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ut those with CF did have significantly lower nasal NO levels (Balfour-Lynn, Laverty et al'
1996;Dotsch, Demirakca et al. 1996; Lundberg, Nordvall et al. 1996). However, three studies
in adult patients with CF showed lower NO levels from both the oral and nasal sampling
(Grasemann, Michler et al. 1997; Jones, Hegab et al. 2000; Thomas, Kharitonov et al' 2000)'
There has been no relationship demonstrated between the oral and nasal NO concentrations,
although one study demonstrated a positive correlation between ambient and measured NO
levels in all subject groups @otsch, Demirakca et al. 1996). In infants' one study showed
reduced levels of exhaled NO in five infants with CF compared to 1l healthy infant controls
at a mean age of 48.6 days (Elphick, Demoncheaux et al. 2001), but a more recent study
showed no difference in exhaled NO levels in 18 infants with CF and 23 healthy infants at a
mean age of 64.9 weeks (Franklin, Hall et al. 2006). Franklin's study also demonstrated an
inverse relationship between age and exhaled No levels in the CF but not the healthy infant
group (Franklin, Hall et al. 2006).
Studies of correlations of NO level to lung function have also been variable in the cF
population. No correlation was demonstrated with levels of either nasal or oral NO in three
studies with 135 subjects @otsch, Demirakca et al. 1996: Thomas, Kharitonov et al' 2000;
Jaffe, slade et al. 2003), while another two studies showed a weak but statistically significant
positive relationship with FEVr in 63 subjects (Grasemann, Michler et al. t997; Ho, Innes et
al. lggg). It should be noted that this is a different response than seen in asthmatics as the cF
patients with better lung function appeared to have higher exhaled NO levels. No association
was observed between the CF genotype and NO values (Thomas, Kharitonov et al' 2000;
Texereau, Fajac et al. 2005) but an inverse correlation between No and the transepithelial
baseline potential difference measured has been described (Texereau, Fajac et al. 2005)'
Whether infection and type of organism has had an effect on the exhaled No levels has also
been examined. There was no difference in nasal or exhaled NO levels in children chronically
infected with staphylococcal aureus (22 infected versus 11 non-infected) (Balfour-Lynn,
Laverty et al. 1996). Nasal NO was significantly lower in L7 of 33 who were chronically
infected with pseudomonas aeruginosa in one study (Balfour-Lynn, Laverty et al. 1996) but
not confirmed in two others with 49 of the 68 subjects who had been chronically infected
(Thomas, Kharitonov et al. 2000; Jaffe, Slade et al. 2003). Exhaled NO was lower in nine
patients considered high risk of developing allergic bronchopulmonary aspergillosis (ABPA)
compared to a low risk group (Lim, Chambers et al.2003) but, as the high risk patients were
on corticosteroids, this may reflect steroid use as opposed to ABPA risk per se'
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