Medição do óxido nítrico no ar exalado: Utilização na avaliação de crianças com história de sibilância

 

The clinical use of exhaled nitric oxide in wheezing children

 

Pedro Martins¹

Iolanda Caires²

José Rosado Pinto³

Pedro Lopes da Mata⁴

Simões Torres⁵

Joana Valente⁶

Carlos Borrego⁷

Nuno Neuparth⁸

 

Resumo

Encontram-se publicados múltiplos trabalhos sobre o papel das determinações do óxido nítrico no ar exalado (FENO) no âmbito do estudo da inflamação brônquica que nos permitem afirmar que se trata duma medição simples, não invasiva e de grande utilidade na avaliação do doente asmático.

No decurso de um estudo prospectivo sobre o impacto da poluição do ar sobre a saúde da população na cidade de Viseu (Projecto Saud’AR), foram identificadas crianças com história clínica de sibilância, mediante a aplicação de questionários do International Study of Asthma and Allergy in Childhood (ISAAC). As crianças foram submetidas posteriormente a um questionário padronizado, testes cutâneos prick para aeroalergénios, espirometria com prova de broncodilatação e medição de FENO. A idade média era de 7,8±1,1 anos. Comparando os doentes com queixas de sibilância e/ou dispneia nos 6 meses anteriores à avaliação (n=27) com os que não apresentaram estes sintomas, observaram–se diferenças estatisticamente significativas para o ÄFEV1 (mediana: 4,5% vs 8%, p=0,0399) e para o FENO (mediana: 12 ppb vs 23 ppb, p=0,0195, respectivamente).

Se olharmos para as crianças que recorreram a broncodilatador nos seis meses anteriores à avaliação (n=19) e as compararmos com as que não necessitaram, encontramos diferenças para o FENO: mediana de 27 ppb versus mediana de 11 ppb, respectivamente; p<0,0001.

Ao compararmos as crianças que recorreram a uma consulta de urgência nos seis meses anteriores à avaliação (n=9) e as compararmos com as que não recorreram, encontramos também diferenças estatisticamente significativas para o FENO: mediana de 28 ppb versus mediana de 13 ppb, p=0.0029.

Constatou-se assim que a existência de sintomas se associou melhor com o FENO de que com a espirometria.

Palavras-chave: Sibilância, asma, óxido nítrico, FENO.

 

Abstract

The body of published work on the role of exhaled nitric oxide (FENO) in the study of bronchial inflammation allows it to be classed as a simple, non-invasive measurement that is very useful in evaluating asthmatic patients.

During a prospective study into the effects of air pollution on the health of the population of Viseu (Saud'AR Project), children with a clinical history of wheezing were identified through using the International Study of Asthma and Allergy in Childhood (ISAAC) questionnaire. Children later filled in a new standardised questionnaire and underwent skin-prick-tests, spirometry and FENO measurement. Their mean age was 7.8±1.1 years.

Comparing those who wheezed in the 6 months before evaluation (n=27) with those who didn’t, statistical differences for ÄFEV1 (8% median versus 4.5%, p=0.0399) and for FENO (23 ppb median versus 12 ppb, p=0.0195, respectively) were observed. Concerning children who needed a bronchodilator in the six previous months (n=19) and those who didn’t, there was also a statistically significant difference in FENO: 27 ppb median versus 11 ppb median, respectively; p<0.0001.

When comparing children who needed an unscheduled medical appointment in the six months previous to the evaluation (n=9) and those who didn’t, there was also significant differences for FENO: 28 ppb median versus 13 ppb median, p=0.0029.

In conclusion, the existence of symptoms seems to be better related to FENO than spirometry.

Key-words: Wheezing, asthma, nitric oxide, FENO.

 

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¹ Assistente Convidado, Departamento Universitário de Fisiopatologia, Faculdade de Ciências Médicas, Universidade Nova de Lisboa (Centro de Estudos de Patologia Respiratória); Assistente Eventual, Serviço de Imunoalergologia, Hospital de Dona Estefânia / Guest Consultant, Department of Physiopathology, Faculty of Medical Sciences, Universidade Nova de Lisboa (Centre for Respiratory Pathology Studies); Future Consultant, Allergy and Clinical Immunology Unit, Hospital de Dona Estefânia pmartinsalergo@gmail.com

² Técnica de Cardiopneumologia, Departamento Universitário de Fisiopatologia, Faculdade de Ciências Médicas, Universidade Nova de Lisboa (Centro de Estudos de Patologia Respiratória) / Cardiopulmonology Technician, Department of Physiopathology, Faculty of Medical Sciences, Universidade Nova de Lisboa (Centre for Respiratory Pathology Studies)

³ Director de Serviço, Serviço de Imunoalergologia, Hospital de Dona Estefânia / Allergy and Clinical Immunology Unit, Hospital de Dona Estefânia

⁴ Especialista em Imunoalergologia, Instituto Clínico de Alergologia / Allergy and Clinical Immunology Specialist, Allergy and Clinical Immunology Institute

⁵ Director de Serviço, Serviço de Pneumologia, Hospital de São Teotónio / Director, Pulmonology Unit, Hospital de São Teotónio

⁶ Engenheira do Ambiente, Departamento de Ambiente e Ordenamento, Universidade de Aveiro / Environmental Engineer, Department of Environmental and Land Planning, Universidade de Aveiro

⁷ Professor Catedrático, Departamento de Ambiente e Ordenamento, Universidade de Aveiro / Cathedratic Professor, Department of Environmental and Land Planning, Universidade de Aveiro

⁸ Professor Auxiliar, Departamento Universitário de Fisiopatologia, Faculdade de Ciências Médicas, Universidade Nova de Lisboa (Centro de Estudos de Patologia Respiratória); Especialista em Imunoalergologia, Serviço de Imunoalergologia, Hospital de Dona Estefânia / Assistant Professor, Department of Physiopathology, Faculty of Medical Sciences, Universidade Nova de Lisboa (Centre for Respiratory Pathology Studies); Allergy and Clinical Immunology Specialist, Allergy and Clinical Immunology Unit, Hospital de Dona Estefânia

 

Recebido para publicação/Received for publication: 07.11.05

Aceite para publicação/accepted for publication: 08.01.04