Relationship between exhaled nitric oxide and small-airway dysfunction in children with asthma using spirometry and the impulse oscillometry system

Bo Seon Seo; Jeong Min Lee; Eunhae Cho; Ji Hyeon Baek; Geong Suk Lee; Youn Ho Shin; Hye Mi Jee; Yong Ho Jung; Man Yong Han

doi:10.4168/aard.2015.3.4.267

Journal List > Allergy Asthma Respir Dis > v.3(4) > 1059111

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Seo, Lee, Cho, Baek, Lee, Shin, Jee, Jung, and Han: Relationship between exhaled nitric oxide and small-airway dysfunction in children with asthma using spirometry and the impulse oscillometry system

Original Article

Allergy Asthma Respir Dis 2015;3(4):267-271.

Published online: 12 July 2015

DOI: https://doi.org/10.4168/aard.2015.3.4.267

Relationship between exhaled nitric oxide and small-airway dysfunction in children with asthma using spirometry and the impulse oscillometry system

Bo Seon Seo, Jeong Min Lee, Eunhae Cho, Ji Hyeon Baek, Geong Suk Lee, Youn Ho Shin, Hye Mi Jee, Yong Ho Jung, Man Yong Han

^¹Department of Pediatrics, CHA Bundang Medical Center, CHA University, Seongnam, Korea

Correspondence to: Man Yong Han http://orcid.org/0000-0002-9077-5779 Department of Pediatrics, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam 463-712, Korea Tel: +82-31-780-6262, Fax: +82-31-780-5239, E-mail: drmesh@gmail.com

Received 23 February 2015 Revised 19 April 2015 Accepted 27 April 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Fractional exhaled nitric oxide (FeNO) is a maker of airway inflammation, and impedance of low frequency in the impulse oscillometry system (IOS) reflects small-airway obstruction. We investigated the association of the FeNO level with IOS parameters and spirometry results in asthma patients.

Methods

Fifty-eight children with asthma (60.3%, male), mean age 8.3 years (range, 4.5–16.0 years), were enrolled in the study. Reactance and resistance at 5 Hz with IOS, forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), and forced expiratory flow 25%–75% of the vital capacity (FEF_25%-75%) with spirometry and FeNO were measured in all patients. The Z-score of spirometry and IOS parameters and the mean level of FeNO were used for correlation and regression analysis.

Results

FeNO was not significantly associated with height, age, or other demographic parameters. There was a statistically significant correlation between spirometry results and IOS measurements. The FeNO level was not significantly correlated with IOS variables. After adjusting for height, sex, atopic status, and the use of inhaled corticosteroid, the FeNO level showed significant correlations with Z-score of FEV₁/FVC (P=0.037, adjusted R² =0.234).

Conclusion

FeNO was significantly correlated with Z-scores of FEV₁/FVC, but not with IOS variables. Therefore, FeNO may be used to detect whole airway obstruction, but not small-airway obstruction.

Keywords: Asthma, Nitric oxide, Respiratory function tests, Spirometry, Arway resistance

References

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Table 1.

Clinical characteristics of the study group (n=58)

Characteristic	Value
Age (yr)	8.27±2.53
Male sex	35 (60.3)
Height (cm)	130.7±18.7
Atopic status	43 (74.1)
Parental asthma	8 (13.8)
FeNO (ppb)	18.74±14.59
Spirometry
FEV₁/FVC (%)	79.90±7.26
FEV₁/FVC, Z-score	–1.42±1.02
FEV₁, Z-score	–1.16±1.62
FVC, Z-score	–0.42±1.60
FEF_25%-75%, Z-score	–1.36±1.19
Impulse oscillometry system
Rrs5, Z-score	0.81±1.06
Xrs5, Z-score	–0.04±0.65
AX, Z-score	–0.09±0.84

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

FeNO, fractional exhaled nitric oxide; ppb, parts per billion; FEV₁, forced expiratory volume in one second; FVC, forced vital capacity; FEF_25%-75%, forced expiratory flow at 25%–75% of vital capacity; IOS, impulse oscillometry system; Rrs5, resistance at 5 Hz; Xrs5, reactance at 5 Hz; AX, reactance area.

Table 2.

Correlation matrix of spirometry and ISO value, FeNO

	FEV₁	FVC	FEV₁/FVC	FEF_25%-75%	Rrs5	Xrs5	AX	FeNO
FEV₁	1	0.896**	0.596**	0.883**	0.469**	0.560**	0.518**	–0.065
FVC		1	0.224	0.629**	0.318*	0.463**	0.375*	0.023
FEV₁/FVC			1	0.842**	0.476**	0.452**	0.427*	–0.283
FEF_25%-75%				1	0.516**	0.584**	0.577**	–0.195
Rrs5					1	0.634**	0.799**	–0.141
Xrs5						1	0.874**	0.021
AX							1	0.030
FeNO								1

IOS, impulse oscillometry system; FeNO, fractional exhaled nitric oxide; FEV₁, forced expiratory volume in one second; FVC, forced vital capacity; FEF_25%-75%, forced expiratory flow at 25%–75% of vital capacity; Rrs5, resistance at 5 Hz; Xrs5, reactance at 5 Hz; AX, reactance area. *P<0.05. **P<0.001; spirometrc and IOS value represents the Z-score.

Table 3.

Multiple linear regression with determinant of fractional exhaled nitric oxide

	Intercept (SE)	R²	B	P-value
FEV₁ Z-score	29.38 (16.61)	0.168	–0.365	0.749
FVC Z-score	–30.84 (16.65)	0.170	0.493	0.664
FEV₁/FVC pred.	–31.93 (15.89)	0.167	–24.085	0.929
FEV₁/FVC Z-score	–29.02 (16.38)	0.234	–3.839	0.037
FEF_25%-75% Z-score	–34.14 (17.01)	0.185	–1.697	0.278
Rrs5 Z-score	–31.04 (17.17)	0.180	1.527	0.350
Xrs5 Z-score	–32.41 (18.09)	0.167	0.689	0.806
AX Z-score	–29.38 (16.61)	0.168	0.800	0.734

Adjusting the confounding factor; height, sex, atopic status, and inhaled corticosteroid. SE, standard error; FEV₁, forced expiratory volume in one second; FVC, forced vital capacity; FEV₁/FVC pred., predicted value of FEV₁/FVC; FEF_25%-75%, forced expiratory flow at 25%–75% of vital capacity; Rrs5, resistance at 5 Hz; Xrs5, reactance at 5 Hz; AX, reactance area.

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