Budesonide but not nedocromil sodium reduces exhaled nitric oxide levels in asthmatic children

Exhaled nitric oxide (ENO) has been proposed as a marker of airway inflamma tion in asthma and could be useful to evaluate the response to anti-inflamm atory treatment. We investigated the effect of budesonide and nedocromil so dium on ENO levels and lung function in asthmatic children. Twenty stable s teroid-naive asthmatic children were randomized in a single blind, cross-ov er study to receive inhaled budesonide (group A) or nedocromil sodium (grou p B) for 6 weeks. ENO was measured with a chemiluminescence analyser at bas eline and at the end of each treatment period. Repeated-measures ANOVA was carried out. In asthmatic baseline ENO levels [mean 32.5 ppb,95% confidence interval (CI) 26.4 to 38.7] were significantly higher compared to referenc e values (8.7 ppb, 95% CI 8.1 to 9.2, P <0.001). There were no treatment-or der effect, no carry-over effect and in both groups the response pattern wa s the same: budesonide significantly lowered ENO levels from 41.0 ppb to 22 .8 ppb in group A (mean, P <0.001) and from 22.6 ppb to 13.0 ppb in group B , (mean, P < 0.05), while nedocromil did not reduce ENO values (from 24.4 p pb to 22.6 ppb in group B and from 22.8 ppb to 38.0 ppb in group A, mean, P = NS and P <0.01 respectively). After budesonide treatment ENO values of a sthmatics were still significantly higher than in healthy children. The bas eline values of FEV1 and FEF25-75 were normal in both groups and no signifi cant changes were observed during the study, In conclusion, our study shows that budesonide, but not nedocromil sodium, significantly reduces ENO leve ls in stable asthmatic children even in absence of changes in the lung func tion. (C) 2001 Harcourt Publishers Ltd.