Download PDF
CC BY-NC-ND 4.0 · J Lab Physicians 2016; 8(02): 090-095
DOI: 10.4103/0974-2727.180788
Original Article

Induced Sputum Nitrite Levels Correlate with Clinical Asthma Parameters in Children Aged 7–18 Years with Mild to Moderate Persistent Asthma

Devki Nandan
Department of Pediatrics, PGIMER, Dr. RML Hospital, New Delhi, India
,
Prachi Kansal
Department of Pediatrics, PGIMER, Dr. RML Hospital, New Delhi, India
,
Neha Patharia
Department of Pediatrics, PGIMER, Dr. RML Hospital, New Delhi, India
,
Parul Goyal
Department of Pediatrics, PGIMER, Dr. RML Hospital, New Delhi, India
› Author Affiliations Financial support and sponsorship: Nil.
› Further Information
Also available at
  PDF Download Permissions and Reprints

ABSTRACT

Purpose: The objective of this study is to measure levels of nitrites in induced sputum in children with asthma and correlate it with clinical asthma parameters.

Method: This prospective observational study was done in PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi, on 91 children aged 7-18 years with mild and moderate persistent asthma. Patients were specifically evaluated for five clinical parameters of asthma (i.e. Days of acute exacerbations, use of salbutamol as rescue medication, emergency visits, nights with cough, days of school absence) and induced sputum nitrite levels was done at the time of enrollment and 3 months after treatment with inhaled budesonide.

Results: The mean age of subjects was 10.79 ± 2.563yrs. Six (6.59%) patients were not able to perform induced sputum, eighty five (93.41%) patients were suitable for data analysis. There was significant reduction in sputum nitrite levels from 33.42 ± 22.04nmol/ml at enrollment to 11.72 ± 5.61 nmol/ml (P < 0.0005) after 3 months of inhaled budesonide therapy. Significant positive correlation was found between reduction in sputum nitrite level and control of asthma symptoms: Days of acute exacerbations(r value = 0.548, P value = 0.0001), Days of salbutamol use as rescue medication (r value = 0.431, P value =< 0.0001), Number of emergency visits(r value = 0.414, P value = 0.0001), Nights with cough (r value = 0.259, P value = 0.0169), Days of school absence(r value = 0.411, P value = 0.0001). Sputum nitrite levels were significantly higher in moderate persistent asthmatics as compared to mild at the time of enrollment (P < 0.0005), which shows that induced sputum nitrite levels correlate with asthma severity.

Conclusions: This study confirms that nitrites in induced sputum correlate well with clinical asthma parameters and asthma severity in children and is a simple, non invasive, and cheap method which can be used as a parameter for monitoring of asthma.

Key words:

Asthma - clinical parameters - induced sputum - inhaled budesonide - nitrites


Publication History

Article published online:
19 April 2020

© 2016.

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • REFERENCES

  • 1 Pal R, Dahal S, Pal S. Prevalence of bronchial asthma in Indian children. Indian J Community Med 2009;34:310-6.
  • 2 Chhabra SK, Gupta CK, Chhabra P, Rajpal S. Prevalence of bronchial asthma in schoolchildren in Delhi. J Asthma 1998;35:291-6.
  • 3 Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention Updated. 2011. Available from: www.ginasthma.org. [Last accessed on 2015 Oct 09].
  • 4 Warke TJ, Fitch PS, Brown V, Taylor R, Lyons JD, Ennis M, et al. Outgrown asthma does not mean no airways inflammation. Eur Respir J 2002;19:284-7.
  • 5 Krawiec ME, Westcott JY, Chu HW, Balzar S, Trudeau JB, Schwartz LB, et al. Persistent wheezing in very young children is associated with lower respiratory inflammation. Am J Respir Crit Care Med 2001;163:1338-43.
  • 6 van den Toorn LM, Overbeek SE, de Jongste JC, Leman K, Hoogsteden HC, Prins JB. Airway inflammation is present during clinical remission of atopic asthma. Am J Respir Crit Care Med 2001;164:2107-13.
  • 7 Le Bourgeois M, Goncalves M, Le Clainche L, Benoist MR, Fournet JC, Scheinmann P, et al. Bronchoalveolar cells in children<3 years old with severe recurrent wheezing. Chest 2002;122:791-7.
  • 8 Pohunek P, Warner JO, Turzíková J, Kudrmann J, Roche WR. Markers of eosinophilic inflammation and tissue re-modelling in children before clinically diagnosed bronchial asthma. Pediatr Allergy Immunol 2005;16:43-51.
  • 9 Saglani S, Malmström K, Pelkonen AS, Malmberg LP, Lindahl H, Kajosaari M, et al. Airway remodeling and inflammation in symptomatic infants with reversible airflow obstruction. Am J Respir Crit Care Med 2005;171:722-7.
  • 10 Pizzichini E, Pizzichini MM, Efthimiadis A, Evans S, Morris MM, Squillace D, et al. Indices of airway inflammation in induced sputum: Reproducibility and validity of cell and fluid-phase measurements. Am J Respir Crit Care Med 1996;154 (2 Pt 1):308-17.
  • 11 Gibson PG, Girgis-Gabardo A, Morris MM, Mattoli S, Kay JM, Dolovich J, et al. Cellular characteristics of sputum from patients with asthma and chronic bronchitis. Thorax 1989;44:693-9.
  • 12 Pizzichini E, Pizzichini MM, Efthimiadis A, Dolovich J, Hargreave FE. Measuring airway inflammation in asthma: Eosinophils and eosinophilic cationic protein in induced sputum compared with peripheral blood. J Allergy Clin Immunol 1997;99:539-44.
  • 13 Green RH, Brightling CE, McKenna S, Hargadon B, Parker D, Bradding P, et al. Asthma exacerbations and sputum eosinophil counts: A randomised controlled trial. Lancet 2002;360:1715-21.
  • 14 Kim CK, Koh YY, Callaway Z. The validity of induced sputum and bronchoalveolar lavage in childhood asthma. J Asthma 2009;46:105-12.
  • 15 Saito J, Inoue K, Sugawara A, Yoshikawa M, Watanabe K, Ishida T, et al. Exhaled nitric oxide as a marker of airway inflammation for an epidemiologic study in schoolchildren. J Allergy Clin Immunol 2004;114:512-6.
  • 16 Dweik RA, Boggs PB, Erzurum SC, Irvin CG, Leigh MW, Lundberg JO, et al. An official ATS clinical practice guideline: Interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med 2011;184:602-15.
  • 17 Kharitonov SA, Yates D, Robbins RA, Logan-Sinclair R, Shinebourne EA, Barnes PJ. Increased nitric oxide in exhaled air of asthmatic patients. Lancet 1994;343:133-5.
  • 18 Lundberg JO, Nordvall SL, Weitzberg E, Kollberg H, Alving K. Exhaled nitric oxide in paediatric asthma and cystic fibrosis. Arch Dis Child 1996;75:323-6.
  • 19 Byrnes CA, Dinarevic S, Shinebourne EA, Barnes PJ, Bush A. Exhaled nitric oxide measurements in normal and asthmatic children. Pediatr Pulmonol 1997;24:312-8.
  • 20 Saleh D, Ernst P, Lim S, Barnes PJ, Giaid A. Increased formation of the potent oxidant peroxynitrite in the airways of asthmatic patients is associated with induction of nitric oxide synthase: Effect of inhaled glucocorticoid. FASEB J 1998;12:929-37.
  • 21 Hamid Q, Springall DR, Riveros-Moreno V, Chanez P, Howarth P, Redington A, et al. Induction of nitric oxide synthase in asthma. Lancet 1993;342:1510-3.
  • 22 Recabarren A, Apaza C, Castro-Rodríguez JA. Nitrites in induced sputum as a simple and cheap non-invasive marker of airway inflammation for asthmatic schoolchildren. Pediatr Allergy Immunol 2008;19:433-7.
  • 23 Gaston B, Drazen JM, Loscalzo J, Stamler JS. The biology of nitrogen oxides in the airways. Am J Respir Crit Care Med 1994;149 (2 Pt 1):538-51.
  • 24 Castro-Rodriguez JA, Molina RO, Cáceres M, Recabarren A. Correlation between nitrites in induced sputum and asthma symptoms in asthmatic schoolchildren. Pediatr Pulmonol 2014;49:214-20.
  • 25 From the Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA); 2006. Available from: http://www.ginasthma.org. [Last accessed on 2015 Oct 09].
  • 26 Kumar L, Rajput N, Majumdar S. Nitric oxide metabolites in induced sputum: A noninvasive marker of airway inflammation in asthma. Indian Pediatr 2005;42:329-37.
  • 27 Jain A, Malik A, Patra SK, Kumar V. Increased levels of nitric oxide metabolites in induced sputum and serum correlates with severity of bronchial asthma. Res J Pharm Biol Chem Sci 2011;02:830-6.
  • 28 Bacharier LB, Strunk RC, Mauger D, White D, Lemanske RF Jr, Sorkness CA. Classifying asthma severity in children: Mismatch between symptoms, medication use, and lung function. Am J Respir Crit Care Med 2004;170:426-32.
  • 29 From the Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma. (GINA); 2015. Available from: http://www.ginasthma.org. [Last accessed on 2015 Oct 09].
  • 30 Kharitonov SA, Chung KF, Evans D, O′Connor BJ, Barnes PJ. Increased exhaled nitric oxide in asthma is mainly derived from the lower respiratory tract. Am J Respir Crit Care Med 1996;153 (6 Pt 1):1773-80.
  • 31 Kanazawa H, Shoji S, Yamada M, Fujii T, Kawaguchi T, Kudoh S, et al. Increased levels of nitric oxide derivatives in induced sputum in patients with asthma. J Allergy Clin Immunol 1997;99:624-9.
  • 32 Jang AS, Choi IS, Lee S, Seo JP, Yang SW, Park KO, et al. Nitric oxide metabolites in induced sputum: A marker of airway inflammation in asthmatic subjects. Clin Exp Allergy 1999;29:1136-42.