Measurement of nasal nitric oxide in children – first experiences

Authors: G. Bugová 1;  B. Uhliarová 2;  P. Ďurdík 3;  A. Hajtman 1;  M. Jeseňák 3
Authors‘ workplace: Klinika ORL a ChHaK UK JLF a UNM, Martin prednosta prof. MUDr. A. Hajtman, PhD. 1;  ORL oddelenie, FNsP F. D. Roosevelta, Banská Bystrica primár MUDr. M. Švec 2;  Klinika detí a dorastu UK JLF a UNM, Martin prednosta prof. MUDr. P. Bánovčin, CSc. 3
Published in: Čes-slov Pediat 2016; 71 (2): 68-75.
Category: Original Papers


In the respiratory system, nitric oxide (NO) acts as a neurotransmitter of nonadrenergic non-cholinergic mediation and significantly participates in the regulation of physiological functions. NO has important effect on the smooth muscles, blood vessels and bronchi. Nitric oxide diffuses into the lumen of the respiratory system and subsequently can be measured by sensitive detector. The importance of measurements of NO levels has been confirmed in the diagnosis as well as management of patients with bronchial asthma. Nowadays, attention is focused on the determination of nasal nitric oxide (nNO). Evaluation of nNO is not standardized and its clinical significance and possible application in clinical practice have not been determined.

The prospective study was conducted with 60 children that were scheduled to endoscopic adenotomy for adenoid vegetation at the Department of Otorhinolaryngology, Head and Neck Surgery, Comenius University, Jessenius Faculty of Medicine, University Hospital in Martin, Slovakia. Concentration of nNO was measured and differences in the levels of nNO according to the age, sex, size of adenoid tissue, presence of atopy and pathogens in the upper airways were evaluated.

The mean concentration of nNO was 337±36 ppb. There were significantly lower levels of nNO in younger children (≤5 years) compared to older ones (P<0.05). Identification of pathogens in nasopharynx was associated with significantly higher levels of nNO (P<0.05). Differences in concentration of nNO according to the sex, side of the nasal cavity, size of adenoid tissue and presence of atopy were not observed (P>0.05).

It is possible to measure nasal nitric oxid also in very young children. Measurement of nNO is non-invasive method that can contribute to the diagnosis of diseases of the upper and lower respiratory tract. Changes in nNO may indicate obstruction and inflammation of the upper airways.

Key words:
nitric oxide, upper airways, adenoid vegetation, pathogenic bacteria


1. Čáp P, Benčová A, Jeseňák M. Vyšetřování vydechovaného oxidu dusnatého u asthma bronchiale. 1. vyd. Praha: Mladá fronta, 2014: 1–144.

2. American Thoracic Society Offical Statement. Recommendation for a standardized ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide. Am J Respir Crit Care Med 2005; 8: 912–930.

3. Alving K, Weitzberg E, Lundberg J. Increased amount of nitric oxide in exhaled air of asthmatics. Eur Respir J 1993; 6: 1368–1370.

4. Jones SL, Kittelson J, Cowan JO, et al. The predictive value of exhalted nitric oxide measurements in assessing changes in asthma control. Am J Respir Crit Care Med 2001; 164: 738–743.

5. European Academy of Allergology and Clinical Immunology. Position paper. Allergen standardization and skin tests. Allergy 1993; 48 (Suppl 14): 48–82.

6. Bugová G, Uhliarová B, Krošláková B, et al. Adenotómia – áno alebo nie. Pediatria (Bratisl) 2015; 10: 29–34.

7. Zautner AE. Adenotonsillar disease. Recent Pat Inflamm Allergy Drug Discov 2012; 6: 121–129.

8. Brook I, Shah K. Bacteriology of adenoids and tonsils in children with recurrent adenotonsillitis. Ann Otol Rhinol Laryngol 2001; 110: 844–848.

9. Marzouk H, Aynehchi B, Thakkar P, et al. The utility of nasopharyngeal culture in the management of chronic adenoiditis. Int J Pediatr Otorhinolaryngol 2012; 76: 1413–1415.

10. Modrzynski M, Zawisza E. An analysis of the incidence of adenoid hypertrophy in allergic children. Int J Pediatr Otorhinolaryngol 2007; 71: 713–719.

11. Ciprandi G, Tosca MA, Fasce L. Allergic children have more numerous and severe respiratory infections than non-allergic children. Pediatr Allergy Immunol 2006; 17: 389–391.

12. Uhliarova B, Bugova G, Jesenak M, Hajtman A. The presence of atopy and its effect on bacterial colonization of the upper airways in children with adenoid vegetation. Open Microb J, prijaté na publikáciu.

13. Dotsch J, Demirakya S, Terbrack HG, et al. Airway nitric oxide in asthmatic children and patients with cystic fibrosis. Eur Respir J 1996; 9: 2537–2540.

14. Lundberg JO, Nordvall SL, Weitzberg E, et al. Exhaled nitric oxide in paediatric asthma and cystic fibrosis. Arch Dis Child 1996; 75: 323–326.

15. Baraldi E, Azzolin NM, Biban P, Zacchello F. Effect of antibiotic therapy on nasal nitric oxide concentration in children with acute sinusitis. Am J Respir Crit Care Med 1997; 55: 1680–1683.

16. Narang I, Ersu R, Wilson NM, Bush A. Nitric oxide in chronic airway inflammation in children: diagnostic use and pathophysiological significance. Thorax 2002; 57: 586–589.

17. Horvath I. Airway inflammation: exhalted NO in clinical practice. Breath 2005; 1: 229–235.

18. Lanz MJ, Prendes S, Peyrou N, et al. Nasal nitric oxide as a noninvasive marker in the antibiotic treatment of acute bacterial sinusitis. J Allergy Clin Immunol 2008; 121: 530–531.

19. Torretta S, Bossi A, Capaccio P, et al. Nasal nitric oxide in children with adenoidal hypertrophy: a preliminary study. Int J Pediatr Otorhinolaryngol 2010; 74: 689–693.

20. Torretta S, Marchisio P, Esposito S, et al. Exhaled nitric oxide levels in children with chronic adenotonsillar disease. Int J Immunopathol Pharmacol 2011; 24: 471–480.

21. Imada M, Iwamoto J, Nonaka S, et al. Measurement of nitric oxide in human nasal airway. Eur Respir J 1996; 9: 556–559.

22. Struben VMD, Wieringa MH, Mantingh CJ, et al. Nasal NO measurement by direct sampling from the nose during breathhold: Aspiration flow, nasal resistance and reproducibility. Eur Arch Otorhinolaryngol 2006; 263: 723–728.

23. Struben VMD, Wieringa MH, Mantingh CJ, et al. Nasal NO: normal values in children age 6 through to 17 years. Eur Respir J 2005; 26: 453–457.

24. Artlich A, Busch T, et al. Single-breath analysis of endogenous nitric oxide in newborn. Biol Neonate 2000; 79: 21–26.

25. Guo FH, Comhair SAA, Zheng S, et al. Molecular mechanism of increased nitric oxide in asthma. J Immunol 2000; 164: 5970–5980.

26. Struben VMD, Wieringa MH, Feenstra L, de Jongste JC. Nasal nitric oxide and nasal allergy. Allergy 2006; 61: 665–670.

27. Banovcin P, Jesenak M, Michnova Z, et al. Factors attributable to the levels of exhaled nitric oxide in asthmatic patients. Eur J Med Res 2009; 14 (Suppl 4): 9–13.

Neonatology Paediatrics General practitioner for children and adolescents
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