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March 2020

Nasal nitric oxide in children with asthma and allergic rhinitis

The study compares nasal nitric oxide levels in upper airways in children with respiratory diseases.

Takeaway

  • Nasal nitric oxide (nNO) level was significantly higher in children with allergic rhinitis (AR) and those with both AR and asthma (AR-asthma) than asthmatic and healthy children.
  • Based on receiver operating characteristic (ROC) curve analysis, the nNO level cut-offs for diagnosis of AR and AR-asthma were 1545 and 1459 ppb, respectively.

Why this matters

  • Currently, different methods or analysers are used to measure nNO, and the assessment of nNO still needs improvements in standardisation to become a more reliable tool.
  • However, it seems nNO measurements provide additional information about ongoing inflammation in the respiratory tract, without painful, expensive and long-lasting laboratory tests.

Study design

  • Levels of nNO measured using an electrochemical analyser in 179 patients (aged 7-15 years) with asthma (n=49), AR (n=47), AR-asthma (n=58) and healthy controls (n=25).
  • Associations between nNO levels and patient clinical parameters were evaluated.
  • Funding: None disclosed.

Key results

  • nNO level was significantly increased in children with AR and AR-asthma (2322.3±447.24 and 2397.3±423.25 ppb, respectively; p<0.001 for both) vs asthmatic and healthy children (1017.4±396.85 and 836.2±333.47 ppb, respectively).
  • No statistically significant difference was noted between nNO levels of patients living in urban and rural areas.
  • Only in the case of patients with AR, nNO was significantly higher in male patients than female patients (2437.38±419.79 ppb vs 2207.22±451.13 ppb; p=0.029).
  • ROC curve analysis showed that a cut-off value of 1545 and 1459 ppb nNO to predict AR and AR-asthma, respectively, obtained 100% sensitivity and 100% specificity.
  • A positive significant correlation between nNO and patient age (R=0.46; p=0.021) and height (R=0.495; p=0.012) was observed only in the control group.
  • No association was observed between nNO level and clinical parameters, including the percentage of eosinophils and total immunoglobulin E.

Limitations

  • Small sample size.
  • Lack of association between nNO measurement and exposure to allergen.

Reference:

  1. Galiniak S, Biesiadecki M, Aebisher D, Rachel M. Nasal nitric oxide in upper airways in children with asthma and allergic rhinitis. Adv Med Sci. 2020 Jan 09 [Epub ahead of print];65(1):127-133. doi: 10.1016/j.advms.2019.11.005. PMID: 31927424