Exhaled nitric oxide in patients with Wegener's granulomatosis

In Wegener's granulomatosis (WG), a pathogenic role of infections, in parti cular of a chronic colonization of the nasal mucosa with Staphylococcus aur eus, has been postulated. Nitric oxide (NO), which is thought to play a rol e in primary host defence and inflammation, is produced endogenously within the respiratory tract, mainly from the paranasal sinuses. In order to furt her characterize its role in WG, nasal and pulmonary NO excretion in WG pat ients in comparison to healthy volunteers was measured. Seventeen patients with WG were included in the study. Five patients had ac tive disease (bloody rhinitis with ulceration and crusting) and immunosuppr essive therapy (IST), and 12 were in remission (six with, and six without, IST). S. aureus was found in the swabs of all patients with active WG and i n three patients in remission. NO was measured in exhaled gas using a chemi luminescence analyser. The NO excretion rate in nasally sampled gas was significantly reduced (p<0 .05) in patients with active WG (mean+/-SD)102+/-100 nL.min(-1)) compared t o healthy controls ((299+/-13 nL.min(-1)), and patients in remission (281+/ -86 nL.min(-1) with IST, 280+/-133 nL.min(-1) without IST). Pulmonary NO ex cretion in active or nonactive WG patients did not significantly differ fro m that of healthy volunteers (48+/-21 nL.min(-1)). These results demonstrate a reduced nasal NO excretion in active Wegener's granulomatosis. This may be caused by destruction and/or functional impairm ent of sinus epithelium. The reduced NO concentration may wed compromise ho st defence in the upper airways, thus contributing to colonization with Sta phylococcus aureus and further promoting Wegener's granulomatosis.