-reported passive smoking was significantly associated with a 1.0% decrease in FeNO 95% CI [0.0, 2.0] among asthmatic subjects but not among healthy subjects. CONCLUSIONS Active smoking, whether measured by self-report or serum cotinine, was associated with decreased FeNO levels. In addition to age, increased attention should be given to tobacco exposure when using FeNO as a biomarker in clinical practice. Additional research is needed to establish reference value of FeNO considering the impact of tobacco exposure.
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Affiliation(s)
- Xiaohui Xu
- a Department of Epidemiology and Biostatistics , School of Public Health, Texas A&M University , College Station , TX , USA
| | - Hui Hu
- b Department of Epidemiology , College of Public Health and Health Professions and College of Medicine, University of Florida , Gainesville , FL , USA
| | - Gregory D Kearney
- c Department of Public Health , East Carolina University, Brody School of Medicine , Greenville , NC, USA
| | - Haidong Kan
- d School of Public Health, Key Laboratory of Public Health Safety of the Ministry of Education and Key Laboratory of Health Technology Assessment of the Ministry of Health, Fudan University , Shanghai , China , and
| | - Genny Carrillo
- e Department of Environmental and Occupational Health , School of Public Health, Texas A&M Health Science Center , McAllen , TX , USA
| | - Xinguang Chen
- b Department of Epidemiology , College of Public Health and Health Professions and College of Medicine, University of Florida , Gainesville , FL , USA
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Abstract
Biomarkers have been critical for studies of disease pathogenesis and the development of new therapies in severe asthma. In particular, biomarkers of type 2 inflammation have proven valuable for endotyping and targeting new biological agents. Because of these successes in understanding and marking type 2 inflammation, lack of knowledge regarding non-type 2 inflammatory mechanisms in asthma will soon be the major obstacle to the development of new treatments and management strategies in severe asthma. Biomarkers can play a role in these investigations as well by providing insight into the underlying biology in human studies of patients with severe asthma.
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Hoffmeyer F, Bünger J, Monsé C, Berresheim H, Jettkant B, Beine A, Brüning T, Sucker K. Clinical Effects, Exhaled Breath Condensate pH and Exhaled Nitric Oxide in Humans After Ethyl Acrylate Exposure. Adv Exp Med Biol 2016; 921:11-20. [PMID: 27161109 DOI: 10.1007/5584_2016_242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Ethyl acrylate is an irritant known to affect the upper airways and eyes. An increase of the eye blink frequency in humans was observed during exposure to 5 ppm. Studies on the lower airways are scant and our study objective was the evaluation of pH in exhaled breath condensate (EBC-pH) and nitric oxide in exhaled breath (FeNO) as markers of inflammation. Sixteen healthy volunteers were exposed for 4 h to ethyl acrylate at a concentration of 5 ppm and to sham (0.05 ppm) in an exposure laboratory. Clinical irritation symptoms, EBC-pH (at a pCO2 of 5.33 kPa) and FeNO were assessed before and after exposure. Differences after ethyl acrylate exposure were adjusted for those after sham exposure. 5 ppm ethyl acrylate induced clinical signs of local irritation in the nose and eyes, but not in lower airways. Exposure produced a subtle, but statistically significant, decrease in breathing frequency (1 breath/min; p = 0.017) and a lower EBC-pH (by 0.045 units; p = 0.037). Concerning FeNO, we did not observe significant changes compared to sham exposure. We conclude that local effects induced by 5 ppm ethyl acrylate consist of sensory irritation of eyes and nose. In addition, acute ethyl acrylate exposure to 5 ppm resulted in a net decrease of EBC-pH. Whether that can be interpreted in terms of additional lower airway irritation or already inflammatory alterations set in needs further investigations.
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