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    "titulo" => "Exhaled Nitric Oxide in Children Under 4 Years of Age With Recurrent Bronchitis"
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            2 => "Preschool child"
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            2 => "Ni&#241;os"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p class="elsevierStyleSimplePara elsevierViewall">The objective of the study was to assess bronchial inflammation in preschool children with recurrent bronchitis by measuring exhaled nitric oxide&#46;</p> <span class="elsevierStyleSectionTitle">Patients and Methods</span><p class="elsevierStyleSimplePara elsevierViewall">The study included patients under 4 years of age with at least 3 episodes of wheezing in the past year &#40;n&#61;63&#41; and a control group &#40;n&#61;30&#41;&#46; Exhaled nitric oxide was measured in samples collected offline during spontaneous tidal breathing with a face mask and stored in Mylar balloons&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The fractional exhaled nitric oxide concentration &#40;FE<span class="elsevierStyleInf">NO</span>&#41; was higher in the group with bronchitis &#40;mean &#91;SD&#93;&#44; 5&#46;3 &#91;1&#46;3&#93; parts per billion &#91;ppb&#93;&#41; than in the control group &#40;4&#46;6 &#91;1&#46;1&#93; ppb&#41; &#40;<span class="elsevierStyleItalic">P</span>&#61;&#46;02&#41;&#46; There was a significant difference between the control group and children in the bronchitis group not treated with inhaled corticosteroids &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;05&#41;&#44; but not between controls and corticosteroid-treated patients&#46; A relationship with eosinophil count was observed in that those with higher counts &#40;&#62;400 mL&#41; had higher FE<span class="elsevierStyleInf">NO</span> levels &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;01&#41;&#46; No relationship was observed between FE<span class="elsevierStyleInf">NO</span> and a positive methacholine challenge test&#46; Follow-up lasted at least 20 months&#46; The initial FE<span class="elsevierStyleInf">NO</span> level did not differ significantly according to whether patients were subsequently transient&#44; infrequent&#44; or frequent wheezers &#40;5&#46;2 &#91;0&#46;98&#93; ppb&#44; 5&#46;6 &#91;1&#46;5&#93; ppb&#44; and 4&#46;8 &#91;1&#46;34&#93; ppb&#44; respectively&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;36&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">In children under 4 years of age with recurrent wheezing bronchitis who were asymptomatic at study entry&#44; a small increase in FE<span class="elsevierStyleInf">NO</span> was observed although there was a good deal of overlap with the control group&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p class="elsevierStyleSimplePara elsevierViewall">El objetivo del estudio ha sido valorar la inflamaci&#243;n bronquial en ni&#241;os preescolares con bronquitis de repetici&#243;n&#44; mediante la determinaci&#243;n del &#243;xido n&#237;trico exhalado&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; en el estudio a pacientes menores de 4 a&#241;os con antecedentes de 3 episodios de sibilantes en el &#250;ltimo a&#241;o &#40;n &#61; 63&#41;&#44; as&#237; como un grupo control &#40;n &#61; 30&#41;&#46; Se determin&#243; el &#243;xido n&#237;trico exhalado mediante la t&#233;cnica de recogida <span class="elsevierStyleItalic">off-line</span>&#44; con respiraci&#243;n espont&#225;nea a volumen corriente con mascarilla&#44; recogida en bolsa de Mylar&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">El grupo con bronquitis present&#243; como media una fracci&#243;n de &#243;xido n&#237;trico en aire exhalado &#40;FE<span class="elsevierStyleInf">NO</span>&#41; m&#225;s elevada &#40;media&#177;desviaci&#243;n est&#225;ndar&#58; 5&#44;3 &#177; 1&#44;3 ppb&#41; que el grupo control &#40;4&#44;6 &#177; 1&#44;1&#41; &#40;p &#61; 0&#44;02&#41;&#46; Hubo una diferencia significativa &#40;p &#60; 0&#44;05&#41; entre el grupo control y los ni&#241;os con bronquitis que no recib&#237;an corticoides inhalados&#44; pero no con los que s&#237; los recib&#237;an&#46; Se observ&#243; una relaci&#243;n con el n&#250;mero de eosin&#243;filos en sangre&#44; de forma que los que ten&#237;an valores m&#225;s elevados &#40;&#62; 400&#47;&#204;l&#41; presentaban concentraciones de FE<span class="elsevierStyleInf">NO</span> m&#225;s altas &#40;p &#60; 0&#44;01&#41;&#46; No se apreci&#243; relaci&#243;n entre la FE<span class="elsevierStyleInf">NO</span> y el hecho de tener una prueba de provocaci&#243;n bronquial positiva a la metacolina&#46; Se realiz&#243; un seguimiento de los pacientes durante m&#225;s de 20 meses&#46; No hubo diferencias significativas &#40;p &#61; 0&#44;36&#41; en el valor inicial de la FE<span class="elsevierStyleInf">NO</span> entre los pacientes que posteriormente presentaron sibilancias transitorias &#40;5&#44;2 &#177; 0&#44;98 ppb&#41;&#44; infrecuentes &#40;5&#44;6 &#177; 1&#44;5 ppb&#41; o frecuentes &#40;4&#44;8 &#177; 1&#44;34 ppb&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Los ni&#241;os menores de 4 a&#241;os afectados de bronquitis sibilantes de repetici&#243;n en fase asintom&#225;tica presentan una discreta elevaci&#243;n de la FE<span class="elsevierStyleInf">NO</span>&#44; con una amplia superposici&#243;n de valores con el grupo control&#46;</p>"
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Vol. 45. Issue 9.
Pages 442-448 (September 2009)
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Vol. 45. Issue 9.
Pages 442-448 (September 2009)
Original Article
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Exhaled Nitric Oxide in Children Under 4 Years of Age With Recurrent Bronchitis
Óxido nítrico exhalado en niños menores de 4 años con bronquitis de repetición
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Inés de Mir Messa
Corresponding author
fernandezdemir@gmail.com

Corresponding author.
, Antonio Moreno Galdó, Nicolás Cobos Barroso, Silvia Gartner, Carlos Martín De Vicente, Santos Liñán Cortés
Unidad de Neumología Pediátrica y Fibrosis Quística, Hospital Universitari Vall d’Hebron, Barcelona, Spain
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Abstract
Background

The objective of the study was to assess bronchial inflammation in preschool children with recurrent bronchitis by measuring exhaled nitric oxide.

Patients and Methods

The study included patients under 4 years of age with at least 3 episodes of wheezing in the past year (n=63) and a control group (n=30). Exhaled nitric oxide was measured in samples collected offline during spontaneous tidal breathing with a face mask and stored in Mylar balloons.

Results

The fractional exhaled nitric oxide concentration (FENO) was higher in the group with bronchitis (mean [SD], 5.3 [1.3] parts per billion [ppb]) than in the control group (4.6 [1.1] ppb) (P=.02). There was a significant difference between the control group and children in the bronchitis group not treated with inhaled corticosteroids (P<.05), but not between controls and corticosteroid-treated patients. A relationship with eosinophil count was observed in that those with higher counts (>400 mL) had higher FENO levels (P<.01). No relationship was observed between FENO and a positive methacholine challenge test. Follow-up lasted at least 20 months. The initial FENO level did not differ significantly according to whether patients were subsequently transient, infrequent, or frequent wheezers (5.2 [0.98] ppb, 5.6 [1.5] ppb, and 4.8 [1.34] ppb, respectively; P=.36).

Conclusions

In children under 4 years of age with recurrent wheezing bronchitis who were asymptomatic at study entry, a small increase in FENO was observed although there was a good deal of overlap with the control group.

Keywords:
Markers of bronchial inflammation
Exhaled nitric oxide
Preschool child
Bronchitis
Recurrent wheezing
Resumen
Introducción

El objetivo del estudio ha sido valorar la inflamación bronquial en niños preescolares con bronquitis de repetición, mediante la determinación del óxido nítrico exhalado.

Pacientes y métodos

Se incluyó en el estudio a pacientes menores de 4 años con antecedentes de 3 episodios de sibilantes en el último año (n = 63), así como un grupo control (n = 30). Se determinó el óxido nítrico exhalado mediante la técnica de recogida off-line, con respiración espontánea a volumen corriente con mascarilla, recogida en bolsa de Mylar.

Resultados

El grupo con bronquitis presentó como media una fracción de óxido nítrico en aire exhalado (FENO) más elevada (media±desviación estándar: 5,3 ± 1,3 ppb) que el grupo control (4,6 ± 1,1) (p = 0,02). Hubo una diferencia significativa (p < 0,05) entre el grupo control y los niños con bronquitis que no recibían corticoides inhalados, pero no con los que sí los recibían. Se observó una relación con el número de eosinófilos en sangre, de forma que los que tenían valores más elevados (> 400/Ìl) presentaban concentraciones de FENO más altas (p < 0,01). No se apreció relación entre la FENO y el hecho de tener una prueba de provocación bronquial positiva a la metacolina. Se realizó un seguimiento de los pacientes durante más de 20 meses. No hubo diferencias significativas (p = 0,36) en el valor inicial de la FENO entre los pacientes que posteriormente presentaron sibilancias transitorias (5,2 ± 0,98 ppb), infrecuentes (5,6 ± 1,5 ppb) o frecuentes (4,8 ± 1,34 ppb).

Conclusiones

Los niños menores de 4 años afectados de bronquitis sibilantes de repetición en fase asintomática presentan una discreta elevación de la FENO, con una amplia superposición de valores con el grupo control.

Palabras clave:
Marcadores de inflamación bronquial
Óxido nítrico exhalado
Niños
Bronquitis
Sibilantes recurrentes
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