Both allergic and nonallergic asthma are associated with increased FENO levels, but only in never-smokers

Authors

  • A. Malinovschi,

    1. Department of Medical Cell Biology: Integrative Physiology, Uppsala University, Uppsala, Sweden
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  • C. Janson,

    1. Asthma and Allergy Research Centre, Uppsala University, Uppsala, Sweden
    2. Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
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  • M. Högman,

    1. Department of Medical Cell Biology: Integrative Physiology, Uppsala University, Uppsala, Sweden
    2. Asthma and Allergy Research Centre, Uppsala University, Uppsala, Sweden
    3. Centre for Research and Development, Uppsala University/County Council of Gävleborg, Sweden
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  • G. Rolla,

    1. Department of Allergy and Clinical Immunology, University of Turin and Mauriziano Hospital, Turin, Italy
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  • K. Torén,

    1. Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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  • D. Norbäck,

    1. Asthma and Allergy Research Centre, Uppsala University, Uppsala, Sweden
    2. Department of Medical Sciences: Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
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  • A.-C. Olin

    1. Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Dr Andrei Malinovschi
Department of Medical Cell Biology: Integrative Physiology
Uppsala University
Box 571
SE-751 23 Uppsala
Sweden

Abstract

Background:  Allergic asthma is consistently associated with increased FENO levels whereas divergence exists regarding the use of exhaled nitric oxide (NO) as marker of inflammation in nonallergic asthma and in asthmatic smokers. The aim of this study is to analyze the effect of having allergic or nonallergic asthma on exhaled nitric oxide levels, with special regard to smoking history.

Methods:  Exhaled NO measurements were performed in 695 subjects from Turin (Italy), Gothenburg and Uppsala (both Sweden). Current asthma was defined as self-reported physician-diagnosed asthma with at least one asthma symptom or attack recorded during the last year. Allergic status was defined by using measurements of specific immunoglobulin E (IgE). Smoking history was questionnaire-assessed.

Results:  Allergic asthma was associated with 91 (60, 128) % [mean (95% CI)] increase of FENO while no significant association was found for nonallergic asthma [6 (–17, 35) %] in univariate analysis, when compared to nonatopic healthy subjects. In a multivariate analysis for never-smokers, subjects with allergic asthma had 77 (27, 145) % higher FENO levels than atopic healthy subjects while subjects with nonallergic asthma had 97 (46, 166) % higher FENO levels than nonatopic healthy subjects. No significant asthma-related FENO increases were noted for ex- and current smokers in multivariate analysis.

Conclusions:  Both allergic and nonallergic asthma are related to increased FENO levels, but only in never-smoking subjects. The limited value of FENO to detect subjects with asthma among ex- and current smokers suggests the predominance of a noneosinophilic inflammatory phenotype of asthma among ever-smokers.

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