Science a GoGo's Home Page Forums General Discussion General Science Discussion Forum Clinical utility of Exhaled Nitric Oxide

Exhaled nitric oxide has been studied since 1991 and several studies have shown it to be powerful tool in management of asthma. The American Thoracic Society (ATS) and European Respiratory Society (ERS) have jointly published guidelines for the standardized measurement of eNO.1 Recent asthma guidelines (NHLBI) indicate the positive role of inflammation measurements, of which eNO is the most clinically viable.

The clinical utility of measuring eNO include:

1. Selecting and Titrating Medication

Exhaled nitric oxide has been shown to predict the likelihood of a steroid response more consistently than spirometry or bronchodilator response.2 Use of eNO to direct inhaled steroid therapy was shown to reduce dosage while maintaining asthma control.3

2. Monitoring Compliance

An elevated eNO is suggestive of inadequate anti-inflammatory therapy – either from an insufficient dose or due to patient non-compliance.4 Reduction of exhaled NO levels after the start of therapy can reassure a physician that the treatment regime is being followed, and can demonstrate to the patient the physiological change that the therapy could achieve if properly followed.5

3. Predicting Exacerbation and Loss of Control

The ability to predict a worsening of symptoms is the most exciting clinical application of eNO measurement. Exhaled nitric oxide is a better predictor over FEV1 of both asthma control, loss of control and worsening of asthma.6 Elevated eNO measured at a clinic visit indicates increased risk of an exacerbation occurring within the next two weeks.7 Pediatric studies have found that an eNO level above 47 ppb predicts loss of control when inhaled steroids are reduced or withdrawn.8 A rise in eNO among patients who cease steroid therapy is predictive of an upcoming relapse.9 A home monitoring study showed that frequent eNO measurements may have predictive power for impending instability of asthma.10,11

I can't decide if this is spam or not. It seems to be a regurgitation of manufacturer's spiel pushing testing of Nitric Oxide. Anyone else have any comments?

Possibly not spam, but seems a waste of the poster's time. It doesn't invite discussion so, unless I'm proved wrong, the thread's dead in the water.

Hi Amaranth,

It's not a spam. I am researching on asthma and I came to know that exhaled nitric oxide is increased in patients with untreated asthma and decreases with corticosteroid treatment. Exhaled nitric oxide also generally correlates with eosinophilic inflammation in asthmatic patients.I thought of sharing this information with everyone so that it will be helpful for patients suffering from asthma.

Nitric Oxide, here's a report of related research on asthma and other allergic diseases. I expect you know about it, but it might be of general interest as an example of the random, hit-and-miss mutations of Darwinian evolution - this one apparently a miss rather than a hit:

http://www.medicalnewstoday.com/articles/157040.php
"A study just published on bmj.com concludes that the defects in a particular gene known as the filaggrin gene are linked to a considerably amplified risk of developing allergic disorders such as eczema, rhinitis, and asthma..." - 10 Jul 2009

Actually, the news is not that new. This from April 2007:

http://www.nature.com/ng/journal/v39/n5/abs/ng2020.html
"We recently reported two common filaggrin (FLG) null mutations that cause ichthyosis vulgaris1 and predispose to eczema and secondary allergic diseases..." - 8 April 2007

Hey redewenur,

Thank you so much for that links. It was really helpful.In recent research they found that using Exhaled nitric oxide is an effective way to monitor asthma. I have come across medical journals, which states that Measuring Nitric Oxide (NO) from the breath (during exhalation) has proven to be a useful tool for some asthma specialists in the U.S. and other parts of the world.

Do we have any device that measures exhaled nitric oxide?
Can you help me with this?

"Since 1991, however, measurement of in vivo NO production in humans have been proven to be technically feasible by means of ex vivo manoeuvres, i.e. by sampling the exhaled breath and analysing it for NO content using a chemiluminescent NO analyser"

http://www.erj.ersjournals.com/cgi/reprint/12/5/1005.pdf

Chemiluminescence is what makes the glow worm glow, but in that case it's called bioluminescence.

Hey redewenur,

Thanks for your swift reply. That link was really excellent. It explains very clearly about the function of Nitric Oxide and how it's used to monitor airway inflammation. But I'm not very clear about the device "chemiluminescent NO analyser". This device can be used by consumers to measure Nitric oxide or it can be used only by physicians.Do we have any other device to monitor nitric oxide? I am researching on the same. Anybody has any information on this?

This might be of some help.

Here's a device used in medical research:

http://hs.environmental-expert.com/STSE_...idproduct=19023

And here's some info on how these gadgets work:

http://www.brandgaus.com/NOxAnalyzerTechnology.htm

Hi, I am new here and i came across this topic on this forum. I am asthma patient, and i would like to get more information on asthma and everything related to asthma. I too would like to share whatever information i get about asthma.

Hey redewenur,

Thank you so much for the links. I have gone through the links and it's quiet interesting. I was researching on medical devices recently which measures exhaled nitric oxide and I came across a device called "Insight eNO system". The Insight eNO System measures exhaled nitric oxide and provides accurate measurement of patients airway inflammation. Any idea about this device?

Hey Marcus,

Welcome to the Forum.

Hi There,
Thank You for the welcome nitric oxide.

Like i said in my earlier post, that i will share whatever information i get on asthma, i will share it. This is one link i found on the internet the other day. Just have a look at it

http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=22583?p=p2

nitric

- Local internet connections are almost unusable right now - fibre-optic problems, I'm told. Just managed to get this page open to let you know that you're not being ignored.

---
Marcus

- Hope to get a peek at your linked page when my connection permits.

---
Whilst assuming that certain products are NOT being promoted in this thread, I would like to make an observation:

In the medical industry the hard-sell tends to be avoided in favour of an appeal to educated scientific reason - which is fine, except that the reasoning is sometimes heavily profit-biased, resulting in the sale of products that are either extortionately expensive, entirely unnecessary, or both. Although I'm not passing personal judgement on specific hardware, neither would I recommend any product solely on the basis of the manufacturer's blurb.

Hey redewenur,

Thanks for your reply.I have been diagnosed with asthma recently, and i am scared and confused. The doctors told me that asthma is a disease that cannot be cured. The doctors also told me that there is cure to control the asthma attacks. What i want to know is how useful are these devices which say that they can help in controlling asthma? This is such an useful topic I felt like discussing with you because it can be helpful for people like me suffering from asthma.

nitric

Sorry that you're afflicted with this condition. Naturally, you're concerned to receive the most effective treatment. How useful any device is depends, at least in part, upon the individual. Of course, you can do no better than consult a specialist - taking into account allergens, atopy, general health, stress/anxiety, precipitating ailments and so on, they would also be in the best position to advise you regarding treatment options. As you're no doubt aware, a common starting point is a bronchodilator nebuliser (Ventolin/albuterol/salbutamol). That's all that many people need.

Marcus, your link is bad. Do you have another?

Hi Amarnath,

I apologize for the link not working. i have another one

http://www.webmd.com/asthma/guide/asthma-attack/p=p2

I hope this works.

Hey redewenur,

Thanks for the info. I am already on Ventolin now. But according to my view,the devices such as "Insight eNO" detects the amount of nitric oxide molecules present in asthma patients.Based on the amount of nitric oxide present in patients doctors can make clinical decisions more confidently. By continuous monitoring of patients eNO levels,doctors can tune their medication accordingly which helps them to bring their asthma in control. Let me know if I am wrong any where. So I feel that if we have such devices at home, we can monitor our asthma levels regularly and improve the effectiveness of our therapy for asthma.

Is there verifiable statistical data to support the contention that having these devices at home would provide a significant benefit?

Sure, it sounds like a good idea. But is it? Even supposing that treatment can be more effective, how severe does the asthma have to be to justify the cost. For that matter, what is the cost?

Marcus, I still got a 404 "not found" error. Do you have any other links that might prove fruitful?

HI

I too have heard about this device called " Insight eNo". The other day i had gone to the hospital for a check up. There was another patient who was using this device. He said he found this device to be helpful. But that's just what he says. I don't know though.

Hey redewenur,

Thanks for your reply. I researched on the devices which is used to measure exhaled nitric oxide and came to know that the device "Insight eNO system" is cleared by the FDA for use in the physician’s office only. Currently, there are no devices in the US approved for home-use to monitor exhaled nitric oxide. Apieron, Inc. a medical device company markets this device(Insight eNO) to doctors offices.

I came across so many articles and excerpts which states that Exhaled Nitric Oxide( eNO) levels are high in untreated asthma. But after anti-inflammatory medications (e.g. inhaled steroids), eNO levels fall rapidly, indicating reduction of airway inflammation.With eNO measurements, physicians can monitor inflammation on a regular basis. By adding accurate eNO measurements to the current ways in which asthma is monitored, physicians can develop a new level of understanding of their patient’s physiology and disease progression.

Hi,

Here is another link on asthma

http://www.find-health-articles.com/rec_...-management.htm

I hope this one works. Sorry again

Got it this time. Thanks for persevering.

Hey Marcus,

Check this link.

http://www.nationaljewish.org/programs/t...tric-oxide.aspx

Hey, Thanks for the link.

I had gone to the hospital the yesterday. I saw this new asthma device in the doctor's room.

Hey Marcus,

Great. How'z the new device? Did you take a look at it? How is it used to monitor asthma?

Hi Nitirc oxide,

The device that i spoke about is a device called Insight eNo. The doctor told me that it is useful to control asthma. The doctor also said that it is FDA Approved.

Hey there,

I came across this link the other day on the internet. It talks about different tests being conducted for diagnosing asthma. I found it to be very useful.

http://princewilliam2.discoveryhospital.com/centers/3.xml

Hey Marcus,

Even I researched on the same and came to know that the device "Insight eNO" has been approved by FDA for use in the physician’s office only. Currently, there are no devices in the US approved for home-use to monitor exhaled nitric oxide.

Check this link. Daily telemonitoring of exhaled nitric oxide and symptoms in the treatment of childhood asthma.

http://www.ncbi.nlm.nih.gov/pubmed/18931330

Thanks marcus,

I had gone to the hospital for a check. My asthma flared up again. I don't what has caused it to flare up. The doctor has taken some tests. Just waiting to see what he says.

The doctor gave me the results of my asthma tests. It turns out that my asthma is caused by some kind of allergy. What allergy causes my asthma to go up is still unknown. That is up to me now to find out what is causing the flare up of my asthma.

Hey Marcus,

According to the National Institute for Allergy and Infectious Diseases, the American Academy of Allergy, Asthma, and Immunology, and other organizations, triggers for asthma include the following:

Allergens

* pollen
* mold
* animal protein (dander, urine, oil from skin)
* house dust/dust mites
* cockroaches
* certain foods

Irritants

* strong odors and sprays, such as perfumes, household cleaners, cooking fumes, paints, and varnishes
* chemicals such as coal, chalk dust, or talcum powder
* air pollutants
* changing weather conditions, including changes in temperature, barometric pressure, humidity, and strong winds
* Chemical-exposure on the job, such as occupational vapors, dust, gases, or fumes.

Smoke

*Tobacco smoke, whether directly or passively inhaled, has been shown to worsen asthma.

*Wood smoke from wood-burning heating stoves and fireplaces can release irritating chemicals such as sulfur dioxide.
Reply to Post

Hope it helps you.

When it comes to medical science I write as a layman. However, I have a personal interest in the topic because, my daughter--I tell the full story of her recovery in the NotQuiteScience forum--was diagnosed with a deadly asthma-like lung condition, triggered by allergies, when she was 7.5 yrs. old. She had pneumonia fives times in a row in the winter of 1963/64. "Her lungs are so weak and scarred, one more bout could kill her" the specialists warned." Drugs and anti-allergy needles were of little help.

I also have a granddaughter--now 20 and healthy--who had many serious bouts, and rushes to the hospital, with asthma.

My daughter is now 53, healthy, a vegetarian and living as an artist with her artist husband on a floating house and gardens (they grow all the vegetables they need.
http://www.youtube.com/watch?v=DDqbfiejLdM
Her husband eats some fish--available for the catching.)

Oddly enough, What helped both my daughter and grand daughter overcome their conditions was the application of hypnosis. It seems it triggered their immune systems and they got well. After one session, my daughter was never bedridden again. It took a little longer with my granddaughter. Having studied the process, with the approval of the family doctor--who admitted he knew little about it--I did the therapy, which I now call pneumatherapy--the spiritual application of hypnotic technique.

Keep in mind that I am not anti medicine, or anti science, but my experience over the years, and not just with my own family, prompts me to ask:
Have we put too much faith in somatic (physical) therapies?
Are there not good reasons to explore the causes and treatment of psychosomatic diseases--ones caused by stressful circumstances, and/or by the controller type of people outside ourselves?

And what about what I call pneuma-psychosomatic diseases--ones, for whatever reasons, we bring on ourselves?
=====================
A google search on HYPNOSIS AND RELIGION brings up numerous items. Among them:
http://www.durbinhypnosis.com/hypnosisreligion.htm

Dear Revlgking,

I can understand how you must have felt as a parent to see your child in so much pain. But on the other hand it's good to know that she is now healthy. But does hypnosis technique really work? Being an asthmatic patient myself, i have been on medication for quite sometime, and i have found some amount of relief through them.

Hey Revlgking,

Very excited to read your post. I am hearing for the first time that hypnosis technique helps to manage asthma. I am an asthma patient and I have been on several medicines to bring my asthma in control. But great to hear that both your daughter and grand daughter are doing well now after the application of hypnosis.
Can you explain more about this?

Nitric Oxide and Marcus,
Take a look at the following:

Hypnosis and asthma: a critical review.


http://www.ncbi.nlm.nih.gov/pubmed/10724294
============================================
Also, check out:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1912142
============================================
PNEUMATOLOGY
=======================
In my opinion, hypnotic technique--or what I call pneumatherapy--falls under the general category of pneumatology, which preceded and is the mother of psychology. Therefore, it should be recognized for what it is: the science of the human spirit (pneuma).

HISTORY OF HYPNOSIS
====================
HISTORY OF HYPNOSIS
====================
The human ability to go in and out of the trance state has been part of our human nature since the dawn of consciousness. The trance phenomenon can be found in all forms of worship and the rituals of religion. Also, great artists and inventors in science have all made, and still make, use of this phenomenon.

The modern word 'hypnosis' was not invented until 1843. The inventor was Dr. James Braid, a Scottish physician and surgeon practicing in Manchester, England, who later admitted that it was actually a misnomer.

He then tried, and failed, to get people to call it "monoideism"--the ability to keep ones mind focused on one idea, as if in a trance.

Because of his interest in science, he coined the word--based on 'hypnos', the Greek for sleep, to get it away from its association with superstition and magic.

I have been a student of hypnosis since the late 1940's when I did some undergraduate studies in psychology.

Because I believe the ability to use and benefit from the trance state is rooted in who we are, spiritually (pneumatologically), I prefer to call what I do 'pneumatherapy'.

The following is good information about what it is, and is not.

http://www.danielolson.com/hypnosis/hypnosis_history.html

Perhaps--if the moderators agree that psychology is a science, and hypnosis/pneumatherapy is a technology--we need a separate thread for this information. I will be glad to help.

Hmmm......

The post looks interesting.

Hey Revlgking,

Great posts. Sounds interesting. Thank you so much for sharing such an interesting piece of information.

Hey guys

I found another link on the internet. Just have a look.

http://www.articlealley.com/article_963413_17.html

When I approach the universe as if it is a friendly quantum computer I find that I get a friendly response and answers. So can anyone, with the will to love--to will GOOD. That is, be at one with G0D. Note: I use an acronym. The concept is too awesome to be contained in a noun--gods or God. God is dead, long live G0D-the eternal Now.
===============================
Have you heard of Professor Seth Lloyd, MITT?
http://en.wikipedia.org/wiki/Seth_Lloyd
PROGRAMMING THE UNIVERSE
http://www.randomhouse.com/kvpa/lloyd/index.html

============================
He writes about The Universe As a Quantum Computer

http://books.google.ca/books?id=vN8TAAAA...lt&resnum=8

The conclusion is good news:

"With the use of FeNO [Exhaled NO] measurements, maintenance doses of inhaled corticosteroids may be significantly reduced without compromising asthma control"

The article was 'part 1'. Presumably there's a part 2. Might be worth subscribing to the RSS feed.

That's an appealing analogy, Rev. If you smile at the universe, it will smile back.

And if the solution one needs is a somatic one, one will be led to find it. The same if true is the need happens to be mental, or spiritual--psychological, or pneumatological.

I like the saying: Don't curse the darkness; light a candle.
And God (G0D) said, "Let there be light!" Genesis 1:3.

Thanks redewenur,

I'm glad you liked the article. I am doing more research, and will post more information

Hey Marcus,

That link was quiet Interesting. I was researching on Exhaled Nitric Oxide and came across the link below. Just take a look.

http://asthma.about.com/b/2009/07/07/exhaled-nitric-oxide-monitoring-for-asthma.htm

Hey Nitric,

Thanks for the link, found it interesting.

Hey guys
Here is another link i found the internet. Have a look at it.

http://asthmaeno.livejournal.com/

Hey All,

Check this Blog.Found on Internet.

http://exhalednitricoxide.blogspot.com/

The Insight eNO System has been available for use in the physician’s office since March 2008. The system uses a proprietary biosensor technology to measure exhaled nitric oxide, a well established indicator of asthma severity and steroid responsive airway inflammation. Measuring eNO and determining the level of airway inflammation can help clinicians more closely manage their patients’ inflammatory condition and therefore more precisely titrate medications, which can lead to fewer exacerbations.

Hey saurabh,

Thanks for the information.

Hey Saurabh,

Thanks for the info. It looks as though one of the bluecross companies has approved Exhaled Nitric Oxide Test as a valid medical procedure. While I cannot say for sure, I imagine others will soon follow. Check the link below I found on the web.

http://www.1888pressrelease.com/carefirs...-pr-137450.html

Hey nitric,

Thanks for the link. It looks like CareFirst's coverage might be of big help.

Hey Marcus,

You are right. Managing Asthma has become easier for people covered under policies introduced by CareFirst BCBS.

Thanks nitric,

I'm still searching for more information on this. If its really good, it will be of big help.

Hey Marcus,

I came across one more link regarding this.

http://asthma.about.com/b/2009/08/22/car...y-necessary.htm

Thanks for the link nitric,

I had gone to the hospital yesterday.

Hey Marcus,

What did the doctor said about your asthma? Did he do any tests?

Marcus, sure there is a physical component, which needs to addressed, but what I would like to know is: what do medical doctors say about other underlying causes of asthma--that is, the psychological and pneumatological ones (mental and spiritual)--not just the somatic or physical ones?

BTW, it is my opinion that many other life-threatening conditions, including cancer and cardiovascular ones also have other than a somatic component.

Hey Revlgking,

According to National Jewish Medical and Research Center,the psychological environment of the child may play a role in the development of asthma.Children in the study whose parents coped poorly with the demands of parenting were more than twice as likely to develop asthma by the time they were 6 to 8 years old than were children whose parents did "okay."

http://www.scienceblog.com/community/older/2001/C/200113312.html

Nitric O, your posts prompt the question: How much pain and suffering do we human beings need to suffer before we awaken to the fact as to who we really are? We are far more than mechanical puppets dancing on the strings of heredity and environment beyond our personal control.

To learn more, check out what I write about on my site: www.flfcanada.com

Hey nitirc,

I found a link the other the day. It has a lot of articles on Exhaled nitric oxide and asthma. Just have a look at it.

http://asthmaeno.livejournal.com/

Hey Marcus,

Thanks for the link, found it interesting and helpful. I found one more link relating to the same. Take a look at it.

http://www.medhelp.org/user_journals/show/116970

Hi, thanks for the links!! It was very informative since I'm studying the effects of asthma on children.


People Search

Hey nitric,

Thanks for the link. Found it to be useful.

Hi Sandravic,

I'm glad you found the links informative. I am doing more research and will post more information.

hey everyone,
check out this link

http://www.apieron.com/

Hey Marcus,

Thanks for the link.It's quiet interesting.

hey i hope my previous link was of some help. Here's another link that i found. Hope it is of some help.

http://www.articlealley.com/article_929929_17.html

Hey All,

Found this link on web. Just take a look in to this.

http://asthma.jbnewsblog.com/?p=2788

Hey Nitric,

Thanks for the link.Here's another link i have found.

http://www.rtmagazine.com/reuters_article.asp?id=20090828clin008.html

Hey Marcus,

Thanks for the link.

Hey everyone,

Check this link. Found it interesting.

http://www.slideshare.net/exhalednitrico...tment-of-asthma

Hey All,

Check this link. Found it interesting. It has information about the methodological issues, clinical and epidemiological applications on Exhaled nitric oxide measurements in the first 2 years of life.

http://pubmeddy.com/cilia/exhaled-nitric...lications/2009/

Hey Nitric,

Thanks for the link. Found it helpful.

Hey All,

Check out this link.

http://hel-healthblog.blogspot.com/2009/09/clinical-utility-of-exhaled-nitric.html

Hey everyone,

Check this link. Found it interesting.

http://www.medhelp.org/user_journals/show/121504

Hey Marcus,

Thanks for the link. It was interesting.

http://www.ingentaconnect.com/content/ocean/aap/2009/00000030/00000004/art00011

Hey Nitric,

Thanks for the link. Check this out.....

http://www.informaworld.com/smpp/content~content=a914291690~db=all~jumptype=rss

Hey All,

Came across this link on web. Just take a look.

http://www.information-online.com/node/18568

Hey All,

The analysis of biomarkers in exhaled breath constituents has recently become of great interest in the diagnosis, treatment and monitoring of many respiratory conditions.

For more information you can click the link below:

http://asthma.jbnewsblog.com/?p=3098

Hey Nitric,

That link was quiet interesting. Check this link.

http://www.articlesbase.com/medicine-art...ii-1233731.html

Hey Marcus,

That link was excellent. Check this out......

http://utdol.com/patients/content/topic.do?topicKey=~P33aJ4TN8/xTf&selectedTitle=37~66&source=search_result

That link was quite informative.

Hey Nitric, Found this new link that mentions use of Exhaled Nitric Oxide as a Screening Tool for Asthma in Young Adults. Hope you find it useful..

http://chestjournal.chestpubs.org/content/133/4/906.abstract

Hey Marcus,

Thanks for the link.Found it helpful. Check this out.....

http://www.zimbio.com/Bodybuilding/artic...teroid+Response

Hey All,

Check this out.......

http://www.medhelp.org/user_journals/show/123989

Hey All,

Came across this new link. Check this out.

http://www.everydayhealth.com/blogs/asth...-chronic-cough-

Hey Marcus, the link was quite informative. Here's another one that I would like to share.

http://notesnet.carefirst.com/ecommerce/...ument#_Section2

Hey All,

Check this out.......

http://depts.washington.edu/pmcenter/koenighealth05symp.pdf

Hi everybody,

Came across this link on web. Just take a look at it.

http://www.apieron.com/asthma-information-downloads/Exhaled-Nitric-Oxide-Resource-Kit.pdf