The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

VARIABILITY OF EXHALED NITRIC OXIDE MEASUREMENT IN A PEDIATRIC SEVERE ATOPIC ASTHMA PATIENT

Stephanie King, Peter H. Michelson, Barbara McLurkin, Christopher Fortner; Pediatric Pulmonary Function Lab, Duke Children’s Healthcare Center, Durham, NC

The past few decades have seen an evolution in the definition of asthma from that of a bronchoreactive airways disease to that of a TH-2-directed inflammatory disease that involves both the large and the small airways. Exhaled nitric oxide(FENO) provide an alternative noninvasive marker of inflammation in asthma that is convenient, quick, and inexpensive. Nitric oxide is elevated in human lungs in a variety of inflammatory diseases. FENO is elevated in untreated or undertreated asthma. FENO decreases in a dose-dependent manner with the use of inhaled corticosteroids. In this case report we describe the varibility of pre and post bronchodilator FENO results with a pediatric severe atopic asthmatic patient. Case Summary: A 13 year old black male with severe atopic asthma with Allergic Bronchopulmonary Aspergillosis presented in the pediatric pulmonary function lab with an upper respiratory infection with congestion, sinus drainage and cough for the past 72 hours. His physical exam revealed expiratory wheezing and nasal mucosa edematous with clear rhinorrhea. His pre spirometry results with the VIASYS Vmax Encore PFT equipment showed FVC(90%), FEV1(63%), FEF25-75%(25%), PEF(82%) of predicted values and Aerocrine NIOX Flex pre FENO results 84.5 parts per billion(ppb) with an SpO2 of 97% on room air. The patient received 0.63mg Levalbuterol in 3ml normal saline for pre and post spirometry testing. His post spirometry results showed FVC(103%),a 14% improvement. FEV1(87%), a 38% improvement. FEF25-75%(52%),a 108% improvement. PEF(100%), a 21% improvement of predicted values and post FENO increased to 118ppb. A prolonged expiratory phase noted on pre and post spirometry testing, but shorter on post spirometry test. Patient stated a subjective improvement in breathing quality following nebulizer treatment. The patient was diagnosed with having an asthma flare and was placed on a course of tapered oral steriods. Discussion: Asthma flares increases airway constriction and results in decreased airflow and gas exchange. Increased airflow following nebulizer treatment administration resulted in an increase in the FENO measurement due to a subsequent decrease in bronchoconstriction of the smooth muscle in the bronchioles thus resulting in increased airflow and gas exchange. The decrease in bronchoconstriction increased gas intake and output which resulted in a higher FENO measurement for the patient. Sponsored Research - None

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