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Alveolar nitric oxide and its role in pediatric asthma control assessment

Olaia Sardón12*, Paula Corcuera1, Ane Aldasoro1, Javier Korta12, Javier Mintegui1, José I Emparanza3 and Eduardo G Pérez-Yarza124

Author Affiliations

1 Division of Pediatric Respiratory Medicine, Hospital Universitario Donostia, Avda. Dr. Beguiristain número 118, San Sebastian, Guipúzcoa CP 20014, Spain

2 Department of Pediatrics, University of the Basque Country (UPV/EHU), San Sebastian, Spain

3 Epidemiology Unit (CIBER-ESP), Donostia University Hospital, San Sebastian, Spain

4 Biomedical Research Centre Network for Respiratory Diseases (CIBERES), San Sebastián, Spain

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BMC Pulmonary Medicine 2014, 14:126  doi:10.1186/1471-2466-14-126

Published: 4 August 2014



Nitric oxide can be measured at multiple flow rates to determine proximal (maximum airway nitric oxide flux; JawNO) and distal inflammation (alveolar nitric oxide concentration; CANO). The main aim was to study the association among symptoms, lung function, proximal (maximum airway nitric oxide flux) and distal (alveolar nitric oxide concentration) airway inflammation in asthmatic children treated and not treated with inhaled glucocorticoids.


A cross-sectional study with prospective data collection was carried out in a consecutive sample of girls and boys aged between 6 and 16 years with a medical diagnosis of asthma. Maximum airway nitric oxide flux and alveolar nitric oxide concentration were calculated according to the two-compartment model. In asthmatic patients, the asthma control questionnaire (CAN) was completed and forced spirometry was performed. In controls, differences between the sexes in alveolar nitric oxide concentration and maximum airway nitric oxide flux and their correlation with height were studied. The correlation among the fraction of exhaled NO at 50 ml/s (FENO50), CANO, JawNO, forced expiratory volume in 1 second (FEV1) and the CAN questionnaire was measured and the degree of agreement regarding asthma control assessment was studied using Cohen’s kappa.


We studied 162 children; 49 healthy (group 1), 23 asthmatic participants without treatment (group 2) and 80 asthmatic patients treated with inhaled corticosteroids (group 3). CANO (ppb) was 2.2 (0.1-4.5), 3 (0.2-9.2) and 2.45 (0.1-24), respectively. JawNO (pl/s) was 516 (98.3-1470), 2356.67 (120–6110) and 1426 (156–11805), respectively. There was a strong association (r = 0.97) between FENO50 and JawNO and the degree of agreement was very good in group 2 and was good in group 3. There was no agreement or only slight agreement between the measures used to monitor asthma control (FEV1, CAN questionnaire, CANO and JawNO).


The results for CANO and JawNO in controls were similar to those found in other reports. There was no agreement or only slight agreement among the three measure instruments analyzed to assess asthma control. In our sample, no additional information was provided by CANO and JawNO.