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2005). Exhaled NO showed strongly positive correlations to non-specific IgE and mite
specific IgE with weaker positive correlations to specific IgE to cat and cedar in 278 children
(Saito, Inoue et al. 2OO4). Finally in 374 school children high exhaled NO levels were
associated with pet sensitisation in atopic children, and respiratory infections and home
window pane condensation in non-atopic children rather than other factors (Janson, Kalm-
Stephens et al. 2005). In a hospital clinic setting in 45 children, there was a correlation
between eczema and exhaled NO but not asthma, allergic rhinitis, food allergY, the use of
inhaled corticosteroids, anti leukotriene therapy, antihistamine therapy or lung function
(Jentzsch, le Bourgeois et al. 2006).
Thus atopy alone is an important confounding factor when using exhaled NO to assess
asthmatic and healthy individuals.
9.8.8 Can nitric oxide be an outcome measure for assessing treatment?
9.8.8 (i) Corticosteroids
Similar to my own study, there have now been many publications confirming that levels of
exhaled NO is high in asthmatics on bronchodilator therapy only and is reduced in asthmatics
on steroid therapy often to the equivalent levels found in healthy controls using adult (Alving,
Weitzberg et al. 1993; Kharitonov, Yates et al. L994; Persson, Zetterstrom et al. 1994;
Kharitonov, Chung et al. 1996; Massaro, Mehta et al. 1996; al-Ali, Eames et al. 1998;
Stirling, Kharitonov et al. 1998; Berlyne, Parameswaran et al. 2000; Lim, Jatakanon et al.
2000; Tsujino, Nishimura et al. 2000; Reid, Johns et al. 2003; Shin, Rose-Gottron et al.2004)
and paediatric subjects (Byrnes, Dinarevic et al. L997; Nelson, Sears et al. 1997; Silvestri,
Spallarossa et al. 1999; Colon-Semidey, Marshik et al. 2000; Little, Chalmers et al. 2000;
Piacentini, Bodini et al. 2000; Silvestri, Spallarossa et al. 2000; Visser, de Wit et al. 2000;
Avital, Uwyyed et al. 2001). Many of these studies also determined that the raised exhaled
NO levels in asthmatics reduced when they were given inhaled or oral steroids from five days
to several weeks in adults (Silkoff, McClean et al. 1998; Jatakanon, Kharitonov et al. 1999;
Lim, Jatakanon et al. 1999; van Rensen, Straathof et al. 1999; Wilson and Lipworth 2000;
Silkoff, McClean et al. 2001; Jones, Herbison et al.20O2: Kharitonov, Donnelly et al. 2002;
Currie, Syme-Grant et al. 2003; Dal Negro, Micheletto et al. 2003; Tnidler, Kleerup et al.
2004; Brightling, Green et al. 2005; Silkoff 2005; Smith, Cowan et al. 2005; Zietkowski,
Bodzenta-Lukaszyk et al. 2006) and children (Byrnes, Dinarevic et al. 1997i Artlich, Busch et
al.1999;Lanz,I-eung et al. 1999; Colon-Semidey, Marshik et al. 2000; Piacentini, Bodini et
al. 2000; Spallarossa, Battistini et al. 2001; Beck-Ripp, Griese et al. 2002; Mondino,
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