Exhaled Nitric Oxide and Airway Caliber in Children With Asthma

Atlantic Health System20 enrolled

Overview

The purpose of this study is to assess if in steroid naïve asthmatic children with elevated baseline exhaled nitric oxide, treatment with inhaled steroid and normalization of exhaled nitric oxide level results in restoration of the bronchodilator response to deep inhalation.

Previous studies have shown that a deep inhalation (DI) would increase airway caliber in normal subjects. Whereas in asthmatics with spontaneous bronchoconstriction (obstruction of the airway), DI was shown to worsen airway obstruction. The mechanism for this variability in response to DI is not well-understood, but seems to be a key in understanding the pathophysiology of the disease, and possibly in the development of an effective therapy. Air way inflammation resulting in airway wall thickening and peribronchial edema is thought to play a role how the airway responds to deep inhalation. This study assess if reduction in airway inflammation (as measured by level of exhaled NO)results in optimization of the bronchodilator response to deep inhalation

Study Type

OBSERVATIONAL

Enrollment

Conditions

Asthma in Children

Eligibility

Sex: ALLMin age: 6 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age: \> 6 years at age of screening. * Physician diagnosed asthma * Elevated exhaled NO at initial evaluation (\>25ppb) * Be able to reproducibly perform DI maneuvers and all other pulmonary function testing * Be clinically stable for at least 2 weeks prior to screening with no evidence of acute upper or lower respiratory infection or current pulmonary exacerbation. * Has not been on inhaled or oral steroid for at least 4 weeks prior to enrollment in the study. * Parent/child willingness to enroll in the study and provide written informed consent. * Be able to present for the required study visits. Exclusion Criteria: * Chest wall or spinal column deformity; known cardiac, neuromuscular, or other chronic diseases * Use of beta agonist, theophylline, leukotriene receptor antagonists, or caffeine-containing soft drinks 12 hr prior to the study. * Use of inhaled steroid in the past 4 weeks. * Respiratory infection or asthma exacerbation in the previous 2 weeks

Locations (1)

Goryeb Children's Hospital, Atlantic Health

Morristown, New Jersey, United States

Outcomes

Primary Outcomes

Change in M/P40 ratio from baseline at 4 weeks of treatment with inhaled steroid

M/P40 ratio is defined as the ratio of flow at 40% of FVC (forced vital capacity) on the flow-volume curve after maximal inspiration to flow at 40% of FVC on the flow-volume curve after partial (60%-70% of FVC) inspiration (M/P40 ratio)

Time frame: at baseline and 4 weeks later

Secondary Outcomes

Change in Ratio of post DI to pre DI airway resistance from baseline at 4 weeks of treatment with inhaled steroid

Post-DI to pre-DI airway resistance at 5 Hz (R5) ratio (as measured by impulse oscillometry) from baseline (elevated exhaled NO) to 4-6 weeks of treatment.

Time frame: at baseline and 4 weeks later

Data from ClinicalTrials.gov

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