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Kang, Yoon, Sim, and Woo: Fractional exhaled nitric oxide and forced expiratory volume in 1 second/ forced vital capacity have predictive value of asthma exacerbation in Korean school children
Original Article

Asia Pac Allergy 2020;10(1):e7.

Published online: 4 January 2020

DOI: https://doi.org/10.5415/apallergy.2020.10.e7

Fractional exhaled nitric oxide and forced expiratory volume in 1 second/ forced vital capacity have predictive value of asthma exacerbation in Korean school children

Min-Gyu Kang1, Shin-Ae Yoon2, Ju-Han Sim3, Sung-Il Woo2, *

1Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea

2Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea

3Oksan and Gangnae Elementary School, Chungbuk, Cheongju, Korea

*Correspondence to Sung-Il Woo Department of Pediatrics, Chungbuk National University Hospital, 776 1(il)sunhwan-ro, Heungdeok-gu, Cheongju 28644, Korea. Tel: +82-43-269-6044 Fax: +82-43-264-6620 E-mail: wsi@chungbuk.ac.kr

Received 21 October 2019       Accepted 23 January 2020

Copyright © 2020 Asia Pacific Association of Allergy, Asthma and Clinical Immunology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Asthma, Exacerbation, Child, Exhaled nitric oxide, Spirometry

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Table 1.
The demographic and clinical characteristics of subjects (n = 160)
Characteristic Value
Sex, male:female 76:94
Age (yr) 9.40 ± 1.48
Diagnosis of atopic dermatitis 32 (20.0)
Diagnosis of allergic rhinitis 63 (39.4)
Diagnosis of asthma or recurrent wheeze 36 (22.5)
Acute wheezing exacerbation within 1 year 14 (8.8)
Sensitization with inhalant allergen 64 (40.0)
FEV1 (L) 1.67 ± 0.32
%predicted FEV1 94.8 ± 13.2

Values are presented as mean ± standard deviation or number (%).

FEV1, forced expiratory volume in 1 second.

Table 2.
Characteristics of children with and without asthma exacerbation (AE) within 1 year
Variable Children with AE (n = 26) Children without AE (n = 134) p value
Sex, male:female 17:9 59:75 0.046
Age (yr) 9.1 ± 1.7 9.5 ± 1.4 0.198
Diagnosis of asthma or recurrent wheeeze 5 (19.2) 31 (23.1) 0.663
Wheezing exacerbation within the prevvious 1 year 3 (11.5) 11 (8.2) 0.582
Diagnosis of atopic dermatitis 7 (26.9) 25 (18.7) 0.335
Diagnosis of allergic rhinitis 15 (57.7) 48 (35.8) 0.037
Sensitization with inhalant allergen 14 (53.8) 50 (37.3) 0.115

Values are presented as mean ± standard deviation or number (%).

Table 3.
Spirometry and FeNO level of children with and without AE within 1 year
Variable Children with AE (n = 26) Children without AE (n = 134) p value
FEV1 1.83 ± 0.35 1.86 ± 0.34 0.223
%predicted FEV1 91.1 ± 13.0 94.8 ± 17.9 0.074
%predicted FEV1 < 80% 8 (30.8) 14 (10.4) 0.006
FEV1/FVC (%) 87.9 ± 8.5 91.1 ± 5.4 0.015
FEV1/FVC < 80% 6 (23.1) 3 (2.2) <0.001
FEF25%–75% 1.90 ± 0.72 2.18 ± 0.56 0.030
%predicted FEF25%–75% 88.1 ± 34.3 98.3 ± 20.4 0.047
%predicted FEF25%–75% < 70% 10 (38.5) 30 (22.4) 0.083
Mean FeNO (ppb), GM (95% CI) 16.5 (13.1–20.6) 13.5 (12.4–14.7) 0.070
Maximal FeNO (ppb), GM (95% CI) 22.9 (17.8–29.4) 18.8 (17.1–20.8) 0.116
Maximal FeNO ≥ 35 ppb 8 (30.8) 10 (7.5) 0.001
Mean FeNO ≥ 25 ppb 7 (26.9) 19 (14.2) 0.107

Values are presented as mean ± standard deviation or number (%) unless otherwise indicated.

FeNO, fractional exhaled nitric oxide; AE, asthma exacerbation; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; FEF25%–75%, forced expiratory flow at 25%–75% of FVC; GM, geometric mean; CI, confidence interval.

Table 4.
Characteristics, spirometry and FeNO level of children with and without AE among children with inhalant allergen sensitization
Variable Children with AE (n = 14) Children without AE (n = 50) p value
Sex, male:female 13:1 25:25 0.004
FEV1 1.63 ± 0.31 1.71 ± 0.30 0.388
%predicted FEV1 94.6 ± 13.6 94.8 ± 11.6 0.962
%predicted FEV1 < 80% 2 (14.2) 3 (6.0) 0.307
FEV1/FVC (%) 88.0 ± 9.3 90.1 ± 6.0 0.325
FEV1/FVC < 80% 3 (21.4) 1 (2.0) 0.008
FEF25%–75% 1.91 ± 0.75 2.22 ± 0.58 0.104
%predicted FEF25%–75% 93.6 ± 40.1 99.0 ± 23.0 0.533
%predicted FEF25%–75% < 70% 4 (28.6) 12 (24.0) 0.727
Mean FeNO (ppb), GM (95% CI) 20.1 (14.2–20.6) 20.0 (17.2–23.4) 0.977
Maximal FeNO (ppb), GM (95%CI) 29.2 (20.1–42.4) 28.8 (24.3–34.1) 0.943
Maximal FeNO ≥ 35 ppb 7 (50.0) 10 (20.0) 0.005
Mean FeNO ≥ 25 ppb 6 (42.8) 19 (38.0) 0.742

Values are presented as mean ± standard deviation or number (%) unless otherwise indicated.

FeNO, fractional exhaled nitric oxide; AE, asthma exacerbation; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; FEF25%–75%, forced expiratory flow at 25%–75% of FVC; GM, geometric mean; CI, confidence interval.

Table 5.
Characteristics, spirometry and FeNO level of children with and without AE among children without inhalant allergen sensitization
Variable Children with AE (n = 12) Children without AE (n = 84) P value
Sex, male:female 4:8 34:50 0.758
FEV1 1.57 ± 0.39 1.68 ± 0.32 0.327
%predicted FEV1 85.9 ± 16.1 96.1 ± 13.2 0.017
%predicted FEV1 < 80% 6 (50.0) 11 (13.1) 0.002
FEV1/FVC (%) 87.6 ± 8.0 91.6 ± 5.4 0.021
FEV1/FVC < 80% 3 (25.0) 2 (2.4) 0.001
FEF25%–75% 1.90 ± 0.71 2.16 ± 0.55 0.145
%predicted FEF25%–75% 82.3 ± 27.3 98.0 ± 18.9 0.014
%predicted FEF25%–75% < 70% 6 (50.0) 18 (21.4) 0.033
25%–75% Mean FeNO (ppb), GM (95% CI) 13.0 (10.0–16.9) 10.7 (10.0–11.3) 0.166
Maximal FeNO (ppb), GM (95% CI) 17.3 (12.9–23.1) 14.7 (13.5–15.9) 0.127
Maximal FeNO ≥ 35 ppb 1 (8.3) 0 (0) 0.125
Mean FeNO ≥ 25 ppb 1 (8.3) 0 (0) 0.125

Values are presented as mean ± standard deviation or number (%) unless otherwise indicated.

FeNO, fractional exhaled nitric oxide; AE, asthma exacerbation; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; FEF25%–75%, forced expiratory flow at 25%–75% of FVC; GM, geometric mean; CI, confidence interval.

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