Nitric Oxide in Monitoring Anti-inflammatory Therapy in Children with Mild Asthma
Authors:   I.M. Sechenov First Moscow State Medical University (Sechenov University) (a Federal Government Autonomous Educational Institution of Higher Education), Russian Federation Ministry of Health, Geppe N.A. ,   Moscow, Russian Federation, Glukhova M.V. ,   I.M. Sechenov First Moscow State Medical University (Sechenov University) (a Federal Government Autonomous Educational Institution of Higher Education), Russian Federation Ministry of Health; Moscow, Russian Federation, Kolosova N.G. ,   I.M. Sechenov First Moscow State Medical University (Sechenov University) (a Federal Government Autonomous Educational Institution of Higher Education), Russian Federation Ministry of Health; Moscow, Russian Federation, Soodaeva S.K. ,   Scientific Research Institute of Pulmonology at the Federal Medical and Biological Agency of the Russian Federation; Moscow, Russian Federation, Klimanov I.A. ,   Scientific Research Institute of Pulmonology at the Federal Medical and Biological Agency of the Russian Federation; Moscow, Russian Federation, Grebeneva Grebeneva I.V. ,   I.M. Sechenov First Moscow State Medical University (Sechenov University) (a Federal Government Autonomous Educational Institution of Higher Education), Russian Federation Ministry of Health; Moscow, Russian Federation
Published: January 2021

Study Objective: To evaluate the parameters of nitric oxide (FeNO) depending on the anti-inflammatory therapy in children with mild asthma, depending on disease control and FeNO dynamics following a 3-month therapy with leukotriene receptor antagonists (LTRA) and low doses of inhaled glucocorticosteroids (IGCS). Study Design: Prospective randomized controlled trial. Materials and Methods. 120 children aged 5-15 years (90 children with mild asthma, 30 healthy children) were examined. History, allergy status, spirometry and FeNO indicators, and the Asthma Control Questionnaire 5 were analysed. Study Results. At baseline, FeNO was increased in 56.6% of asthma patients. 86.2% were patients with partially controlled asthma and 13.8% had fully controlled disease. All controls had normal FeNO. Treatment group (90 children) was randomised into subgroups A and B (sealed code envelope method). Subgroup А included 50 children with mild asthma treated with LTRA for 3 months, while subgroup B comprised 40 patients with mild asthma who were prescribed low IGCS doses. At baseline, FeNO was increased in 70% of patients (n=28) treated with IGCS (38.4 ± 14.2 ppb), and in patents treated with LTRA, 40% (n=20) demonstrated significant increase in FeNO (42.83 ± 21.9 ppb, p < 0.05 vs. subgroups with elevated NO). After the 3-month therapy, FeNO was significantly lower in both subgroups: 76.6% in subgroup А and 66.6% in subgroup B had normalised values. Mean values in subgroup A decreased from 42.83 ppb to 11.9 ppb (р < 0.05), whereas in subgroup B, the decrease was from 38.4 ppb to 14.95 ppb (р < 0.05). FeNO decrease was more prominent in children treated with low doses of IGCS (р < 0.05). Persistently increased FeNO values in 33.4% of children resulting from mild inflammation show the need in continuous therapy with low doses of IGCS. Conclusion. FeNO examination is a modern non-invasive sensitive method to evaluate respiratory inflammations which improves diagnosis and monitoring of asthma therapy in children and is a reliable predictor of IGCS sensitivity. Keywords: bronchial asthma, nitric oxide, leukotriene receptor antagonists, inhaled glucocorticosteroids.