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analyser machines. This thesis presents one researcher negotiating research in one area of
medicine -
which will be presented how it unfolded at the time and will be reviewed with the
up to date NO literature in the penultimate chapter.
In the chapter to follow, I will review what was known about NO and nitrogen dioxide (NOz)
in pollution where it was recognised to be a major component, and its effects at the population
level on respiratory disease. The study of pollution was where the machines were first
developed in order to analyse levels. The chapter will then describe the recognition of NO as a
physiological mediator and its key role in inflammation. Chapter 3 will review the actions and
interactions of NO as well as the NOS enzymes that produce this molecule in vivo. Chapter 4
will elaborate on the methods of measuring this short lived, reactive molecule. Chapter 5 will
discuss how the chemiluminescence analyser, the method of choice for the subsequent
experiments, could be modified to measure NO in exhaled air in humans using an analyser
developed for NO measurement in the environment. Chapter 6 is the corlmencement of the
research in normal, control adult subjects looking at the measurement of exhaled NO through
two different methods, either directly into the NO analyser which also allowed the
measurement of mouth pressure and COz, and through a t-piece system which enabled the
measurement of flow in addition to the other parameters. Chapter 7 describes the research
undertaken to see what technical aspects of measurement altered the NO levels obtained.
Chapter 8 describes the research as I measured exhaled NO in normal and then asthmatic
children. It briefly reviews the effect of age, atopy, the presence of pets or the presence of
smoking in the home on the NO obtained in a group of healthy pre-pubertal children. There is
a comparison of results from this control group to a group of asthmatics on bronchodilator
therapy only and a group of asthmatics who were on chronic inhaled corticosteroid therapy. A
small number of steroid naive asthmatics were measured before and after commencing
inhaled corticosteroids. Chapter 9 summarises what was learned about measurement of
exhaled NO from these studies and how that has contributed to the literature. This is followed
by a further review of the literature to the current time and the place of NO measurement as it
currently stands. Finally chapter l0 will present the final thoughts with regard to this research
project and 'where to from here'.
NB: Some of the work presented in this opening chapter formed the monograph for the
Asthma and Respiratory Foundation of New Zealand; (Anonymous 2006) in which I
contibuted two chapters and edited in conjunction with Professor Innes Asher. This was
presented to The Honorable Mr Peter Hodgeson, Minister of Health April 2006, and is
av ailabl e on tw o w eb s it e s : www. asthmanz. c o. nz o r www. p ae diat ric s. o r 8. nz.
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