Measurement of exhaled nitric oxide in children with asthmatic crisis. Systematic review

Abstract

Introduction: The frequency and intensity of symptoms in asthma are related to the degree of inflammation and bronchial obstruc- tion. Nitric oxide is a free radical produced at the endothelial cells of the bronchial wall as an intrinsic part of the inflammatory process. The exhaled nitric oxide fraction (ENOF) is a marker that evaluates bronchial inflammation and it is presumed that will also assess the initial response to treatment, decision making in terms of hospital discharge and ambulatory monitoring of children with asthmatic crises. Material and methods: Systematic review of every publication that explore the validity of ENOF for the diagnosis of bronchial inflam- mation and response to treatment in asthmatic children. Results: Three of the publications reviewed are designed as diagnostic tests. Two of them recommend the use of ENOF to detect bronchial hyper-responsiveness. One cohort recommends ENOF as a diagnostic tool in suspected asthma; another one suggests its use to assess the severity of asthma; another one points that the ENOF is useful to detect relapses. A controlled clinical trial does not recommend the routine use of ENOF as a predictor of relapse. Discussion: No study has been done to assess the usefulness of the ENOF in children with asthma exacerbation. In regard to ambulatory control, new publications require a higher level of evidence with excellent results to encourage pediatricians to include the measurement of ENOF in the optimal follow-up of asthmatic children.

Keywords

• Crisis asmática
• francción exhalada de óxico nítrico
• respuesta al tratamiento
• control ambulatorio