Factors Influencing the Concentration of Exhaled Nitric Oxide (FeNO) in School Children Aged 8-9-Years-Old in Krakow, with High FeNO Values ≥ 20 ppb.

Background and Objectives: Measurement of fractional exhaled nitric oxide (FeNO) concentration is currently used as a non-invasive biomarker to assess airway inflammation. Many factors can influence the FeNO level. However, there have been no reports concerning factors attributed to FeNO levels in different age groups of children, especially those with high FeNO values. Therefore, this study aimed to assess the influence of selected factors on nitric oxide concentration in exhaled air in children aged 8-9 attending class 3 of public primary schools in Krakow with high FeNO values ≥ 20 ppb. Materials and Methods: The population-based study covered all third-grade pupils attending primary schools in the city of Krakow. Five thousand, four hundred and sixty children participated in the first screening stage, conducted from October 2017 to January 2018. Then, 792 participants with an FeNO level ≥ 20 ppb were selected. Finally, those selected pupils were invited to participate in the second stage, diagnostic, in April 2018. Four hundred and fifty-four children completed the diagnostic stage of the study, and their data was included in the presented analysis. Results and Conclusions: Significantly higher FeNO levels were observed in children diagnosed with the following diseases: asthma, allergic rhinitis, atopic dermatitis, and allergy (p < 0.05). In addition, it was observed that a higher FeNO concentration characterised children taking antihistamines compared to children not taking those medications (p = 0.008). In multivariate models, we observed that regardless of sex, age, BMI value, home smoking, and whether they were taking medications, children who had allergic rhinitis, or atopic dermatitis, or allergies had significantly higher FeNO levels. The strongest relationship was noted with allergic diseases. The results of our study may be of importance to clinicians when interpreting FeNO results, for example, when making a therapeutic decision.

Relationship Between Air Pollution and the Concentration of Nitric Oxide in the Exhaled Air (FeNO) in 8-9-Year-Old School Children in Krakow.

The consequences of air pollution pose one of the most serious threats to human health, and especially impact children from large agglomerations. The measurement of nitric oxide concentration in exhaled air (FeNO) is a valuable biomarker in detecting and monitoring airway inflammation. However, only a few studies have assessed the relationship between FeNO and the level of air pollution. The study aims to estimate the concentration of FeNO in the population of children aged 8-9 attending the third grade of public primary schools in Krakow, as well as to determine the relationship between FeNO concentration and dust and gaseous air pollutants. The research included 4580 children aged 8-9 years who had two FeNO measurements in the winter-autumn and spring-summer periods. The degree of air pollution was obtained from the Regional Inspectorate of Environmental Protection in Krakow. The concentration of pollutants was obtained from three measurement stations located in different parts of the city. The FeNO results were related to air pollution parameters. The study showed weak but significant relationships between FeNO and air pollution parameters. The most significant positive correlations were found for CO8h (r = 0.1491, p < 0.001), C6H6 (r = 0.1420, p < 0.001), PM10 (r = 0.1054, p < 0.001) and PM2.5 (r = 0.1112, p < 0.001). We suggest that particulate and gaseous air pollutants impact FeNO concentration in children aged 8-9 years. More research is needed to assess the impact of air pollution on FeNO concentration in children. The results of such studies could help to explain the increase in the number of allergic and respiratory diseases seen in children in recent decades.

[The influence of increased preload on left ventricular systolic function in infants with congenital heart disease]. / Wplyw zwiekszonego obciazenia wstepnego na funkcje skurczowa lewej komory u niemowlat z wrodzonymi wadami sercabadania echokardiograficzne.

UNLABELLED: The aim of the study was to assess the systolic function of the volume overloaded left ventricle (LV) in infants with congenital heart disease. MATERIAL: Seventy five consecutive patients (36 males, 39 females) with following breakdown were examined: 14 (18.7%) newborns, 24 (32%) infants under 3 months, 16 (21.3%) between 4 and 6, and 21 (28%) infants above 6 months of age. VSD was recognized in 60 (80%), PDA--6(8%), DORV--7 (9.3%), and CT (type I) in 2 (2.7%) of the patients. METHODS: Based on ECHO studies LV end diastolic volume (LVedv), end diastolic muscle mass (LVedm), LV shortening fraction (FS), ejection fraction (EF), LV fractional area changes (FAC), and heart rate (HR) versus pulmonary blood flow (Qp), which reflected the LV preload systemic blood flow (Qs), Qp/Qs, Qp-Qs (left-to-right shunt) and indexed for body surface area (BSA) and age, were assessed by statistical analysis. RESULTS: With a gradual increase of BSA with age (cc = 0.82, p < 0.001), a significant decrease in Qp-Qs (cc = -0.27, p = 0.035) and Qp/Qs (cc = -0.31, p = 0.013) were noted. Qp for the whole group ranged from 3.3 to 21.7 l/min/m2 (m = 8.9, x = 9.7, SD = 4.1), significantly increased with the rise of Qp-Qs (cc = 0.9, p < 0.0001) and influenced the increment of Qp/Qs (cc = 0.59, p < 0.001). Qs for the whole group ranged from 2.1 to 11.7 l/min/m2 (m = 4.3, x = 4.6, SD = 1.7) correlating with the rise of Qs (cc = 0.45, p < 0.001), and being lower than 2.5 l/min/m2 in only 5 (6.7%) patients but in only 5 (6.7%) patients (all newborns). The heart rate gradually decreased with age (r = -0.26, p = 0.04), from mean 145/min in newborns to 123/min in infants over 6 months, and with BSA (cc = -0.34, p = 0.006). Heart rate also correlated well with Qp (cc = 0.31, p = 0.014). The increase of LVedv was related to age (cc = 0.37, p = 0.003), BSA (cc = 0.43, p = 0.0004) and Qp (cc = 0.33, p = 0.009). However, only in newborns was the mean LVedv within normal limits for age. LVedm only correlated with BSA (cc = 0.26, p = 0.04), except in newborns where its mean values exceeded the upper limits for age in other subgroups of patients. LV systolic function indicators (FS, EF, FAC) were diminished in only 2 cases and did not correlate either with age, BSA, nor with hemodynamic parameters. CONCLUSIONS: 1. The reactions to increased preload of the systemic ventricle in children below one year of age were different. In newborns, the adrenergic response predominated, while infants manifested increased end-diastolic volume and left ventricular muscle mass. 2. The systolic function of the overloaded left ventricle in infants was normal regardless of age, body surface area and intensity of hemodynamic disturbances.