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Note that ordcring o1'ncw NO gases cylinclcrs takcs 2 months t() sort out ancl arrive stl whct-l ttr a quarter 1-ull cortrtttcncc tl-tc order tor tl-tc ncxt cylinclcr' NB: Tlie calibration gascs usecl clr-rring thc tirnc ol'thc str,rclies wcrc 37 ppb. l03ppb' ll0ppb' 55ppb, ancl llSppl-, F-or an cxarrplc of calitrration on the chart rccorcl scc Figure 6.1. Figure 6.1: Recording of the calibrations for NO, CO2 and pressure analysers Pr6s3urc cqlibralion in 2 mmHg stepg The charl recording is read f rom right to left and the green tracing shows NO, the red tracing CO2 wtth the zero. ambient and calibrations for each. The blue tracing is for mouth pressure and this is shown as calibration in sets of 2mmHq. c'o. latibraion s.sz :I .l -t r: - Cal it-rration o1' thc capnograph: . Make surc thc r()lantctcr valvc is closccl. o Prcss the CAL button on the front o1'thc pancl. The punrp clctcrtltitlcs the sarupling ratc ol' thc CO: plobc. (Thc santpling rate can bc changcd by pressing thc Lrp and down ilrrow | 11 Details recorded : r ZarONO I .-r --- r--
keys but it is currently in the middle of the range suggested by the manufacturers, and used for all the early assessments). o Tnro calibration: connect the COz sampling probe to the NO/i.{z tubing (NO calibration gas) and press the CAL button to accept the zero calibration - mark on chart record - turn off the gas. o COz calibration gas one - connect the COz sampling probe to the COz calibration gas nozzle used and press CAL button to accept calibration - mark on the chart recorder - turn off the gas. o Barometric calibrations: Press the CAL button until the barometric pressure is displayed - press the up arrow to set the barometric pressure - the COz bobbin will fall for 3 seconds and then rise back up again and the current barometric pressure will be displayed - make a note on chart record. o Connect the sample port to the mouthpiece. o Press display on the front panel to obtain the end-tidal COz display. o Run the chart recorder to record both NO and COz baseline values noting the ambient levels (more important for the NO recordings) (see Figure 6.1). Calibration of the flow rotameter: o Tnro calibration: with the air supply turned off and the rotameter needle valve turned off - connect the air supply tubing to the bottom inlet of the rotameter - turn the air supply on - run the chart recorder and label the trace. o Calibration levels: open the valve until the rotameter bobbin moves and calibrate to l50mls/min, 22lmlslmin, 325mls/min, 40Omls/min, 500mls/min, 600mls/min, 700mls/min, 800mls/min, 900mls/min, 1000mls/min at each level run the chart recorder each time and note the calibration on the chart record - beyond this range the readings become less stable when repeated over time and therefore less likely to be accurate. o Leave the rotameter valve open - turn off the air supply, the bobbin will fall to zero releasing the pressure in the air line (see Figure 6.2). 134
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http://researchspace.auckland.ac.nz
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UNIVERSITV OF AUCKI'AND Abstract -
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There was no significant difference
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This is Dedicated: Dedication To th
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New Zealand The Paediatric Departme
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Contents Abstract ........tr Dedica
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6.5.4 The subjects............... .
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XIV
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List of Figures Figure l.l: Top l0
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List of Abbreviations ABPA allergic
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LADA N*N* dimethyl L-arginine LFA1
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t}ryem(eNoS)Typeltrendothelialnifti
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area, some of it has been expanded
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In addition, both of these groups a
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studies conducted throughout the Un
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Video clips of infants with a varie
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the Paediatric Society of New 7*ala
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inhaled anti-cholinergic agents and
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ecommended to monitor asthma at hom
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improvement to 70Vo PEF would have
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Furthermore, investigators have als
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poorer predictor of a diagnosis of
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Bronsky et al. 1998), and a long-te
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SIGN guideline (SIGN 2005) stated "
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In brief, the human airway can be d
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The ability to biopsy has led to st
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small proportion of cells recovered
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methodology of sputum induction and
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et al. 1999; Giannini, Di Franco et
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over a six month treatment prograrn
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There are other studies suggesting
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So is induced sputum in adults and
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asymptomatic patients independent o
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onchial hyper-responsiveness (Reich
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led to research which looked for le
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analyser machines. This thesis pres
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The pollution of the 'great smog of
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adults greater than 65 years (Ostro
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levels compared to those children l
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More recently 'Air Quality Indexes'
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acetylcholine. These were known to
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cyclase does not produce significan
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Garthwaite l99l), and the non adren
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significant complication, this trea
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locus for the enzyme is a susceptib
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NO synthesis and in so doing blocke
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3.1 Chapter 3: The synthesis, react
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BHa = tetrahyrobiopterin, FAD = fla
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(Knowles, McWeeny et al. 1974) and
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more potent at low oxygen tensions
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toxic products such as isoprostanes
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Figure 3.3: The nitric oxide syntha
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Page 107 and 108: The enzyme of this second pathway -
Page 109 and 110: inappropriate production from comme
Page 111 and 112: Nicotinamide adenosine dinucleotide
Page 113 and 114: enzyme and are competitively revers
Page 115 and 116: 4.1 Introduction Chapter 4: Methods
Page 117 and 118: 4.4 Nitrite and nitrate The measure
Page 119 and 120: insensitive (Braker and Mossman 197
Page 121 and 122: A group of instruments have been de
Page 123 and 124: The original group demonstrated tha
Page 125 and 126: equired it. For example, there was
Page 127 and 128: helium for 30 minutes to remove Oz.
Page 129 and 130: (Postlethwait and Bidani 1990; Post
Page 131 and 132: is set at 5ppm (AIHA 1966) based on
Page 133 and 134: 5.1 Chapter 5: Methodological asses
Page 135 and 136: wanted to compare the patterns of e
Page 137 and 138: in different colours that became th
Page 139 and 140: an advisor for this work and main s
Page 141 and 142: Delay time: the time between turnin
Page 143 and 144: led to an increased water content t
Page 145 and 146: Chapter 6: Methodological studies o
Page 147 and 148: pulmonary circulation appeared to c
Page 149 and 150: al found levels of 10.3ppb compared
Page 151 and 152: Authors and Pap€r Sublect numbers
Page 153 and 154: only those measured by mouth or low
Page 155: 6. Check that the pens work. Fill w
Page 159 and 160: Calibration pressures: the test por
Page 161 and 162: T-piece: tO The first figure shows
Page 163 and 164: the rotameter. Tracings of each par
Page 165 and 166: Figure 6.6: Mean exhaled NO levels
Page 167 and 168: NO and COz results from single exha
Page 169 and 170: 6.6.4 (iii) Comparison of exhaled n
Page 171 and 172: Figure 6.11b: COz levels at peak NO
Page 173 and 174: I also considered whether the diffe
Page 175 and 176: the direct to the indirect method l
Page 177 and 178: need for methodological experiments
Page 179 and 180: The exhalations were carried out in
Page 181 and 182: Figure 7.2: Example of the tracing
Page 183 and 184: 7.4.4 Results There was an increase
Page 185 and 186: Table 7.3: NO, COz and duration of
Page 187 and 188: The second set of exhalations invol
Page 189 and 190: Figure 7.6: Photographs of the chan
Page 191 and 192: Table 7.5: Exhaled NO results with
Page 193 and 194: the NO concentrations taken pre and
Page 195 and 196: Figure 7.10: Hyperbolic relationshi
Page 197 and 198: pressure over the likely range enco
Page 199 and 200: subjects with respiratory disease,
Page 201 and 202: 8.1 Chapter 8: Exhaled nitric oxide
Page 203 and 204: standard error of the mean (SEM), s
Page 205 and 206: T-piece sampling system to analyser
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Figure 8.2a: Comparison of peak exh
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if yes who? if yes who? if yes who?
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There are limitations with regard t
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significantly between research grou
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controls. Kharitinov et al reported
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direct method in asthmatic children
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Figure 8.4a: The eftect of commenci
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had last used her p2 agonist inhale
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higher level of exhaled NO at 4.9pp
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9.1 Introduction Chapter 9: Exhaled
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For the oral measurements options i
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Table 9.1: The recommended standard
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taken from the available literature
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compartment correlated with the ser
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measurement with variable expirator
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to settle. We may have been measuri
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9.5 Off-line measurement NO determi
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(Hyde, Geigel et al. 1997; Tsoukias
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9.6 Nasal nitric oxide measurement
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measured over two 24 hour periods,
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women who coincidently experienced
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While these cross-sectional and the
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symptoms. Steroid response was sign
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'difficult asthma' also had higher
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season and then reduced down to bas
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of cross sectional studies with a t
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Ciabattoni et al. 2004; Petersen, A
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FEV9.5, symptom score and airways r
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Indomethacin - This medication alte
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89Vo for PCD, and above that exclud
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This low NO occurs despite higher t
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patients were followed through one
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differences noted based on filter,
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9.L6 Nitric oxide levels in exercis
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another study of 111 school childre
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Almost all studies used sedation, w
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peak exhaled NO production in the f
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flow and to minimize nasal contamin
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ecruit blood vessels in the lung. S
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Chapter 10: Reflections The outcome
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and I enrolled 52 asthmatic childre
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Edwards EA, Douglas C, Broome S, Je
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o Cass Byrnes & Nicky Holt. "Drugs
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o Byrnes CA. Paediatric fibreoptic
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Appendix 2: Questionnaire for enrol
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Al-Ali, M. K. and P. H. Howarth (20
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Archer, S. L., P. J. Shultz, et al.
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Baraldi, E., N. M. Azzolin, et al.
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Belda, J., P. Hussack, et al. (2001
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Bongers, T. and B. R. ODriscoll (20
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Brown, G. C. and C. E. Cooper (1994
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Castro-Rodriguez, J. A., C. J. Holb
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Cockcroft, D. W., D. N. Killian, et
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de Blic, J., V. Marchac, et al. (20
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Donaldson, S. H., W. D. Bennett, et
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Emi-Miwa, M., A. Okitani, et al. (1
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Frey, U., J. Stocks, et al. (2000).
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Gershman, N. H., H. Liu, et al. (19
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Grasemann, H., E. Michler, et al. (
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Hashimoto, T., K. Minoguchi, et al.
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Holgate, S. T., D. E. Davies, et al
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Iriso, R., P. M. Mudido, et al. (20
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Jones, A. W., M. Fransson, et al. (
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Kercsmar, C. M. (2006). Wheezing in
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Kleinert, H., T. Wallerath, et al.
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Lamblin, C., P. Gosset, et al. (199
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Li, X. and J. W. Wilson (1997). "In
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Lymar, S. V. and J. K. Hurst (1996)
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Massaro, A. F., S. Mehta, et al. (1
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Miyabara, Y., R. Yanagisawa, et al.
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contribute to impaired endothelium-
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ODell, T. J., R. D. Hawkins, et al.
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Panza, J. A., C. E. Garcia, et al.
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Peters, S. P. (2006). "Safety of in
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Prieto, L., L. Bruno, et al. (2003)
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Ribbons, K. A., X. J. Zhang, et al.
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Sacco, O., R. Sale, et al. (2003).
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Sessa, W. C., K. Pritchard, et al.
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Silvestri, M., F. Sabatini, et al.
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Stamler, J. S. (1994). "Redox signa
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Stuehr, D. J., N. S. Kwon, et al. (
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Tierney, W. M., J. F. Roesner, et a
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Upchurch, G. R., G. N. Welch, et al
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Wadsworth, R., E. Stankevicius, et
Page 375 and 376:
Williams, O., R. Y. Bhat, et al. (2
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Yates, D. H., S. A. Kharitonov, et
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