RATIONALE: Exhaled nitric oxide (NO) is a well-known marker of established airway inflammation in asthma. Its role in the disease process before the onset of respiratory symptoms remains unclear. OBJECTIVES: To examine whether elevated NO in newborns with clinically naive airways is associated with subsequent respiratory symptoms in infancy. METHODS: We measured exhaled NO concentration and output after birth and prospectively assessed respiratory symptoms during infancy in a birth cohort of 164 unselected healthy neonates. We examined a possible association between NO and respiratory symptoms using Poisson regression analysis. RESULTS: In infants of atopic mothers, elevated NO levels after birth were associated with increased risk of subsequent respiratory symptoms (risk ratio [RR], 7.5; 95% confidence interval [CI], 1.7-32.4 for each nl/s increase in NO output; p = 0.007). Similarly, a positive association between NO and symptoms was seen in infants of smoking mothers (RR, 6.6; 95% CI, 2.3-19.3; p = 0.001), with the strongest association in infants whose mothers had both risk factors (RR, 21.8; 95% CI, 5.8-81.3; p < 0.001). CONCLUSIONS: The interaction of NO with maternal atopy and smoking on subsequent respiratory symptoms is present early in life. Clinically, noninvasive NO measurements in newborns may prove useful as a new means to identify high-risk infants. Future confirmation of a role for NO metabolism in the evolution of respiratory disease may provide an avenue for preventative strategies.
RATIONALE: Exhaled nitric oxide (NO) is a well-known marker of established airway inflammation in asthma. Its role in the disease process before the onset of respiratory symptoms remains unclear. OBJECTIVES: To examine whether elevated NO in newborns with clinically naive airways is associated with subsequent respiratory symptoms in infancy. METHODS: We measured exhaled NO concentration and output after birth and prospectively assessed respiratory symptoms during infancy in a birth cohort of 164 unselected healthy neonates. We examined a possible association between NO and respiratory symptoms using Poisson regression analysis. RESULTS: In infants of atopic mothers, elevated NO levels after birth were associated with increased risk of subsequent respiratory symptoms (risk ratio [RR], 7.5; 95% confidence interval [CI], 1.7-32.4 for each nl/s increase in NO output; p = 0.007). Similarly, a positive association between NO and symptoms was seen in infants of smoking mothers (RR, 6.6; 95% CI, 2.3-19.3; p = 0.001), with the strongest association in infants whose mothers had both risk factors (RR, 21.8; 95% CI, 5.8-81.3; p < 0.001). CONCLUSIONS: The interaction of NO with maternal atopy and smoking on subsequent respiratory symptoms is present early in life. Clinically, noninvasive NO measurements in newborns may prove useful as a new means to identify high-risk infants. Future confirmation of a role for NO metabolism in the evolution of respiratory disease may provide an avenue for preventative strategies.
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Authors: Jean Bousquet; James E Gern; Fernando D Martinez; Josep M Anto; Christine C Johnson; Patrick G Holt; Robert F Lemanske; Peter N Le Souëf; Robert S Tepper; Erika R M von Mutius; S Hasan Arshad; Leonard B Bacharier; Allan Becker; Kathleen Belanger; Anna Bergström; David I Bernstein; Michael D Cabana; Kecia N Carroll; Mario Castro; Philip J Cooper; Matthew W Gillman; Diane R Gold; John Henderson; Joachim Heinrich; Soo-Jong Hong; Daniel J Jackson; Thomas Keil; Anita L Kozyrskyj; Karin C Lødrup Carlsen; Rachel L Miller; Isabelle Momas; Wayne J Morgan; Patricia Noel; Dennis R Ownby; Mariona Pinart; Patrick H Ryan; Julie M Schwaninger; Malcolm R Sears; Angela Simpson; Henriette A Smit; Debra A Stern; Padmaja Subbarao; Rudolf Valenta; Xiaobin Wang; Scott T Weiss; Robert Wood; Anne L Wright; Rosalind J Wright; Alkis Togias; Peter J Gergen Journal: J Allergy Clin Immunol Date: 2014-03-15 Impact factor: 10.793