Exhaled Nitric Oxide (FeNO) in Patients with Asthma Exacerbation and in Non Exacerbation at Persahabatan Hospital

· Asthma, Lung Function

Arief Riadi Arifin, Faisal Yunus, Ratnawati, Aria Kekalih

Background : Nitric oxide is detected in expired air which is physiologically released by epithedial cells of pulmonary vasculature,
cells of lower respiratory tract, upper respiratory tract and paranasal sinuses. Levels in normal human expiratory air range from 5-10
parts per billion (ppb); which is increased with degree of inflammation in the respiratory tract. Metabolites of NO is also detected in the
respiratory fluid aspirate and BAL. Currently NO is being used as a marker of airway inflammation, especially in asthma that can be
used as an alternative to aid diagnosis and evaluate of treatment.

Methods : This is a prospective cohort study. Data retrieval is performed 2 times at the beginning and end of the study. Research
carried out from January 2012 – April 2012. Baseline data were taken at the time of acute exacerbation which include FEV1 & FeNO
level. On following visit, spirometry, FeNO, PFR & ACT questionnaire were assessed. Average values of FeNO was measured in
different states of asthma, acute, partly controlled and uncontrolled. The data were analyzed and compared with FEV1 and PFR
values to compare with the degree of asthma.

Results : A total of 35 patients were follow up after 1 month, mostly women (77%). Average FeNO levels of mild acute asthma was
61 ppb and in acute asthma were at 69 ppb. Based on ACT, fully controlled asthma patients had FeNO level at 20 ppb, 27 ppb partly
controlled and uncontrolled by 50 ppb. At the FeNO level comparisons obtained during exacerbation average at 68.51 ppb and 31.37
ppb when no exacerbations. Average FeNO level of fully controlled asthma according to ACT was 20 ppb in 5 people, 27 ppb in 21
people with partially controlled asthma and 49 ppb in 9 people with uncontrolled asthma.

Conclusion : There are varying levels of FeNO in asthma patients during exacerbation. There are differences in average FeNO
levels in each of the asthma control level. There is a considerable relationship between elevated levels of FeNO and decreased
of FEV1/predicted in the absence of exacerbations. FeNO can be used to assess the degree of asthma at the time exacerbation
compared to using FEV1/predicted. (J Respir Indo. 2013; 33:40-9)

Keywords : NO levels, asthma exacerbations, asthma non exacerbations.

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