Miguel J. Lanz

Exhaled nitric oxide before and after montelukast sodium therapy in school-age children with chronic asthma: A preliminary study

Exhaled nitric oxide (ENO) is a surrogate marker of airway inflammation in asthma. In 12 children aged 6–11 years with mild to moderate persistent asthma, ENO concentrations were measured before and after 4 weeks of treatment with montelukast sodium, a leukotriene receptor antagonist, and 2 weeks after withdrawal of therapy.

Comparison of exhaled nitric oxide, serum eosinophilic cationic protein, and soluble interleukin-2 receptor in exacerbations of pediatric asthma

The hypotheses tested in this study were that during acute asthma exacerbations (1) exhaled nitric oxide concentrations [eNO] are a more sensitive, noninvasive indicator of asthma disease activity than serum markers of inflammation such as eosinophil cationic protein (ECP) or soluble interleukin 2 receptor (sIL2R), and (2) elevated [eNO] are reduced after treatment with glucocorticoids (GC). Peak eNO levels were measured by chemiluminescence during slow expiration. Seven asthmatic subjects (mean age 11 yrs; mean morning FEV1 65% predicted) receiving inhaled GC, and with no radiographic evidence of acute sinusitis, were studied before and after a course of oral GC. Measurements of [eNO], ECP and sIL2R levels, and FEV1% were obtained before and after a course of GC. Six atopic nonasthmatic subjects (mean age 12 years; mean FEV1 94% predicted) and seven normal subjects (mean age 13 years; mean FEV1 100% predicted) were studied.

Comparison of exhaled nitric oxide to spirometry during emergency treatment of asthma exacerbations with glucocorticoids in children

BACKGROUND Asthma is characterized as a chronic inflammatory process; however, there is no easily measured marker for airway inflammation. Such a marker, particularly in children, would be very helpful in the management of asthma even in the acute setting. OBJECTIVE The purposes of this study were to determine whether asthmatic children have (1) elevation of exhaled breath nitric oxide (ENO) during acute exacerbations when presenting to the emergency room, (2) reduction of ENO following glucocorticoid treatment, or (3) improvement in spirometry and clinical examination accompanying reduction of ENO levels. METHODS Peak ENO levels were measured by chemiluminescence during exhalation into the NO analyzer. Ten asthmatic children (mean age 10 years) who presented to the Pediatric Special Care Unit at National Jewish Medical and Research Center in acute respiratory distress with an asthma exacerbation were studied. The subjects were recruited, after informed consent was obtained from the parent, on the basis of specific inclusion/exclusion criteria. Measurements of ENO in parts per billion (ppb) and spirometry, including percentiles of forced expiratory volume in one second (FEV1%) and peak expiratory flow (PEF%), were performed before and after at least 5 days of glucocorticoid therapy. RESULTS The mean ENO level in the asthmatic children prior to glucocorticoid treatment was 48 +/- 8ppb, and after glucocorticoid treatment the ENO level was 17 +/- 1ppb; (P < .002). Prior to glucocorticoid treatment, the mean FEV1% value was 68 +/- 3% compared with the postglucocorticoid treatment FEV1% value of 100 +/- 5%; (P < .0001). Prior to glucocorticoid treatment, the mean PEF% value was 81 +/- 7%, compared with the postglucocorticoid treatment PEF% value of 105 +/- 6%; (P < .02). CONCLUSIONS The mean peak ENO level after glucocorticoid therapy was significantly less than that measured before treatment in children with acute asthma exacerbations. Concomitant with the decrease in ENO levels, there was improvement in the spirometry values and physical examination in the asthmatic children; thus, ENO is a sensitive marker for response to anti-inflammatory treatment in children.

400 Differences in Indoor Allergen Quantification in Hispanic/Latino Children Living in Miami to Those Living in Latin America.

Background Higher levels of indoor allergens can induce in children more susceptiblity to atopy and possibly asthma. Methods Indoor allergen sampling was collected by families of allergic children referred to our Allergy clinic. Two groupings were based on location of residence, either locally, Miami Florida (MF), or from Latin America (LA). LA children were from Dominican Republic, Ecuador, Venezuela, or Central America. All MF children were of Hispanic/Latino descent, first or second generation, from similar countries. A dust collection device, (Duststream, Indoor Biotechnologies, Charlottesville) was used to vacuum the bedroom samples. These samples came from the mattress, pillows, floors, rugs, and A/C vents. After collecting, samples were weighed, extracted, vortexed, and incubated. For allergen detection, MARIA (Indoor Biotechnologies) was used to quantify levels of dust mite (DM) allergens, (Dermatophagoides pteronyssinus, Der p 1; Dermatophagoides farinae, Der f 1), and Felis domesticus (Fel d 1), Canis familiaris (Can f 1), Blattella germanica (Bla g 2). Quantification of these allergens was performed on a multiplexing instrument, Luminex 200, (Luminex Corporation, Austin, TX). Results Samples from 63 MF and 69 LA were returned. There was a statistical significance in total DM levels between both locations. The mean DM level was 118.7 ng/mL from MF and 241.0 ng/mL from LA (*P > 0.05). Both were in the moderate range for clinical exposure, 2.37 mcg/mL and 4.82 mcg/mL. Contribution of the total DM significance was from the DP species. The mean DP level was 34.1 ng/mL from MF compared to 188.6 ng/mL from LA (**P > 0.001). The clinical exposure of DP was moderate at 3.77 mcg/mL from LA, but in the low range at 0.68 mcg/mL from MF. No significant difference was found in DF between locations, but a minor trend towards more DF exposures in MF rather than LA exists. There was no difference found between locations with the other allergens tested. High cat allergen exposure was found in MF, but with variability and miniscule levels found in LA. Moderate dog and very low cockroach clinical exposures were found in both locations. Conclusions Our study reveals intriguing indoor allergen levels based on different environments that may contribute to the epidemiology of allergy/asthma in Hispanic/Latino children.

531 Comparison of Exhaled Nitric Oxide and Spirometry in Hispanic/Latino Children Living in Miami to Those Living in Latin America

Background Differences in atopic markers of inflammation has been shown to be due to varying environmental exposures between individuals. There is sparse information in the literature to compare the levels of atopic inflammatory markers in Hispanics/Latinos from distinctly different environments. Our aim was to study the levels of these clinical inflammatory markers in this population with similar levels of allergy/asthma control but from differing environments. Methods A retrospective review was limited to Hispanic/Latino children referred to our Allergy clinic over 6 months. These children were referred by their pediatrician for diagnosis of asthma and/or reactive airways disease. Respiratory tests of spirometry with Koko (nSpire Health, Colorado) and exhaled NO with MINO (Aerocrine, Sweden) was performed in all children by ATS guidelines. Collection of laboratory results of serum eosinophils and total IgE was also done. Two groupings were made based on the location of family residence, either locally in Miami, Florida (MF) or Latin America (LA). All patients in the MF group were of Hispanic/Latino ancestry, either first or second generation. The country of ancestry represented in the MF group were Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Mexico, Nicaragua, Venezuela. The patients in the LA group were coming from Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, and Venezuela. Results Thirty-five children fromMF group and 29 children from the LA group were found. The mean age in the MF group was 8+3 years of age and in the LA group was 9+4 years of age. There was statistical significance between eNO in both groups. The mean eNO was 23ppb in the MF group and 41ppb in the LA group. Normal eNO based on age and height for both groups is less than 15 to 20 ppb. There was no statistical significance between FEV1% in spirometry between both groups. The mean FEV1% in the MF group was 95 + 13%, and the mean FEV1% in the LA group was 92 + 9%. No differences were found between groups with either laboratory measures of serum eosinophils or total IgE. Conclusions Our analysis confirmed that despite similar levels of allergy/asthma control, there was a difference found in eNO in Hispanics/Latinos. This may be attributable to differences in environmental exposures between MF and LA.