Asthma, Rhinitis, Other Respiratory DiseasesBoth inflammation and remodeling influence nitric oxide output in children with refractory asthma
Section snippets
Patients
Children with refractory asthma were included prospectively and investigated by fiberoptic bronchoscopy. The diagnosis of asthma was based on clinical symptoms and history of reversible airflow limitation. In accordance with the recent ATS workshop, refractory asthma was defined as presence of the major criterion, for example, need for high-dose inhaled corticosteroids and at least 2 of the following 5 minor criteria: (1) requirement for daily long-acting β-agonist or leukotriene antagonist in
Patients, pulmonary function testing
Twenty-eight children (16 boys and 12 girls) were enrolled (median age, 11 years; range, 10 to 14 years). All had asthma since early childhood and were atopic, as defined by one or more positive skin tests. All were receiving beclomethasone (1000 μg/d) or equivalent (major inclusion criterion) and a long-acting β-agonist (22 children) or leukotriene antagonist (6 children) (first minor inclusion criterion). The second minor criteria were (1) persistent airway obstruction defined as FEV1 < 80%
Discussion
In children with asthma, bronchoscopy, and BB are appropriate only to clarify the diagnosis and to assist in treatment decisions for patients with poorly controlled disease. The patients in this study were children with refractory asthma, for example, with frequent symptoms and/or airflow obstruction despite maximal conventional therapy. We examined relations between multiple-flow measurements of exhaled NO and evidence of airway inflammation or remodeling obtained by bronchoscopy and BB. Our
Acknowledgments
The authors wish to thank SERES Industry for providing the NO analyzer.
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