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(Chest. 2005;127:1696-1702.)
© 2005 American College of Chest Physicians

Alveolar Nitric Oxide and Effect of Deep Inspiration During Methacholine Challenge*

Christophe Delclaux, MD, PhD{dagger}; Françoise Zerah-Lancner, MD; Bruno Mahut, MD; Stephan Ribeil; Armelle Dubois; Christian Larger and Alain Harf, MD, PhD{ddagger}

* From Unité INSERM U492-Université Paris XII (Drs. Delclaux and Harf), Faculté de Médecine de Créteil; and Service de Physiologie (Drs. Zerah-Lancner and Mahut, and Mr. Ribeil, Ms. Dubois, and Mr. Larger), Explorations Fonctionnelles, Hôpital Henri Mondor, AP-HP, Créteil, France. {dagger} Currently at Service de Physiologie-Radio-Isotopes, Hôpital Européen Georges Pompidou, Paris. France. {ddagger} Deceased at the time of article submission.

Correspondence to: Christophe Delclaux, MD, PhD, Service de Physiologie, Explorations Fonctionnelles, Hôpital Henri Mondor, 51, avenue du Maréchal de Lattre de Tassigny, 94 010 Créteil, France; e-mail: christophe.delclaux{at}creteil.inserm.fr

Study objectives: To assess whether the dual anatomic origin of exhaled nitric oxide (NO), namely alveolar and bronchial, could explain the link between exhaled NO and airway responsiveness, and could participate in the bronchodilatory effect of deep inspiration (DI) that may be evidenced during methacholine challenge.

Design and setting: Prospective study in a laboratory performing pulmonary function tests of an academic hospital.

Patients and interventions: Patients underwent multiple flow analysis of exhaled NO, allowing calculation of total maximum airway NO flux (J’awNO) and NO concentration of expansible compartment (CANO), and received a cumulative methacholine dose of 2,000 µg. DI effect was assessed by continuous measurement of the resistance of respiratory system using the forced oscillation technique before and after DI.

Results: In a first phase involving 23 patients, a positive correlation between log values of J’awNO and CANO was demonstrated with the degree of airway responsiveness (percentage of FEV1 decrease). In a second phase involving 38 patients, only log CANO was correlated with responsiveness, and no significant relationship was demonstrated between J’awNO or CANO and the effect of DI. Patients with smaller airways and/or distal airflow limitation exhibited a constrictive response to DI.

Conclusion: Airway responsiveness is mainly associated with an increase in distal origin of NO output, and no relationship between exhaled NO and the effect of DI was evidenced.

Key Words: concentration of NO from the expansible compartment • forced oscillation technique • total maximum flux of NO from airways






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