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Original Article


Comparison of Exhaled Nitric Oxide Measurement With Conventional Tests in Steroid-Naive Asthma Patients


Z Zietkowski,1 A Bodzenta-Lukaszyk,1 MM Tomasiak,1 R Skiepko,1 M Szmitkowski 2

1 Department of Allergology and Internal Diseases, Medical University of Bialystok, Bialystok, Poland
2 Department of Biochemical Diagnostics, Medical University of Bialystok, Bialystok, Poland

J Investig Allergol Clin Immunol 2006; Vol. 16(4): 239-246



Background: Nitric oxide (NO) is a molecule with potent biological activity that plays an important role in the physiology of the respiratory system. Increased expression of inducible nitric oxide synthase (iNOS) and elevated fractional concentration of exhaled nitric oxide (FENO) are seen in asthmatic patients. Measurement of FENO has become increasingly recognized for use in the evaluation of bronchial inflammation during monitoring of antiinflammatory treatment.

Objectives: The aim of this study was to evaluate FENO in a group of steroid-naive asthmatics and assess the relationship of this parameter with the results of other tests used in the diagnosis of asthma and monitoring of antiinflammatory treatment in asthmatic patients.

Methods: The study was conducted in a group of 101 steroid-naive asthmatics (56 allergic and 45 nonallergic) and 39 healthy volunteers. All patients underwent measurement of FENO, skin prick tests with common inhaled allergens, analysis of serum eosinophil cationic protein (ECP) and blood eosinophilia, and flow-volume spirometry. When the forced expiratory volume in the first second (FEV1) was less than 80% of predicted, reversibility of airway obstruction with a ß2-agonist was assessed. A nonspecific bronchial provocation test with histamine was carried out in asthmatic patients with a baseline FEV1 of more than 70% of predicted.

Results: Compared to the healthy volunteers, FENO was elevated in both groups of asthmatics. FENO in the allergic asthma group was higher than in the group of nonallergic asthmatics. In allergic and nonallergic asthmatics, FENO was significantly correlated with bronchial hyperresponsiveness to histamine, reversibility of airway obstruction, serum ECP levels, and blood eosinophilia. FENO did not correlate with baseline FEV1 in either group of asthmatics. In 31% of nonallergic and 9% of allergic patients, FENO was less than 20 parts per billion.

Conclusions: We suggest that measurement of FENO could be clinically useful in steroid-naive asthmatics and should be more widely used in clinical practice. Measurement of FENO is a noninvasive, simple, and reproducible
procedure, the results of which correlate with other routinely used methods in the diagnosis of asthma. However, it is worth noting that some patients, especially those with nonallergic asthma, do not display elevated FENO.

Key words: Asthma. Exhaled nitric oxide. Pulmonary function tests. Eosinophil cationic protein. Blood eosinophilia. IgE.