Low exhaled nitric oxide in school-age children with bronchopulmonary dysplasia and airflow limitation

Am J Respir Crit Care Med. 2005 Jan 1;171(1):68-72. doi: 10.1164/rccm.200403-298OC. Epub 2004 Oct 11.


Bronchopulmonary dysplasia (BPD), the chronic lung disease of prematurity, may be associated with long-term airflow limitation. Survivors of BPD may develop asthma-like symptoms in childhood, with a variable response to beta(2)-agonists. However, the pathologic pathways underlying these respiratory manifestations are still unknown. The aim of this study was to measure exhaled nitric oxide (FE(NO)) and lung function in a group of 31 school-age survivors of BPD. They showed variable degrees of airflow obstruction (mean FEV(1) 77.8 +/- 2.3% predicted) unresponsive to beta(2)-agonists in 72% of the subjects. Their FE(NO) values (geometric mean [95% confidence interval]: 7.7 [+/- 1.1] ppb) were significantly lower than in a group of healthy matched control subjects born at term (10.7 [+/- 1.1] ppb, p < 0.05) and a group of preterm children without BPD (9.9 [+/- 1.1] ppb, p < 0.05). The children with BPD were also compared with a group of 31 patients with asthma with a comparable airflow limitation (FEV(1) 80.2 +/- 2.1% predicted) and showed FE(NO) values four times lower than in those with asthma (24.9 [+/- 1.2] ppb, p < 0.001). In conclusion, unlike children with asthma, school-age survivors of BPD have airflow limitation associated with low FE(NO) values and lack of reversibility to beta(2)-agonists, probably as a result of mechanisms related to early life structural changes in the airways.

MeSH terms

  • Adrenergic beta-Agonists / therapeutic use
  • Asthma / physiopathology
  • Breath Tests*
  • Bronchopulmonary Dysplasia / immunology
  • Bronchopulmonary Dysplasia / metabolism
  • Bronchopulmonary Dysplasia / physiopathology*
  • Child
  • Female
  • Follow-Up Studies
  • Forced Expiratory Volume
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Intradermal Tests
  • Male
  • Maximal Midexpiratory Flow Rate
  • Nitric Oxide / analysis*
  • Pulmonary Ventilation* / drug effects
  • Respiratory Sounds
  • Spirometry
  • Vital Capacity


  • Adrenergic beta-Agonists
  • Nitric Oxide