Exhaled nitric oxide: Not associated with asthma, symptoms, or spirometry in children with sickle cell anemia

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:138

Article

Cohen, Robyn T.¹  Rodeghier, Mark²  Kirkham, Fenella J.³  Rosen, Carol L.⁴  Kirkby, Jane⁵  DeBaun, Michael R.⁶  Strunk, Robert C.⁷ 

[1] Boston Univ, Sch Med, Dept Pediat, Boston, MA 02118 USA

[2] Rodeghier Consultants, Chicago, IL USA

[3] UCL, Inst Child Hlth, Neurosci Unit, London WC1E 6BT, England

[4] Case Western Reserve Univ, Sch Med, Dept Pediat, Cleveland, OH 44106 USA

[5] UCL, Inst Child Hlth, Portex Resp Unit, London WC1E 6BT, England

[6] Vanderbilt Univ, Sch Med, Dept Pediat, Nashville, TN 37212 USA

[7] Washington Univ, Sch Med, Dept Pediat, Div Allergy Immunol & Pulm Med, St Louis, MO 63110 USA

关键词: Sickle cell disease;    exhaled nitric oxide;    asthma;    airway inflammation;    acute chest syndrome;   

DOI  :  10.1016/j.jaci.2016.06.043

来源: Elsevier

【 摘 要 】

Background: The significance of fractional exhaled nitric oxide (FENO) levels in children with sickle cell anemia (SCA) is unclear, but increased levels can be associated with features of asthma and thus increased morbidity. Objectives: We sought to determine factors associated with FENO and whether FENO levels are associated with increased rates of acute chest syndrome (ACS) and pain. Methods: All participants had SCA, were part of the prospective observational Sleep and Asthma Cohort study, and had the following assessments: FENO levels, spirometry, blood samples analyzed for hemoglobin, white blood cell counts, eosinophil counts and total serum IgE levels, questionnaires about child medical and family history, and review of medical records. Results: The analytic sample included 131 children with SCA (median age, 11.2 years; age range, 6-18 years) followed for a mean of 16.2 years, including a mean of 5.1 years after baseline FENO data measurements. In multivariable analyses higher FENO levels were associated with ln(IgE) levels (P <.001) and the highest quartile of peripheral eosinophil counts (P=.03) but not wheezing symptoms, baseline spirometric indices, or response to bronchodilator. Multivariable analyses identified that the incident rate ofACS was associated with ln(FENO) levels (P=.03), as well as male sex (P =.025), wheezing causing shortness of breath (P=.002), andACSat less than 4 years of age (P<. 001). FENO levels were not associated with future pain episodes. Conclusions: Steady-state FENO levels were not associated with an asthma diagnosis, wheezing symptoms, lung function measures, or prior sickle cell morbidity but were associated with markers of atopy and increased risk of future ACS events.

【 授权许可】

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