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Exhaled Nitric Oxide Predicts Exercise-Induced Bronchoconstriction in Asthmatic School Children^*

^* From the Danish Pediatric Asthma Centre, Department of Pediatrics, Copenhagen University Hospital, Gentofte, Denmark.

Correspondence to: Hans Bisgaard, MD, DMSci, Danish Pediatric Asthma Centre, Copenhagen University Hospital, DK-2900 Gentofte, Niels Andersensvej 79, 2900 Hellerup, Denmark; e-mail: Bisgaard{at}copsac.dk

Background: Exercise-induced bronchoconstriction (EIB) is of particular importance in children with asthma. It is an important measure of asthma control and should be monitored by exercise testing. However, exercise testing puts a large demand on health-care resources and is therefore not widely used in routine monitoring of pediatric asthma control. The fractional concentration of exhaled nitric oxide (FeNO) also reflects uncontrolled asthma. We hypothesized that FeNO may be used for prescreening of asthmatic children to exclude those with good asthma control unlikely to have EIB, thereby reducing the need for exercise testing.

Objective: The aim of this study was to estimate the value of FeNO as a predictor of EIB in asthmatic children.

Methods: Stable outpatient asthmatic school children performed standard exercise challenge tests and measurement of FeNO.

Results: FeNO and response to a standardized submaximal exercise test on the treadmill were measured in 111 school children with asthma. EIB could be excluded with a probability of 90% in asthmatic children with FeNO levels < 20 parts per billion (ppb) without current inhaled corticosteroid treatment, and < 12 ppb in children with current inhaled corticosteroid treatment.

Conclusion: Measurement of FeNO is a simple, and time- and resource-efficient tool that may be used to screen for EIB testing and therefore optimizes the resources for exercise testing in pediatric asthma monitoring.

Key Words: children • exercise-induced bronchoconstriction • FeNO • prediction

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