Time-Dependent Changes in Orally Exhaled Nitric Oxide and Pulmonary Functions Induced by Inhaled Cortico-steroids in Childhood Asthma

Author： Spallarossa Daniela Battistini Elena Silvestri Michela Sabatini Federica Biraghi Maurizio Rossi Giovanni

Publisher： Informa Healthcare

ISSN： 0277-0903

Source： Journal of Asthma, Vol.38, Iss.7, 2001-10, pp. : 545-553

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Abstract

Exhaled nitric oxide levels are elevated in asthmatic children and decrease after inhaled steroid treatment. We evaluated the time-dependent changes in fractional exhaled nitric oxide concentration (FE NO ) and pulmonary function parameters following inhaled steroid therapy. Thirty-nine steroid-naive atopic patients (age 11.92 ± 0.48 years) with mild intermittent asthma and 22 age-matched healthy controls were enrolled in the study; pulmonary functions and FE NO levels were measured. Low doses of inhaled steroids were prescribed to all asthmatic patients who were reevaluated in a second visit (between 10 and 40 days after the beginning of the treatment). At the enrolment, asthmatic patients had similar forced expiratory volume in 1 sec (FEV 1 ) and forced vital capacity (FVC) values (p > 0.05) but reduced forced expiratory flows at 25–75% of the vital capacity (FEF 25–75% ) values, as compared to controls (p 2 standard deviations of the mean in controls). After steroid treatment, patients showed significant improvement of FEV 1 , FVC, and FEF 25–75% (p = 0.0001; each comparison) and a reduction of FE NO levels (p = 0.0001). A weak significant correlation was found between percent decrease in FE NO levels and percent increase in FEV 1 (r = 0.33, p = 0.04) or in FEF 25–75% (r = 0.4, p = 0.01) after treatment. When changes in FE NO levels and in pulmonary function parameters were corrected for days of treatment, significant correlations were still present between percent decrease in FE NO levels and percent increase in FEV 1 (r = 0.57, p = 0.0004) or percent increase in FEF 25–75% (r = 0.45, p = 0.006). Sixteen of the 39 asthmatic patients were evaluated on two occasions after the beginning of treatment, at days 10 and 40. The significant reduction in FE NO levels (p < 0.01) and the significant increase in FEV 1 and FEF 25–75% values observed (p < 0.05) after 10 days did not further improve at day 40. These data show that it is possible to demonstrate early effects of low-dose inhaled steroids in asthmatic children using objective measurements of airway caliber and inflammation.