Exhaled carbon monoxide in children with asthma and allergic rhinitis

Yulia Fatma Wardani; Rina Triasih; Amalia Setyati

doi:10.14238/pi62.2.2022.115-9

Yulia Fatma Wardani Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Central Java
Rina Triasih Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Central Java
Amalia Setyati Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Central Java

DOI: https://doi.org/10.14238/pi62.2.2022.115-9

Keywords: exhaled CO; asthma; allergic rhinitis; children

Abstract

Background Exhaled carbon monoxide has been related to the degree of inflammation. An easy, inexpensive, and non-invasive test to measure exhaled CO levels (eCO) may help in supporting the diagnosis of asthma and allergic rhinitis (AR) in children.

Objective To compare the eCO levels in children with asthma, AR, or both asthma and AR, to children without asthma or AR.

Methods This was a cross-sectional study involving 450 children aged 13-14 years in Yogyakarta. Asthma and AR were determined according to the International Study of Asthma and Allergies in Childhood (ISAAC) study criteria, while eCO level was examined using a Smokerlyzer^Â®. The levels of eCO between groups were analyzed using Kruskal-Wallis and Mann-Whitney tests.

Results Of 450 children, 48 (10.67%) had asthma only, 91 (20.22%) had AR only, 67 (14.89%) had both asthma and AR, and 244 (54.22%) had neither asthma nor AR. The eCO levels of children with asthma or AR were not significantly different compared to those without asthma and AR (P=0.33 and P=0.19, respectively). However, children with both asthma and AR had significantly higher eCO level compared to children without asthma and AR (P< 0.001).

Conclusion The levels of eCO in children with asthma only or AR only are similar to those without both diseases. Children with both asthma and AR have significant higher eCO compared to healthy children.

Author Biographies

Rina Triasih, Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Central Java

Respirology Division, Department of

Child Health, Faculty of Medicine, Public Health, and Nursing Universitas

Gadjah Mada/Dr. Sardjito Hospital

Amalia Setyati, Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Central Java

Respirology Division, Department of

Child Health, Faculty of Medicine, Public Health, and Nursing Universitas

Gadjah Mada/Dr. Sardjito Hospital

References

1. Pawankar R. Allergic diseases and asthma: a global public health concern and a call to action. World Allergy Organ J. 2014;7:12. DOI: 10.1186/1939-4551-7-12.
2. Asher MI, Montefort S, Björkstén B, Lai CKW, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 2006;368:733–43. DOI: 10.1016/S0140-6736(06)69283-0.
3. Lai CKW, Beasley R, Crane J, Foliaki S, Shah J, Weiland S, et al. Global variation in the prevalence and severity of asthma symptoms?: phase three of the International Study of Asthma and Allergies in Childhood ( ISAAC ). Thorax. 2009;64:476–83. DOI:10.1136/thx.2008.106609.
4. GINA. Global Strategy for Asthma Management and Prevention. Glob Strateg Asthma Manag Prev [Internet]. [cited 2019 Jun 13]. 2018;32. Available from: https://ginasthma.org/wp-content/uploads/2018/04/wms-GINA-2018-report-tracked_v1.3.pdf
5. Badan Penelitian dan Pengembangan Kesehatan, Kemenkes RI. Laporan Nasional RISKESDAS 2017. [cited 2019 Jun 13]. Available from: https://www.litbang.kemkes.go.id/laporan-riset-kesehatan-dasar-riskesdas/
6. Badan Penelitian dan Pengembangan Kesehatan, Kemenkes RI. Laporan Nasional RISKESDAS 2018. [cited 2019 Jun 13]. Available from: http://labdata.litbang.kemkes.go.id/images/download/laporan/RKD/2018/Laporan_Nasional_RKD2018_FINAL.pdf.
7. Brozek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, Brignardello-Petersen R, et al. Allergic Rhinitis and its Impact on Asthma ( ARIA ) guidelines — 2016 revision. J Allergy Clin Immunol. 2016;140:950–8. DOI: 10.1016/j.jaci.2017.03.050
8. Nunes C, Pereira AM, Morais-Almeida M. Asthma costs and social impact. Asthma Res Pract. 2017;3:1–11. doi: 10.1186/s40733-016-0029-3.
9. Babusikova E, Jesenak M, Durdik P, Dobrota D, Banovcin P. Exhaled carbon monoxide as a new marker of respiratory diseases in children. J Physiol Pharmacol. 2008;59 Suppl 6:9–17. PMID: 19218629.
10. Uasuf CG, Jatakanon A, James A, Kharitonov SA, Wilson NM, Barnes PJ. Exhaled carbon monoxide in childhood asthma. J Pediatr. 1999;135:569–74. DOI: 10.1016/s0022-3476(99)70054-5.
11. Andersson JA, Uddman R, Cardell LO. Increased carbon monoxide levels in the nasal airways of subjects with a history of seasonal allergic rhinitis and in patients with upper respiratory tract infection. Clin Exp Allergy. 2002;32:224–7. DOI: 10.1046/j.1365-2222.2002.00532.x.
12. Zhang J, Yao X, Yu R, Bai J, Sun Y, Huang M, Adcock IM, et al. Exhaled carbon monoxide in asthmatics: a meta-analysis. Respir Res. 2010;11:50. DOI: 10.1186/1465-9921-11-50
13. Shaoqing Y, Ruxin Z, Yingjian C, Jianqiu C, Yanshen W, Genhong L. A meta-analysis of the association of exhaled carbon monoxide on asthma and allergic rhinitis. Clin Rev Allergy Immunol. 2011;41:67–75. DOI: 10.1007/s12016-009-8195-1.
14. Kuruvilla ME, Vanijcharoenkarn K, Shih JA, Lee FE. Epidemiology and risk factors for asthma. Respir Med. 2019;149:16–22. DOI: 10.1016/j.rmed.2019.01.014. DOI: 10.1046/j.1365-2222.2001.01013.x.
15. Yamaya M, Hosoda M, Ishizuka S, Monma M, Matsui T, Suzuki, T. et al. Relation between exhaled carbon monoxide levels and clinical severity of asthma. Clin Exp Allergy. 2001;31:417–22. DOI: 10.1046/j.1365-2222.2001.01013.x.
16. Jesenak M, Banovcin P, Havlicekova Z, Dobrota D, Babusikova E. Factors influencing the levels of exhaled carbon monoxide in asthmatic children. J Asthma. 2014;51:900–6. DOI: 10.3109/02770903.2014.936448.
17. Ohara Y, Ohrui T, Morikawa T, He M, Yasuda H,Yamaya M, et al. Exhaled carbon monoxide levels in school-age children with episodic asthma. Pediatr Pulmonol. 2006;41:470–4. DOI: 10.1002/ppul.20395.
18. Ryter S, Choi A. Carbon monoxide in exhaled breath testing and therapeutics. J Breath Res. 2013;7:017111. DOI: 10.1088/1752-7155/7/1/017111
19. Al-Ahmad M. Combined Allergic Rhinitis and Asthma Syndrome [Internet]. World Allergy Organization. 2015. [cited 2019 Jun 13]. Available from: https://www.worldallergy.org/education-and-programs/education/allergic-disease-resource-center/professionals/combined-allergic-rhinitis-and-asthma-syndrome.
20. Pawankar R. Allergic rhinitis and asthma - The global burden of asthma. Proceedings of the WAO International Scientific Conference; 2010 Dec 5-8. Dubai UEA; World Allergy Organization; 2010. p. 1–33.
21. Jeffery PK, Haahtela T. Allergic rhinitis and asthma: inflammation in a one-airway condition. BMC Pulm Med. 2006;6:S5. DOI: 10.1186/1471-2466-6-S1-S5.
22. Xia S, Zhu Z, Guan WJ, Xie YQ, An JY, Peng T, et al. Correlation between upper and lower airway inflammations in patients with combined allergic rhinitis and asthma syndrome: a comparison of patients initially presenting with allergic rhinitis and those initially presenting with asthma. Exp Ther Med. 2018;15:1761–7. DOI: 10.3892/etm.2017.5536.