Dr. Sami ŞAHAN, Dr. Arzu ERTÜRK, Doç. Dr. Nermin ÇAPAN, Doç. Dr Meral GÜLHAN, Dr. Cihangir ÇAYAN, Prof. Dr. Deniz ERBAŞ

BRONŞEKTAZİLİ HASTALARDA EKSHALE EDİLEN NİTRİK OKSİT ÖLÇÜMÜ

Anahtar Kelimeler:

Bronşektazi, nitrik oksit, ekshale nitrik oksit, ortam nitrik oksit

MEASUREMENT OF EXHALED NİTRİC OXİDE İN BRONCHİECTASİS PATİENTS

Exhaled nitric oxide (NO) may be a marker of disease activity in a variety of lung diseases. Exhaled NO has been found to be high in patients with asthma, chronic obstructive pulmonary disease, bronchiectasis and interstitial lung diseases. The aim of this study was to examine the levels of exhaled NO in stable bronchiectasis patients and compare to control subjects, and investigate whether the concentration of exhaled NO is related to the extent of disease as defined by HRCT(high resolution computed tomography), lung function tests and blood oxygen saturation. Twenty patients with presenting stable bronchiectasis in the Ataturk Chest Disease and Chest Surgery Center between January 2000 and April 2001 were included in this study. Exclusion criteria were history of atopy or allergy, history of asthma or other pulmonary and systemic disease, treatment with oral or inhaled glucocorticoids. The levels of exhaled NO was measured using a chemiluminescence NO analyser. The concentration of NO in ambient air was recorded before each test. The patients’ exhaled NO levels were compared with those of ten healthy control subjects. There was a significant correlation between exhaled NO levels (eNO) and ambient NO (aNO) levels in the patients and control group (patients eNO:24,7±18,9ppb aNO:36,1±42,4ppb p=0,001 r=0,70; control group eNO:88,9±85,8ppb aNO:148,8±131,5ppb p<0,0001 r=0,97). The exhaled NO levels in the patients were significantly lower (p<0.03) than those of the control group. This result was explained that ambient NO levels in the patients were significantly lower (p<0.01) than control group . On the other hand, there was no statistically significant correlation between HRCT score, FEV1 , oxygen saturation levels and eNO levels in the patients (p>0.05). In summary, the ambient NO influenced the exhaled NO levels, and we believe that exhaled NO levels did not reflect pulmonary NO production in this study. Therefore, interpretation about the levels of exhaled NO in bronchiectasis can not be made clearly with the present results. This study suggests that the standardization of techniques for measurement exhaled NO is very important

Keywords:

Bronchiectasis, nitric oxide, exhaled nitric oxide, ambient nitric oxide,

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Palmer RMJ, Ferrige AG, Moncada S. Nitric oxide release accounts for the biological activity of endotelium-derived relaxing factor. Nature 1987;327:524-6
Ignarro LJ, Buga GM, Wood KS, Byrns RE, Chaudhuri G. Endothelium derived relaxing factor produced and released from artery and vein is nitric oxide. Proc Natl Acad Sci USA 1987; 84:9265-9 Mizutani T, Layon AJ. Clinical applications of nitric oxide. Chest 1996; 110: 506-24
Hart CM. Nitric oxide in adult lung diseases. Chest 1999; 115: 1407-17
Gaston B, Drazen JM, Loscalzo J, Stamler JS. The biology of nitrogen oxides in the airways. Am J Respir Crit Care Med 1994;149:538-51
Barnes PJ, Belvisi MG. Nitric oxide and lung disease. Thorax 1993; 48(10):1034-43
Wang CH, Liu CY, Lin HC, Yu CT, Chung KF, Kuo HP. Increased exhaled nitric oxide in active
pulmonary tuberculosis due to inducible NO synthase upregulation in alveoler macrophages. Eur Respir J 1998; 11:809-15
Hamid Q, Springall DR, Riveros-Moreno V, Chanez P, Howarth P, Bousquet J, Godard P,
Holgate S, Polak JM. Induction of nitric oxide synthase in asthma. Lancet 1993; 342:1510-13
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
Payen D, Bernard C, Beloucif C. Nitric oxide in sepsis. Clin Chest Med 1996; 17: 333-50 Silkoff PE. The pathobiology of asthma: implicatıon s for treat m e n t ; no ni n v a s i v e m e a s u r m e n t airw a y infla m m a t i o n u si n g ex h al e d nitric oxid e an d ind u c e d s p ut u m . Clin C h e s t M e d 200 0; 21( 2 ): 34 5- 60
Corradi M, Majori M, Cacciani GC, Consigli GF, de’ Munari E, Pesci A. Increased exhaled nitric
oxide in patients with stable chronic obstructive pulmonary disease. Thorax 1999; 54:572-5
Fazac I, Kahan A, Menkes CJ, Dessanges JF, Dall’Ava-Santucci J, Dinh-Xuan AT. Increased nitric oxide in exhaled air in patients with systemic sclerosis. Clin Exp Rheumatol 1998;16:547- 52
Oğu z ü l g e n İK, T ürkt a ş H, L e v e n t E, Er b a ş D. Ak u t ast m a ata ğ ı n d a k i ha st al a r d a ek s h a l e nitrik ok s it ölç ü m ü . Tüberküloz ve Toraks Dergisi 1999;47(3):259-64
Türktaş H, Levent E, Oğu z ü l g e n İK, Er b a ş D. Effe ct s of inh al e d bu d e s o n i d e an d ne d o c r o m i l s o d i u m on ex h aled nitric oxide levels in mild asthmatic patients. Gazi Medical Journal 1998;9:167-71
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
Loukides S, Kharitonov SA, Wodehouse T,Cole PJ, Barnes PJ. Effect of L-arginine on
mucociliary function in primary ciliary dyskinesia. Lancet 1998; 352: 371-2
Paredi P, Kharitonov SA, Loukides S, Pantelidis P, du Boris RM, Barnes PJ. Exhaled nitric oxide is increased in active fibrosing alveolitis. Chest 1999; 115:1352-6
Haubitz M, Busch T, Gerlach M, Schöfer S, Brunkhorst R, Falker K, Koch KM, Gerlich H.
Exhaled nitric oxide in patients with Wegener’s granulomatosis. Eur Respir J 1999;14:113-7
Kharitonov SA, Wells AU, O’Connor BJ, Cole PJ, Hansell DM, Logan-Sinclair RB, Barnes PJ. Elevated levels of exhaled nitric oxide in bronchiectasis. Am J Respir Crit Care Med 1995; 151: 1889-93 Ho LP, Innes JA, Greening AP. Exhaled nitric oxide is not elevated in the inflammatory airways diseases of cystic fibrosis and bronchiectasis. Eur Respir J 1998;12: 1290-4
Kharitonov SA, Alving K, Barnes PJ. Exhaled and nasal nitric oxide measurements:
Recommendations. The European Respiratory Society Task Force . Eur Respir J 1997; 10:1683-93
American Thoracic Society American Lung Association. Recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide in adults and children. Am J Respir Crit Care Med 1999; 160: 2104-17
Lynch AD, Newell J, Hale V, Dyer D, Corkery K, Fox NL Gerend P, Fick R. Correlation of CT findings with clinical evaluations in 261 patients with symptomatic bronchiectasis. AJR 1999; 173: 53-58
Dillon WC, Hampl V, Shultz PJ, Rubins JB, Archer SL. Origins of breath nitric oxide in humans.
Chest 1996;110:930-8
Tsujıno I, Mı y a m o t o K, Nı s h ı m u r a M, S h i n a n o H, M a kita H, S ait o S, N a k a n o T, K a w a k a m i Y. Pr o d u c ti o n of nitric oxid e in intrath or a c i c airw a y s of nor m a l hu m a n s . A m J R e s p i r Crit C ar e M e d 19 9 6 ; 1 5 4 : 1 3 7 0 - 4 Lundberg JO, Farkas-Szallasi T, Weitzberg E, Rinder J, Lidholm J, Anggard A, Hokfelt T, Lundberg JM, Alving K. High nitric oxide production in human paranasal sinuses. Nature 1995;1 :370-3
Kimberly B, Nejadnik B, Giraud GD, Holden WE. Nasal contribution to exhaled nitric oxide at rest and during breathholding in humans. Am J Respir Crit Care Med 1996; 153: 829-36
Persson MG, Wiklund NP, Gustafsson. LE. Endogenous nitric oxide in single exhalations and the change during exercise. Am Rev Respir Dis 1993;148: 1210-4
Pıac e n ti ni G L , B o d i ni A, Vı n o L, Z o n a ll a L, C o s t e ll a S, Vic e n ti ni L, B o n e r A L . Influence of enviromental concentrations of nitric oxide on the exhaled nitric oxide test. Am J Respir Crit Care Med 1998; 158:1299-301
Robbins RA, Floreani AA, Von Essen SG, Sisson JH, Hill AE, Rubinstein I, Townley RG. Measurement of exhaled nitric oxide by three different techniques. Am J Respir Crit Care Med 1996; 153:1631-5
Silkoff PE, McClean PA, Slutsky AS, Furlott G, Hoffstein E, Wakita S, Chapman KR, Szalai JP,
Zamel N. Marked flow-dependence of exhaled nitric oxide using a new technique to exclude nasal nitric oxide. Am J Respir Crit Care Med 1997; 155:260-7
Corradi M, Pelizzoni A, Majori M, Cuomo A, Munari E, Pesci A. Influence of atmospheric nitric
oxide concentration on the measurement of nitric oxide in exhaled air. Thorax 1998; 53:673-6.
Sato K., Sakamaki T, Sumino H, Sakamoto H, Hoshino S, Masuda H, Sawada Y, Mochida M, Ohyama Y, Kurashina T, Nakamura T, Ona Z. Rate of nitric oxide release in the lung and factors influencing the concentration of exhaled nitric oxide. Am J Physiol 1996;270: 914-20
Rubinstein I, McClean PA, Boucher R, Zamel N, Fredberg JJ, Hoffstein V. Effect of mouthpiece, noseclips and head position on airway area measured by acoustic reflections. J Appl Physiol 1995 ; 63:1469-74
Kanazava H, Shoji S, Hirata K, Kurihara N, Yoshikava J. Role of endogenous nitric oxide in airflow obstruction in smokers. Chest 1996; 110:927-9
Robbins RA, Millatmal T, Lassi K, Rennard S, Daughton D. Smoking cessation is associated
with an increase in exhaled nitric oxide. Chest 1997; 112: 313-8