Comparison of exhaled nitric oxide, serum eosinophilic cationic protein, and soluble interleukin-2 receptor in exacerbations of pediatric asthma

Pediatr Pulmonol. 1997 Nov;24(5):305-11. doi: 10.1002/(sici)1099-0496(199711)24:5<305::aid-ppul1>;2-h.


The hypotheses tested in this study were that during acute asthma exacerbations (1) exhaled nitric oxide concentrations [eNO] are a more sensitive, noninvasive indicator of asthma disease activity than serum markers of inflammation such as eosinophil cationic protein (ECP) or soluble interleukin 2 receptor (sIL2R), and (2) elevated [eNO] are reduced after treatment with glucocorticoids (GC). Peak eNO levels were measured by chemiluminescence during slow expiration. Seven asthmatic subjects (mean age 11 yrs; mean morning FEV1 65% predicted) receiving inhaled GC, and with no radiographic evidence of acute sinusitis, were studied before and after a course of oral GC. Measurements of [eNO], ECP and sIL2R levels, and FEV1% were obtained before and after a course of GC. Six atopic nonasthmatic subjects (mean age 12 years; mean FEV1 94% predicted) and seven normal subjects (mean age 13 years; mean FEV1 100% predicted) were studied. The mean peak [eNO] level (parts per billion: ppb) for the asthma subjects before treatment (52 +/- 5 ppb SEM) was greater than the value for both nonasthmatic atopic and normal subjects (16 +/- 2 ppb and 14 +/- 2 ppb SEM, respectively; P < 0.0001). There was no significant difference in ECP or sIL2R values between asthmatic subjects and either atopic or normal subjects (P > 0.05). Baseline pre-GC treatment ECP levels in the asthmatic subjects were significantly higher (P < 0.002) than post-GC treatment values. The mean peak [eNO] level in the asthmatic subjects declined after oral GC treatment to 14 +/- 1 ppb (P < 0.0002) and was less than 2 ppb different from either control group (P > 0.75). We conclude that [eNO] is a more sensitive marker of asthma disease activity than ECP and sIL2R levels. In addition, [eNO] appears to be a more useful indicator of the beneficial response to GC therapy than these other measurements in pediatric asthma.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease
  • Adolescent
  • Anti-Inflammatory Agents / therapeutic use
  • Asthma / blood
  • Asthma / drug therapy
  • Asthma / immunology*
  • Biomarkers
  • Blood Proteins / analysis
  • Blood Proteins / metabolism*
  • Breath Tests
  • Case-Control Studies
  • Child
  • Drug Monitoring
  • Eosinophil Granule Proteins
  • Female
  • Forced Expiratory Volume
  • Humans
  • Inflammation Mediators / blood*
  • Male
  • Nitric Oxide / analysis*
  • Receptors, Interleukin-2 / blood*
  • Ribonucleases*
  • Sensitivity and Specificity
  • Steroids


  • Anti-Inflammatory Agents
  • Biomarkers
  • Blood Proteins
  • Eosinophil Granule Proteins
  • Inflammation Mediators
  • Receptors, Interleukin-2
  • Steroids
  • Nitric Oxide
  • Ribonucleases