Exhaled Nitric Oxide in Children Under 4 Years of Age With Recurrent Bronchitis

de Mir Messa, Inés; Galdó, Antonio Moreno; Barroso, Nicolás Cobos; Gartner, Silvia; De Vicente, Carlos Martín; Cortés, Santos Liñán

doi:10.1016/S1579-2129(09)73486-X

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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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