Association of fractional exhaled nitric oxide with asthma morbidity in urban minority children

Abstract

Objective

Fractional exhaled nitric oxide (FeNO) is a well-established measure of allergic airway inflammation and possible useful adjunct disease management tool. We investigated the association of baseline and follow-up FeNO measurements with disease burden in minority children with persistent asthma.

Methods

A retrospective chart review was conducted on 352 African American and Hispanic children seen at an urban Asthma Center in Bronx, NY. Demographic, clinical characteristics, and pulmonary function tests (PFTs) were compared between children with low, intermediate, and high baseline FeNO levels. Among 95 children with subsequent follow up visits, associations of change in FeNO with demographics, clinical characteristics, and PFTs were examined using mixed effects linear regression models.

Results

A higher proportion of children with intermediate (54%) and high FeNO (58%) levels had lower airways obstruction compared to those with low FeNO levels (33%). Children with intermediate FeNO levels had more annual hospitalizations (2.8 ± 6.2) compared to those with low and high FeNO levels (1.3 ± 2.8 and 1.3 ± 2.5). These associations did not differ between ethnicities. An increase in FeNO over time was associated with higher BMI z-scores (β = 6.2, 95% CI: 1.0 to 11.4) and two or more hospitalizations in the past year (β = 16.1, 95% CI: 1.5 to 30.8).

Conclusions

Intermediate and high FeNO levels are associated with lower airways obstruction and hospitalizations. Initial and serial FeNO measurements can be a useful adjunctive tool in identifying asthma-related morbidity in urban African American and Hispanic children.

Keywords:

• Pediatrics
• biomarkers

Acknowledgements

We would like to thank Dr. Aneela Bidiwala for her input on a subset of the data, the results of which were presented as an abstract at the American Thoracic Society International Conference.

Contributors’ statement

Dr. Chen contributed substantially to the acquisition, analysis, interpretation of data for the work, and drafting of the manuscript.

Dr. Agalliu contributed substantially to the design of the work, analysis and interpretation of data, drafting of the manuscript, and critically revising the work for important intellectual content.

Dr. Roth contributed substantially to the acquisition of data and critically revising the manuscript for important intellectual content.

Dr. Rastogi conceptualized and designed the study, coordinated and supervised data collection, analyzed and interpreted data, reviewed and revised the manuscript for important intellectual content.

All authors have provided final approval of the version of this manuscript to be submitted.

Declarations of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Deepa Rastogi is funded by NIH #HL141849.