Fraction of Exhaled Nitric Oxide and Asthma Predictive Index in Infants Less Than Two Years-Old

Prado, Olaia Sardón; Pérez-Yarza, Eduardo G.; Ruiz, Ane Aldasoro; Murua, Javier Korta; Elósegui, Paula Corcuera; Aramburu, Javier Mintegui; Emparanza Knorr, José Ignacio

doi:10.1016/S1579-2129(11)70058-1

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Abstract

Introduction

The fraction of exhaled nitric oxide (FENO) is considered an indirect marker of eosinophilic inflammation of the airway. In cooperative children, the usual method is a single breath. The impossibility of performing this in uncooperative children has led to the development of the online and offline tidal breathing technique. The objective of the study has been to analyse the relationship between the multiplebreath online FENO and the asthma predictive index (API) in children under the age of two.

Material and methods

An observational and cross-sectional study on a consecutive sample of boys and girls between 2 months and 2 years of age, over a period of 4 months. The post-prandial multiple breaths online FENO and flow spirometry between 40 and 60ml/s, using a stationary chemiluminescence analyser (CLD 88 sp). The quantitative variables were: age, weight, IgE, eosinophilia, FENO, flow spirometry. The qualitative variables were: gender, atopic dermatitis, allergic rhinitis, food and medical allergies, family history of asthma and atopy, diagnosis and treatment. The relationship between API and FENO was analysed using the exact Fisher and Student t tests and the level of agreement between API and FENO using Cohen's Kappa. The relationship between eosinophilia, IgE, atopic dermatitis and FENO was also studied (exact Fisher and Student t tests).

Results

The cohort consisted of 38 patients. The determinations were successfully carried out on 32 (84.21) of the cases. The mean age was 10.9±5.06 months. The cases with a positive API had significantly higher FENO values than those with a negative API, with a level of agreement between API and FENO of 0.71.

Conclusions

There is a significant relationship and a good level of agreement between the online tidal breathing FENO and the API.

Keywords:

Fraction of exhaled nitric oxide

Asthma predictive index

Infants

Resumen

Introducción

La fracción exhalada del óxido nítrico (FENO) se considera marcador indirecto de la inflamación eosinofílica de la vía aérea. En niños colaboradores la metodología habitual es mediante respiración única. La imposibilidad de realizarla en niños no colaboradores ha permitido desarrollar la técnica a respiración corriente on-line y off-line. El objetivo del estudio ha sido analizar la relación entre la FENOon-line a respiraciones múltiples y el índice predictivo de asma (IPA) en niños menores de dos años.

Material y métodos

Estudio observacional y transversal en una muestra consecutiva de niños y niñas entre dos meses y dos años de edad, durante un período de 4 meses. Se determinó la FENO postprandial on-line a respiración corriente con respiraciones múltiples y flujo espiratorio entre 40 y 60ml/s, mediante analizador de quimioluminiscencia estacionario (CLD 88 sp). Variables cuantitativas: edad, peso, IgE, eosinofilia, FENO, flujo espiratorio. Variables cualitativas: sexo, dermatitis atópica, rinitis alérgica, alergia alimentaria y medicamentosa, antecedentes familiares de asma y atopia, diagnóstico y tratamiento. Se ha analizado la asociación entre IPA y FENO mediante test exacto de Fisher y t de Student y el grado de acuerdo entre IPA y FENO mediante Kappa de Cohen. Se ha estudiado la relación entre eosinofilia, IgE, dermatitis atópica y FENO (test exacto de Fisher y t de Student).

Resultados

Cohorte constituida por 38 pacientes. Realizaron las determinaciones con éxito 32 (84,21%) casos. Edad media 10,9±5,06 meses. Los casos con IPA positivo tenían valores de FENO significativamente superiores a los IPA negativos con grado de acuerdo entre IPA y FENO de 0,71.

Conclusiones

Existe asociación significativa y un buen grado de acuerdo entre la FENO a respiración corriente on-line y el IPA.

Palabras clave:

Fracción exhalada de óxido nítrico

Índice predictivo de asma

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