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The clinical use of exhaled nitric oxide in wheezing children
Medição do óxido nítrico no ar exalado: Utilização na avaliação de crianças com história de sibilância
Pedro Martins1, Iolanda Caires2, José Rosado Pinto3, Pedro Lopes da Mata4, Simões Torres5, Joana Valente6, Carlos Borrego7, Nuno Neuparth8
1 Assistente Convidado, Departamento Universitário de Fisiopatologia, Faculdade de Ciências Médicas, Universidade Nova de Lisboa (Centro de Estudos de Patologia Respiratória); Assistente Eventual, Serviço de Imunoalergologia, Hospital de Dona Estefânia / Guest Consultant, Department of Physiopathology, Faculty of Medical Sciences, Universidade Nova de Lisboa (Centre for Respiratory Pathology Studies); Future Consultant, Allergy and Clinical Immunology Unit, Hospital de Dona Estefânia
2 Técnica de Cardiopneumologia, Departamento Universitário de Fisiopatologia, Faculdade de Ciências Médicas, Universidade Nova de Lisboa (Centro de Estudos de Patologia Respiratória) / Cardiopulmonology Technician, Department of Physiopathology, Faculty of Medical Sciences, Universidade Nova de Lisboa (Centre for Respiratory Pathology Studies)
3 Director de Serviço, Serviço de Imunoalergologia, Hospital de Dona Estefânia / Allergy and Clinical Immunology Unit, Hospital de Dona Estefânia
4 Especialista em Imunoalergologia, Instituto Clínico de Alergologia / Allergy and Clinical Immunology Specialist, Allergy and Clinical Immunology Institute
5 Director de Serviço, Serviço de Pneumologia, Hospital de São Teotónio / Director, Pulmonology Unit, Hospital de São Teotónio
6 Engenheira do Ambiente, Departamento de Ambiente e Ordenamento, Universidade de Aveiro / Environmental Engineer, Department of Environmental and Land Planning, Universidade de Aveiro
7 Professor Catedrático, Departamento de Ambiente e Ordenamento, Universidade de Aveiro / Cathedratic Professor, Department of Environmental and Land Planning, Universidade de Aveiro
8 Professor Auxiliar, Departamento Universitário de Fisiopatologia, Faculdade de Ciências Médicas, Universidade Nova de Lisboa (Centro de Estudos de Patologia Respiratória); Especialista em Imunoalergologia, Serviço de Imunoalergologia, Hospital de Dona Estefânia / Assistant Professor, Department of Physiopathology, Faculty of Medical Sciences, Universidade Nova de Lisboa (Centre for Respiratory Pathology Studies); Allergy and Clinical Immunology Specialist, Allergy and Clinical Immunology Unit, Hospital de Dona Estefânia
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        "resumen" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The body of published work on the role of exhaled nitric oxide &#40;FE<span class="elsevierStyleInf">NO</span>&#41; in the study of bronchial inflammation allows it to be classed as a simple&#44; non-invasive measurement that is very useful in evaluating asthmatic patients&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">During a prospective study into the effects of air pollution on the health of the population of Viseu &#40;Saud&#8217;AR Project&#41;&#44; children with a clinical history of wheezing were identified through using the International Study of Asthma and Allergy in Childhood &#40;ISAAC&#41; questionnaire&#46; Children later filled in a new standardised questionnaire and underwent skin-prick-tests&#44; spirometry and FE<span class="elsevierStyleInf">NO</span> measurement&#46; Their mean age was 7&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;1 years&#46; Comparing those who wheezed in the 6 months before evaluation &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&#41; with those who didn&#8217;t&#44; statistical differences for &#916;FEV1 &#40;8&#37; median versus 4&#46;5&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0399&#41; and for FE<span class="elsevierStyleInf">NO</span> &#40;23 ppb median versus 12 ppb&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0195&#44; respectively&#41; were observed&#46; Concerning children who needed a bronchodilator in the six previous months &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#41; and those who didn&#8217;t&#44; there was also a statistically significant difference in FE<span class="elsevierStyleInf">NO</span>&#58; 27 ppb median versus 11 ppb median&#44; respectively&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#46; When comparing children who needed an unscheduled medical appointment in the six months previous to the evaluation &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#41; and those who didn&#8217;t&#44; there was also significant differences for FE<span class="elsevierStyleInf">NO</span>&#58; 28 ppb median versus 13 ppb median&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0029&#46; In conclusion&#44; the existence of symptoms seems to be better related to FE<span class="elsevierStyleInf">NO</span> than spirometry&#46;</p>"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Encontram-se publicados m&#250;ltiplos trabalhos sobre o papel das determina&#231;&#245;es do &#243;xido n&#237;trico no ar exalado &#40;FE<span class="elsevierStyleInf">NO</span>&#41; no &#226;mbito do estudo da inflama&#231;&#227;o br&#244;nquica que nos permitem afirmar que se trata duma medi&#231;&#227;o simples&#44; n&#227;o invasiva e de grande utilidade na avalia&#231;&#227;o do doente asm&#225;tico&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">No decurso de um estudo prospectivo sobre o impacto da polui&#231;&#227;o do ar sobre a sa&#250;de da popula&#231;&#227;o na cidade de Viseu &#40;Projecto Saud&#8217;AR&#41;&#44; foram identificadas crian&#231;as com hist&#243;ria cl&#237;nica de sibil&#226;ncia&#44; mediante a aplica&#231;&#227;o de question&#225;rios do <span class="elsevierStyleItalic">International Study of Asthma and Allergy in Childhood</span> &#40;ISAAC&#41;&#46; As crian&#231;as foram submetidas posteriormente a um question&#225;rio padronizado&#44; testes cut&#226;neos <span class="elsevierStyleItalic">prick</span> para aeroalerg&#233;nios&#44; espirometria com prova de broncodilata&#231;&#227;o e medi&#231;&#227;o de FE<span class="elsevierStyleInf">NO</span>&#46; A idade m&#233;dia era de 7&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;1 anos&#46; Comparando os doentes com queixas de sibil&#226;ncia e&#47;ou dispneia nos 6 meses anteriores &#224; avalia&#231;&#227;o &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&#41; com os que n&#227;o apresentaram estes sintomas&#44; observaram -se diferen&#231;as estatisticamente significativas para o &#916;FEV1 &#40;mediana&#58; 4&#44;5&#37; <span class="elsevierStyleItalic">vs</span> 8&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0399&#41; e para o FENO &#40;mediana&#58; 12 ppb <span class="elsevierStyleItalic">vs</span> 23 ppb&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0195&#44; respectivamente&#41;&#46; Se olharmos para as crian&#231;as que recorreram a broncodilatador nos seis meses anteriores &#224; avalia&#231;&#227;o &#40;n&#61;19&#41; e as compararmos com as que n&#227;o necessitaram&#44; encontramos diferen&#231;as para o FE<span class="elsevierStyleInf">NO</span>&#58; mediana de 27 ppb versus mediana de 11 ppb&#44; respectivamente&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#46; Ao compararmos as crian&#231;as que recorreram a uma consulta de urg&#234;ncia nos seis meses anteriores &#224; avalia&#231;&#227;o &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#41; e as compararmos com as que n&#227;o recorreram&#44; encontramos tamb&#233;m diferen&#231;as estatisticamente significativas para o FE<span class="elsevierStyleInf">NO</span>&#58; mediana de 28 ppb <span class="elsevierStyleItalic">versus</span> mediana de 13 ppb&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0029&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Constatou-se assim que a exist&#234;ncia de sintomas se associou melhor com o FE<span class="elsevierStyleInf">NO</span> de que com a espirometria&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;&#46;"
        "nota" => "<p class="elsevierStyleNotepara">Este estudo foi realizado no &#226;mbito do projecto Saud&#8217;AR &#40;A Sa&#250;de e o Ar que Respiramos&#41;&#44; uma parceria entre o Departamento de Ambiente e Ordenamento da Universidade de Aveiro e a Faculdade de Ci&#234;ncias M&#233;dicas da Universidade Nova de Lisboa&#44; e foi financiado pela Funda&#231;&#227;o Calouste Gulbenkian&#46; Os doentes foram avaliados no Servi&#231;o de Pneumologia do Hospital de S&#227;o Teot&#243;nio &#40;Director&#58; Dr&#46; Sim&#245;es Torres&#41; &#47; <span class="elsevierStyleItalic">This study was part of the Saud&#8217;AR &#40;Health is the Air that we Breathe&#41; Project and was undertaken jointly with the Department of Environmental and Land Planning of the Universidade de Aveiro and the Faculty of Medical Sciences&#44; Universidade Nova de Lisboa&#46; It was funded by the Calouste Gulbenkian Foundation&#46; Patients were evaluated by the Pulmonology Unit of the Hospital de S&#227;o Teot&#243;nio &#40;Director&#58; Dr&#46; Sim&#245;es Torres&#41;</span>&#46;</p>"
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        0 => array:2 [
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                      "autores" => array:1 [
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