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Fractured Exhaled Nitric Oxide and Biologic Therapies for Paediatric Asthma

Peter Kunc

Peter Kunc

Clinic of Children Tuberculosis and Respiratory Diseases, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, and University Hospital Martin, National Institute of Pediatric Tuberculosis and Respiratory DiseasesSlovak Republic
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Kunc, Peter
, 
Jaroslav Fabry

Jaroslav Fabry

Clinic of Children Tuberculosis and Respiratory Diseases, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, and University Hospital Martin, National Institute of Pediatric Tuberculosis and Respiratory DiseasesSlovak Republic
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Fabry, Jaroslav
, 
Peter Ferenc

Peter Ferenc

Clinic of Children Tuberculosis and Respiratory Diseases, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, and University Hospital Martin, National Institute of Pediatric Tuberculosis and Respiratory DiseasesSlovak Republic
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Ferenc, Peter
, 
Zuzana Hribikova

Zuzana Hribikova

Clinic of Children Tuberculosis and Respiratory Diseases, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, and University Hospital Martin, National Institute of Pediatric Tuberculosis and Respiratory DiseasesSlovak Republic
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Hribikova, Zuzana
, 
Michaela Matiscakova

Michaela Matiscakova

Clinic of Children Tuberculosis and Respiratory Diseases, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, and University Hospital Martin, National Institute of Pediatric Tuberculosis and Respiratory DiseasesSlovak Republic
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Matiscakova, Michaela
 and 
Renata Pecova

Renata Pecova

  • Clinic of Children Tuberculosis and Respiratory Diseases, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, and University Hospital Martin, National Institute of Pediatric Tuberculosis and Respiratory DiseasesSlovak Republic
  • Department of Pathological Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in BratislavaMartin, Slovak Republic
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Pecova, Renata
  
Aug 20, 2023
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Published Online: Aug 20, 2023
Page range: 74 - 83
Received: Jun 28, 2023
Accepted: Jul 12, 2023
DOI: https://doi.org/10.2478/acm-2023-0011
Keywords
© 2023 Peter Kunc et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1

IL-13 as a central effector cytokine of the T2-mediated inflammatory process, created in Biorender.com, abbreviations: IL-25: interleukin 25, IL-33: interleukin 33, TSLP: thymic stromal lymphopoietin, ILC2: natural lymphoid cell type 2
IL-13 as a central effector cytokine of the T2-mediated inflammatory process, created in Biorender.com, abbreviations: IL-25: interleukin 25, IL-33: interleukin 33, TSLP: thymic stromal lymphopoietin, ILC2: natural lymphoid cell type 2

Fig. 2

Main pathways resulting in development of T2 type asthma and selected biologicals related to FENO, source: own elaboration, created in Biorender.com, abbreviations: IL-25: interleukin 25, IL-33: interleukin 33, TSLP: thymic stromal lymphopoietin, ILC2: natural lymphoid cell type 2, Th2: Th2 lymphocytes.
Main pathways resulting in development of T2 type asthma and selected biologicals related to FENO, source: own elaboration, created in Biorender.com, abbreviations: IL-25: interleukin 25, IL-33: interleukin 33, TSLP: thymic stromal lymphopoietin, ILC2: natural lymphoid cell type 2, Th2: Th2 lymphocytes.

Review article highlights

Highlights

FENO as asthma biomarker reflects the level of T2 eosinophil inflammation in the bronchial tree.

FENO is a non-invasive, easy-to-implement, repetitive measurable, and cost-effective biomarker.

FENO can be measured by exhalation into an analyser in young children aged 5 years.

Nitric oxide production in asthma inflamed airways is associated with the IL-13 signalling pathway.

FENO levels depend on various determinants and should be interpreted in the context of the patient's history and clinical symptoms.

FENO is helpful to recognise responders on corticosteroids and to follow the response and adherence to treatment.

FENO can be useful biomarker to predict therapeutic response and efficacy in reducing the risk of future asthma exacerbations in candidates for biologic therapy with Omalizumab, Mepolizumab, Dupilumab and Tezepelumab.

Various factors affecting FENO levels

FENO levels increase with: FENO levels decrease with:
Allergic rhinitis Early allergic reactions
Atopic dermatitis Bronchoconstriction
White race Corticosteroids (oral and/or inhaled)
Intake of a nitrate-rich diet Passive and active smoking
Acute infection Obesity
Morning (diurnal variation) Reduced age in children
Male sex
Caffeine
Alcohol
Language:
English
Publication timeframe:
3 times per year
Journal Subjects:
Medicine, Clinical Medicine, Internal Medicine, Cardiology
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