Environmental Exposures, NOS Genes, and Exhaled Nitric Oxide in Pediatric Asthma

描述（由申请人提供）：哮喘是儿童最常见的慢性和致残性疾病。没有简单的、非侵入性的气道炎症指标来指导医生对哮喘儿童进行医学管理。呼出的一氧化氮（eNO），随着气道炎症增加的措施，已被提出作为这样一种工具来管理儿童哮喘;然而，有差距，我们的知识，必须填补eNO之前，它可以被用作哮喘管理的临床工具。本研究将探讨环境暴露和一氧化氮合酶基因多态性如何影响哮喘儿童的eNO水平。此外，我们还将研究eNO水平与哮喘急性发作次数、报告的医疗保健利用率和经验证的生活质量指数（哮喘儿童健康调查）之间的关系。拟定的次要分析使用了来自辛辛那提哮喘预防（CAP）研究（R 01-HL 65731 -01）的数据，这是一项由NHLBI资助的HEPA-CPZ空气净化器纵向试验。CAP研究涉及225名6至12岁的儿童，他们患有医生诊断的哮喘并暴露于环境烟草烟雾（ETS）。在长达一年的研究期间，收集了环境暴露（例如，固定的室内过敏原、ETS暴露的生物标志物和空气尼古丁水平）和哮喘严重程度的许多指标。本申请的目的是评估环境和遗传因素对eNO水平的纵向影响，并检查eNO与哮喘严重程度的相关性。为了实现我们的目标，我们将完成以下目标：目标1：确定12个月研究期间环境暴露（致敏和暴露于室内过敏原）与eNO水平的纵向关系。目标二：评估NOS基因多态性是否与12个月研究期间测量的eNO水平相关，以及环境暴露是否改变了这种关系。目的3：确定12个月内eNO水平与哮喘严重程度的关系。这项分析是创新的，因为据我们所知，没有研究探讨了多种环境暴露和基因多态性与哮喘儿童中eNO的关系，采用纵向研究设计。这项拟议的探索性研究是相关的，因为它提供了一个独特的机会，将有关eNO的流行病学数据从研究竞技场转化为临床实践。如果这项研究和其他研究证明了eNO的效用，它将提高我们管理疾病的能力，并改善患有儿童期最致残疾病的儿童的生活质量。

DESCRIPTION (provided by applicant): Asthma is the most common chronic and disabling disease of childhood. There are no simple, noninvasive measures of airway inflammation to help guide physicians in the medical management of children with asthma. Exhaled nitric oxide (eNO), a measure that increases with airway inflammation, has been proposed as such a tool to manage childhood asthma; however, there are gaps in our knowledge about eNO that must be filled before it can be used as a clinical tool in asthma management. This study will explore how environmental exposures and polymorphisms in nitric oxide synthase genes may affect eNO levels in children with asthma. In addition, we will examine the relationship of eNO levels with number of asthma exacerbations, reported healthcare utilization, and a validated quality of life index (Child Health Survey for Asthma). This proposed secondary analysis uses data from the Cincinnati Asthma Prevention (CAP) study (R01-HL65731-01), a longitudinal, NHLBI-funded trial of HEPA-CPZ air cleaners. The CAP study involved 225 children, 6 to 12 years of age, who had doctor diagnosed asthma and were exposed to environmental tobacco smoke (ETS). Numerous measures of environmental exposure (e.g. settled indoor allergens, biomarkers of ETS exposure, and air nicotine levels) and asthma severity were collected during the year long study period. The objectives of this application are to evaluate the longitudinal effects of environmental and genetic factors on eNO levels and to examine the association of eNO with asthma severity. To achieve our objectives we will complete the following aims: Aim 1: To determine the longitudinal relationship of environmental exposures (sensitization and exposure to indoor allergens) with eNO levels over the 12 month study period. Aim 2: To evaluate whether polymorphisms in NOS genes are associated with eNO levels as measured over the twelve month study period and whether environmental exposures modify this relationship. Aim 3: To determine the relationship of eNO levels and asthma severity over a 12 month period. This analysis is innovative because to our knowledge no studies have examined the relationship of multiple environmental exposures and genetic polymorphisms with eNO in asthmatic children using a longitudinal study design. This proposed exploratory study is relevant because it offers a unique opportunity to translate epidemiologic data about eNO from the research arena to clinical practice. If this and other studies demonstrate the utility of eNO, it would enhance our ability to manage disease and improve the quality of life for children who have the most disabling disease of childhood.