Different patterns of exhaled nitric oxide response to [beta]2-agonists in asthmatic patients according to the site of bronchodilation
Background In asthmatic patients undergoing airway challenge, fraction of exhaled nitric oxide (Feno) levels decrease after bronchoconstriction. In contrast, model simulations have predicted both decreased and increased Fenolevels after bronchodilation, depending on the site of airway obstruction re...
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| Veröffentlicht in: | Journal of allergy and clinical immunology 2016-03, Vol.137 (3), p.806 |
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| creator | Michils, Alain Malinovschi, Andrei Haccuria, Amaryllis Michiels, Sebastien Van Muylem, Alain |
| description | Background In asthmatic patients undergoing airway challenge, fraction of exhaled nitric oxide (Feno) levels decrease after bronchoconstriction. In contrast, model simulations have predicted both decreased and increased Fenolevels after bronchodilation, depending on the site of airway obstruction relief. Objective We sought to investigate whether β2-agonists might induce divergent effects on Fenovalues in asthmatic patients as a result of airway obstruction relief occurring at different lung depths. Methods Feno, FEV1, and the slope of phase III of the single-breath washout test (S) of He (SHe) and sulfur hexafluoride (SSF6) were measured in 68 asthmatic patients before and after salbutamol inhalation. SHeand SSF6decreases reflected preacinar and intra-acinar obstruction relief, respectively. Changes (Δ) were expressed as a percentage from the baseline. Results No Fenochange (|ΔFeno| |
| doi_str_mv | 10.1016/j.jaci.2015.09.054 |
| format | Article |
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In contrast, model simulations have predicted both decreased and increased Fenolevels after bronchodilation, depending on the site of airway obstruction relief. Objective We sought to investigate whether β2-agonists might induce divergent effects on Fenovalues in asthmatic patients as a result of airway obstruction relief occurring at different lung depths. Methods Feno, FEV1, and the slope of phase III of the single-breath washout test (S) of He (SHe) and sulfur hexafluoride (SSF6) were measured in 68 asthmatic patients before and after salbutamol inhalation. SHeand SSF6decreases reflected preacinar and intra-acinar obstruction relief, respectively. Changes (Δ) were expressed as a percentage from the baseline. Results No Fenochange (|ΔFeno| <= 10%) was found in 16 patients (mean [SD]: 2.5% [5.2%]; ie, Feno= group); a ΔFenovalue of greater than 10% was found in 23 patients (31.7% [20.3%]; ie, the Feno+ group); and a ΔFenovalue of less than -10% was found in 29 patients (-31.5% [17.3%]; ie, the Feno- group). All groups had similar ΔFEV1values. In the Feno= group neither SHenor SSF6changed, in the Feno+ group only SHedecreased significantly (-21.8% [SD 28.5%],P= .03), and in the Feno- group both SHe(-29.8% [24.0%],P< .001) and SSF6(-27.2% [23.3%],P< .001) decreased. Discussion Three Fenobehaviors were observed in response to β2-agonists: a decrease likely caused by relief of an intra-acinar airway obstruction that we propose reflects amplification of nitric oxide back-diffusion, an increase likely associated with a predominant dilation up to the preacinar airways, and Fenostability when obstruction relief involved predominantly the central airways. In combination, these results suggest a new role for Fenoin identifying the site of airway obstruction in asthmatic patients.</description><identifier>ISSN: 0091-6749</identifier><identifier>EISSN: 1097-6825</identifier><identifier>DOI: 10.1016/j.jaci.2015.09.054</identifier><language>eng</language><publisher>St. Louis: Elsevier Limited</publisher><subject>Airway management ; Asthma ; Gases ; Inflammation ; Values ; Ventilation</subject><ispartof>Journal of allergy and clinical immunology, 2016-03, Vol.137 (3), p.806</ispartof><rights>Copyright Elsevier Limited Mar 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids></links><search><creatorcontrib>Michils, Alain</creatorcontrib><creatorcontrib>Malinovschi, Andrei</creatorcontrib><creatorcontrib>Haccuria, Amaryllis</creatorcontrib><creatorcontrib>Michiels, Sebastien</creatorcontrib><creatorcontrib>Van Muylem, Alain</creatorcontrib><title>Different patterns of exhaled nitric oxide response to [beta]2-agonists in asthmatic patients according to the site of bronchodilation</title><title>Journal of allergy and clinical immunology</title><description>Background In asthmatic patients undergoing airway challenge, fraction of exhaled nitric oxide (Feno) levels decrease after bronchoconstriction. In contrast, model simulations have predicted both decreased and increased Fenolevels after bronchodilation, depending on the site of airway obstruction relief. Objective We sought to investigate whether β2-agonists might induce divergent effects on Fenovalues in asthmatic patients as a result of airway obstruction relief occurring at different lung depths. Methods Feno, FEV1, and the slope of phase III of the single-breath washout test (S) of He (SHe) and sulfur hexafluoride (SSF6) were measured in 68 asthmatic patients before and after salbutamol inhalation. SHeand SSF6decreases reflected preacinar and intra-acinar obstruction relief, respectively. Changes (Δ) were expressed as a percentage from the baseline. Results No Fenochange (|ΔFeno| <= 10%) was found in 16 patients (mean [SD]: 2.5% [5.2%]; ie, Feno= group); a ΔFenovalue of greater than 10% was found in 23 patients (31.7% [20.3%]; ie, the Feno+ group); and a ΔFenovalue of less than -10% was found in 29 patients (-31.5% [17.3%]; ie, the Feno- group). All groups had similar ΔFEV1values. In the Feno= group neither SHenor SSF6changed, in the Feno+ group only SHedecreased significantly (-21.8% [SD 28.5%],P= .03), and in the Feno- group both SHe(-29.8% [24.0%],P< .001) and SSF6(-27.2% [23.3%],P< .001) decreased. Discussion Three Fenobehaviors were observed in response to β2-agonists: a decrease likely caused by relief of an intra-acinar airway obstruction that we propose reflects amplification of nitric oxide back-diffusion, an increase likely associated with a predominant dilation up to the preacinar airways, and Fenostability when obstruction relief involved predominantly the central airways. In combination, these results suggest a new role for Fenoin identifying the site of airway obstruction in asthmatic patients.</description><subject>Airway management</subject><subject>Asthma</subject><subject>Gases</subject><subject>Inflammation</subject><subject>Values</subject><subject>Ventilation</subject><issn>0091-6749</issn><issn>1097-6825</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNqNjUtOw0AQREcIJMLnAqxaYm3T48S_NR9xgOwQiiZ2Ox7LTJvpjpQTcG4mEgdgVSrVqypjHizmFm31NOWT63xeoC1zbHMsNxdmZbGts6opykuzQmxtVtWb9trciEyY_LppV-bnxQ8DRQoKi1OlGAR4ADqNbqYegtfoO-CT7wkiycJBCJThY0_qPovMHTh4UQEfwImOX04Tn6Z8mhRwXcex9-Fw7uhIIF7pfLCPHLqRez8nlMOduRrcLHT_p7fm8e11-_yeLZG_jyS6m_gYQ4p2tm6wKurG4vp_1C_RNltQ</recordid><startdate>20160301</startdate><enddate>20160301</enddate><creator>Michils, Alain</creator><creator>Malinovschi, Andrei</creator><creator>Haccuria, Amaryllis</creator><creator>Michiels, Sebastien</creator><creator>Van Muylem, Alain</creator><general>Elsevier Limited</general><scope>7SS</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope></search><sort><creationdate>20160301</creationdate><title>Different patterns of exhaled nitric oxide response to [beta]2-agonists in asthmatic patients according to the site of bronchodilation</title><author>Michils, Alain ; Malinovschi, Andrei ; Haccuria, Amaryllis ; Michiels, Sebastien ; Van Muylem, Alain</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-proquest_journals_17806278103</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Airway management</topic><topic>Asthma</topic><topic>Gases</topic><topic>Inflammation</topic><topic>Values</topic><topic>Ventilation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Michils, Alain</creatorcontrib><creatorcontrib>Malinovschi, Andrei</creatorcontrib><creatorcontrib>Haccuria, Amaryllis</creatorcontrib><creatorcontrib>Michiels, Sebastien</creatorcontrib><creatorcontrib>Van Muylem, Alain</creatorcontrib><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><jtitle>Journal of allergy and clinical immunology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Michils, Alain</au><au>Malinovschi, Andrei</au><au>Haccuria, Amaryllis</au><au>Michiels, Sebastien</au><au>Van Muylem, Alain</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Different patterns of exhaled nitric oxide response to [beta]2-agonists in asthmatic patients according to the site of bronchodilation</atitle><jtitle>Journal of allergy and clinical immunology</jtitle><date>2016-03-01</date><risdate>2016</risdate><volume>137</volume><issue>3</issue><spage>806</spage><pages>806-</pages><issn>0091-6749</issn><eissn>1097-6825</eissn><abstract>Background In asthmatic patients undergoing airway challenge, fraction of exhaled nitric oxide (Feno) levels decrease after bronchoconstriction. In contrast, model simulations have predicted both decreased and increased Fenolevels after bronchodilation, depending on the site of airway obstruction relief. Objective We sought to investigate whether β2-agonists might induce divergent effects on Fenovalues in asthmatic patients as a result of airway obstruction relief occurring at different lung depths. Methods Feno, FEV1, and the slope of phase III of the single-breath washout test (S) of He (SHe) and sulfur hexafluoride (SSF6) were measured in 68 asthmatic patients before and after salbutamol inhalation. SHeand SSF6decreases reflected preacinar and intra-acinar obstruction relief, respectively. Changes (Δ) were expressed as a percentage from the baseline. Results No Fenochange (|ΔFeno| <= 10%) was found in 16 patients (mean [SD]: 2.5% [5.2%]; ie, Feno= group); a ΔFenovalue of greater than 10% was found in 23 patients (31.7% [20.3%]; ie, the Feno+ group); and a ΔFenovalue of less than -10% was found in 29 patients (-31.5% [17.3%]; ie, the Feno- group). All groups had similar ΔFEV1values. In the Feno= group neither SHenor SSF6changed, in the Feno+ group only SHedecreased significantly (-21.8% [SD 28.5%],P= .03), and in the Feno- group both SHe(-29.8% [24.0%],P< .001) and SSF6(-27.2% [23.3%],P< .001) decreased. Discussion Three Fenobehaviors were observed in response to β2-agonists: a decrease likely caused by relief of an intra-acinar airway obstruction that we propose reflects amplification of nitric oxide back-diffusion, an increase likely associated with a predominant dilation up to the preacinar airways, and Fenostability when obstruction relief involved predominantly the central airways. In combination, these results suggest a new role for Fenoin identifying the site of airway obstruction in asthmatic patients.</abstract><cop>St. Louis</cop><pub>Elsevier Limited</pub><doi>10.1016/j.jaci.2015.09.054</doi></addata></record> |
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| subjects | Airway management Asthma Gases Inflammation Values Ventilation |
| title | Different patterns of exhaled nitric oxide response to [beta]2-agonists in asthmatic patients according to the site of bronchodilation |
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