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Exhaled nitric oxide: Not associated with asthma, symptoms, or spirometry in children with sickle cell anemia

Exhaled nitric oxide: Not associated with asthma, symptoms, or spirometry in children with sickle cell anemia
Exhaled nitric oxide: Not associated with asthma, symptoms, or spirometry in children with sickle cell anemia
BACKGROUND:
The significance of fractional exhaled nitric oxide (Feno) levels in children with sickle cell anemia (SCA) is unclear, but increased levels can be associated with features of asthma and thus increased morbidity.

OBJECTIVES:
We sought to determine factors associated with Feno and whether Feno levels are associated with increased rates of acute chest syndrome (ACS) and pain.

METHODS:
All participants had SCA, were part of the prospective observational Sleep and Asthma Cohort study, and had the following assessments: Feno levels, spirometry, blood samples analyzed for hemoglobin, white blood cell counts, eosinophil counts and total serum IgE levels, questionnaires about child medical and family history, and review of medical records.

RESULTS:
The analytic sample included 131 children with SCA (median age, 11.2 years; age range, 6-18 years) followed for a mean of 16.2 years, including a mean of 5.1 years after baseline Feno data measurements. In multivariable analyses higher Feno levels were associated with ln(IgE) levels (P < .001) and the highest quartile of peripheral eosinophil counts (P = .03) but not wheezing symptoms, baseline spirometric indices, or response to bronchodilator. Multivariable analyses identified that the incident rate of ACS was associated with ln(Feno) levels (P = .03), as well as male sex (P = .025), wheezing causing shortness of breath (P = .002), and ACS at less than 4 years of age (P < .001). Feno levels were not associated with future pain episodes.

CONCLUSIONS:
Steady-state Feno levels were not associated with an asthma diagnosis, wheezing symptoms, lung function measures, or prior sickle cell morbidity but were associated with markers of atopy and increased risk of future ACS events.
0091-6749
1338-1343
Cohen, R.T.
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Rodeghier, M.
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Kirkham, F.J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Rosen, C.L.
a23c59a1-289b-437b-9043-7f7d6f5d1cbd
Kirkby, J.
366bf2c7-a56c-4974-8f25-8de0ea829787
DeBaun, M.R.
27b59ded-b0ab-4e21-b661-a49b15ac7fb9
Strunk, R.C.
b02c926a-fab2-425e-a887-decc320eeb8a
Cohen, R.T.
26f47e0b-b684-4762-be85-57df8710c4d7
Rodeghier, M.
2353c111-f1fd-4571-ae18-f232c8afe25e
Kirkham, F.J.
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Rosen, C.L.
a23c59a1-289b-437b-9043-7f7d6f5d1cbd
Kirkby, J.
366bf2c7-a56c-4974-8f25-8de0ea829787
DeBaun, M.R.
27b59ded-b0ab-4e21-b661-a49b15ac7fb9
Strunk, R.C.
b02c926a-fab2-425e-a887-decc320eeb8a

Cohen, R.T., Rodeghier, M., Kirkham, F.J., Rosen, C.L., Kirkby, J., DeBaun, M.R. and Strunk, R.C. (2016) Exhaled nitric oxide: Not associated with asthma, symptoms, or spirometry in children with sickle cell anemia. Journal of Allergy and Clinical Immunology, 138 (5), 1338-1343. (doi:10.1016/j.jaci.2016.06.043). (PMID:27521278)

Record type: Article

Abstract

BACKGROUND:
The significance of fractional exhaled nitric oxide (Feno) levels in children with sickle cell anemia (SCA) is unclear, but increased levels can be associated with features of asthma and thus increased morbidity.

OBJECTIVES:
We sought to determine factors associated with Feno and whether Feno levels are associated with increased rates of acute chest syndrome (ACS) and pain.

METHODS:
All participants had SCA, were part of the prospective observational Sleep and Asthma Cohort study, and had the following assessments: Feno levels, spirometry, blood samples analyzed for hemoglobin, white blood cell counts, eosinophil counts and total serum IgE levels, questionnaires about child medical and family history, and review of medical records.

RESULTS:
The analytic sample included 131 children with SCA (median age, 11.2 years; age range, 6-18 years) followed for a mean of 16.2 years, including a mean of 5.1 years after baseline Feno data measurements. In multivariable analyses higher Feno levels were associated with ln(IgE) levels (P < .001) and the highest quartile of peripheral eosinophil counts (P = .03) but not wheezing symptoms, baseline spirometric indices, or response to bronchodilator. Multivariable analyses identified that the incident rate of ACS was associated with ln(Feno) levels (P = .03), as well as male sex (P = .025), wheezing causing shortness of breath (P = .002), and ACS at less than 4 years of age (P < .001). Feno levels were not associated with future pain episodes.

CONCLUSIONS:
Steady-state Feno levels were not associated with an asthma diagnosis, wheezing symptoms, lung function measures, or prior sickle cell morbidity but were associated with markers of atopy and increased risk of future ACS events.

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More information

Accepted/In Press date: 13 June 2016
e-pub ahead of print date: 9 August 2016
Published date: November 2016
Organisations: Clinical & Experimental Sciences

Identifiers

Local EPrints ID: 404243
URI: https://eprints.soton.ac.uk/id/eprint/404243
ISSN: 0091-6749
PURE UUID: d258c6eb-0571-4612-8066-d36f265ff63f
ORCID for F.J. Kirkham: ORCID iD orcid.org/0000-0002-2443-7958

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Date deposited: 05 Jan 2017 09:36
Last modified: 12 Nov 2019 06:21

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