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Atopy Influences Exhaled Nitric Oxide Levels in Adult Asthmatics^*

^* From the Respiratory Unit (Drs. Wood, Robson, Innes, and Greening), Western General Hospital, Edinburgh, and Osler Chest Unit (Dr. Ho), Churchill Hospital, Oxford, United Kingdom.

Correspondence to: Ling-Pei Ho, MD, Osler Chest Unit, Churchill Hospital, Headington, Oxford OX3 7LJ, United Kingdom

Study objective: To examine whether atopy influences exhaled nitric oxide (NO) levels in adults with established asthma.

Setting: Specialist respiratory unit in a university teaching hospital.

Patients: Twenty-eight asthmatics (mean FEV₁, 85.7%) receiving short-acting inhaled bronchodilators and a range of inhaled steroids (0 to 4,000 µg/d).

Interventions: Subjects were studied on two occasions, 5 to 7 days apart, between September and March.

Measurements and results: On the first day, FEV₁, exhaled NO, and histamine challenge were performed. On the second day, exhaled NO, total IgE, and skin-prick testing to six common allergens were conducted. Exhaled NO was measured with the single exhalation method. We found exhaled NO levels to correlate positively with total IgE (r = 0.43, p = 0.02) and number of positive skin-prick tests (p = 0.002). By contrast, there was no significant correlation between exhaled NO and FEV₁ or the provocative concentration causing a 20% fall in FEV₁. Subanalyses of steroid-treated and steroid-naive patients in this group revealed the same findings.

Conclusion: Exhaled NO levels in asthmatics correlate more closely with atopy than with bronchial hyperreactivity and lung function.

Key Words: asthma • atopy • exhaled nitric oxide

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