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Chapter 10: Reflections
The outcome of any serious research can only be to make two questions grow where
only one grew before. (Torstein Veblin 1857-1929)
By the time I had finished the research presented in this thesis, I felt that in attempting to
answer a few questions - about the exact nature of exhaled NO and what made a difference to
the levels obtained - I now had far more questions than when I began. It is hard to
comprehend the rapid explosion regarding NO from the first discovery of its physiological
role in 1987. Now the vital roles it occupies as a widespread mediator to maintain
homeostasis and in host defence seems to be a long-known fact. The Medline searches reveal
the rapid growth of research in this area in the 1990s and 2000s with studies conducted
involving every organ system in every conceivable subject population (see Figure 10.1).
When I started with the investigations presented in these chapters, very little was known about
its role. Having acknowledged this, the measurement of exhaled NO is still not part of routine
clinical practice and the exact use of this technology and its place in clinical medicine
continues to be investigated today. In the thesis I have not touched on the measures of gases
in exhaled breath condensate. This is an even more recent rapidly expanding area of research
worthy of its own chapters by those involved in investigating its use.
Figure 10.1: Medline publications with a focus on nitric oxide research per year 1980-2006
16000
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1980 1983 1986 1989 1992 199s 1998 2001 2004
When I first cornmenced research, it was as a means to an end. By the end of the 1990s, I
knew that I wanted to train as a paediatric respiratory specialist given the burden of disease
seen in children in the UK where I was currently working, and, perhaps more particularly, at
I
Years 1980-2006
262