Non-asthmatic patients show increased exhaled nitric oxide concentrations

Beatriz M Saraiva-Romanholo, Fabio S Machado, Francine M Almeida, Maria do Patrocínio T Nunes, Milton A Martins, Joaquim E Vieira, Beatriz M Saraiva-Romanholo, Fabio S Machado, Francine M Almeida, Maria do Patrocínio T Nunes, Milton A Martins, Joaquim E Vieira

Abstract

Objective: Evaluate whether exhaled nitric oxide may serve as a marker of intraoperative bronchospasm.

Introduction: Intraoperative bronchospasm remains a challenging event during anesthesia. Previous studies in asthmatic patients suggest that exhaled nitric oxide may represent a noninvasive measure of airway inflammation.

Methods: A total of 146,358 anesthesia information forms, which were received during the period from 1999 to 2004, were reviewed. Bronchospasm was registered on 863 forms. From those, three groups were identified: 9 non-asthmatic patients (Bronchospasm group), 12 asthmatics (Asthma group) and 10 subjects with no previous airway disease or symptoms (Control group). All subjects were submitted to exhaled nitric oxide measurements (parts/billion), spirometry and the induced sputum test. The data was compared by ANOVA followed by the Tukey test and Kruskal-Wallis followed by Dunn's test.

Results: The normal lung function test results for the Bronchospasm group were different from those of the asthma group (p <0.05). The median percentage of eosinophils in induced sputum was higher for the Asthma [2.46 (0.45-6.83)] compared with either the Bronchospasm [0.55 (0-1.26)] or the Control group [0.0 (0)] (p <0.05); exhaled nitric oxide followed a similar pattern for the Asthma [81.55 (57.6-86.85)], Bronchospasm [46.2 (42.0 -62.6] and Control group [18.7 (16.0-24.7)] (p< 0.05).

Conclusions: Non-asthmatic patients with intraoperative bronchospasm detected during anesthesia and endotracheal intubation showed increased expired nitric oxide.

Figures

Figure 1-
Figure 1-
Study design
Figure 2-
Figure 2-
Exhaled nitric oxide parts per billion (ENO ppb) measurements from healthy subjects (control) and subjects with history of bronchospasm in intraoperative period (Bronchospasm and Asthma). The boxplot shows the 25th, 50th and 75th percentiles, with the extreme bars representing the 10th and 90th percentiles. ENO (ppb) measure, *p = 0.001 compared with control and **p = 0.005 compared with control.

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