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Scottish Adult
Cystic Fibrosis Service, Western General Hospital NHS Trust and
University of Edinburgh, Crewe Road South, Edinburgh EH4 2XU, UK
Correspondence to: Dr A P Greening.
Received 26 February 1998; Returned to authors 18 March 1998; Revised version received 8 April 1998; Accepted for publication 8 April 1998
BACKGROUND
Nitric
oxide (NO) is released by activated macrophages, neutrophils, and
stimulated bronchial epithelial cells. Exhaled NO has been shown to be
increased in patients with asthma and has been put forward as a marker
of airways inflammation. However, we have found that exhaled NO is not
raised in patients with cystic fibrosis, even during infective
pulmonary exacerbation. One reason for this may be that excess airway
secretions may prevent diffusion of gaseous NO into the airway lumen.
We hypothesised that exhaled NO may not reflect total NO production in
chronically suppurative airways and investigated nitrite as another
marker of NO production.
METHODSBreath
condensate nitrite concentration and exhaled NO levels were measured in
21 clinically stable patients with cystic fibrosis of mean age 26 years
and mean FEV1 57% and 12 healthy normal volunteers of mean
age 31 years. Breath condensate was collected with a validated method
which excluded saliva and nasal air contamination and nitrite levels
were measured using the Griess reaction. Exhaled NO was measured using
a sensitive chemiluminescence analyser (LR2000) at an exhalation rate
of 250 ml/s. Fourteen patients with cystic fibrosis had circulating
plasma leucocyte levels and differential analysis performed on the day
of breath collection.
RESULTSNitrite levels
were significantly higher in patients with cystic fibrosis than in
normal subjects (median 1.93 µM compared with 0.33 µM). This
correlated positively with circulating plasma leucocytes and
neutrophils (r = 0.6). In contrast, exhaled
NO values were not significantly different from the normal range (median 3.8 ppb vs 4.4 ppb). There was no correlation between breath
condensate nitrite and lung function and between breath condensate
nitrite and exhaled NO.
CONCLUSIONSNitrite
levels in breath condensate were raised in stable patients with cystic
fibrosis in contrast to exhaled NO. This suggests that nitrite levels
may be a more useful measure of NO production and possibly airways
inflammation in suppurative airways and that exhaled NO may not reflect
total NO production.
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