{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T10:51:27Z","timestamp":1789037487958,"version":"build-2803163510"},"reference-count":26,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T00:00:00Z","timestamp":1615939200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Fractional exhaled nitric oxide (FeNO) is a biomarker for eosinophilic inflammation used for diagnosis and monitoring of asthma. High FeNO indicates significant airway eosinophilia and steroid\u2010responsive airway inflammation. Some children with asthma have extremely high FeNO levels, but whether these levels represent a different asthma phenotype compared with those with mildly elevated FeNO is unclear. The objective of this study is to investigate whether the extent of high FeNO levels correlates with clinical phenotype, asthma control, comorbidity, and pulmonary function test (PFT) findings in children with asthma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Anthropometric data, daytime and nighttime symptoms, controller treatment, comorbidity, and PFT findings were retrieved from the Pediatric Pulmonology Unit database (2014\u20132020) and correlated with FeNO levels in pediatric asthma patients with high FeNO levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two\u2010hundred children and adolescents with high FeNO levels (range 36\u2013227\u2009ppb) were included. Within this range, higher FeNO levels positively correlated with increased daytime and nighttime symptoms (<jats:italic>p<\/jats:italic>\u2009=\u2009.013 and <jats:italic>p<\/jats:italic>\u2009=\u2009.01, respectively) and poorly controlled asthma (<jats:italic>p<\/jats:italic>\u2009=\u2009.034). A FeNO level of \u226580\u2009ppb was the cutoff for significantly more severe daytime and nighttime symptoms and very poorly controlled asthma compared with levels &lt;80\u2009ppb (<jats:italic>p<\/jats:italic>\u2009=\u2009.004, <jats:italic>p<\/jats:italic>\u2009=\u2009.005, and <jats:italic>p<\/jats:italic>\u2009=\u2009.036, respectively). No correlation was found between FeNO and controller treatment, comorbidity, and PFT performance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In pediatric asthma patients, high FeNO levels correlate with increased symptom severity and poor asthma control. A FeNO level of \u226580\u2009ppb may serve as an objective indicator for severe asthma.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ppul.25333","type":"journal-article","created":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T19:42:26Z","timestamp":1616010146000},"page":"1449-1454","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["High fractional exhaled nitric oxide levels in asthma patients: Does size matter?"],"prefix":"10.1002","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9420-8686","authenticated-orcid":false,"given":"Nir","family":"Diamant","sequence":"first","affiliation":[{"name":"Pediatric Pulmonology Unit, Dana\u2010Dwek Children's Hospital, Tel\u2010Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to The Sackler Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Israel","family":"Amirav","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonology Unit, Dana\u2010Dwek Children's Hospital, Tel\u2010Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to The Sackler Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1191-1697","authenticated-orcid":false,"given":"Keren","family":"Armoni\u2010Domany","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonology Unit, Dana\u2010Dwek Children's Hospital, Tel\u2010Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to The Sackler Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Efraim","family":"Sadot","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonology Unit, Dana\u2010Dwek Children's Hospital, Tel\u2010Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to The Sackler Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Udi","family":"Shapira","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonology Unit, Dana\u2010Dwek Children's Hospital, Tel\u2010Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to The Sackler Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4303-9952","authenticated-orcid":false,"given":"Michal","family":"Cahal","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonology Unit, Dana\u2010Dwek Children's Hospital, Tel\u2010Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to The Sackler Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moria","family":"Be'er","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonology Unit, Dana\u2010Dwek Children's Hospital, Tel\u2010Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to The Sackler Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mika","family":"Rochman","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonology Unit, Dana\u2010Dwek Children's Hospital, Tel\u2010Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to The Sackler Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7498-7085","authenticated-orcid":false,"given":"Moran","family":"Lavie","sequence":"additional","affiliation":[{"name":"Pediatric Pulmonology Unit, Dana\u2010Dwek Children's Hospital, Tel\u2010Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to The Sackler Faculty of Medicine Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3,17]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Global initiative for asthma (GINA);2019."},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200406-710ST"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.93.06091368"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(94)90931-8"},{"key":"e_1_2_8_6_1","first-page":"87","article-title":"Expired nitric oxide concentrations are elevated in patients with reactive airways disease","volume":"1","author":"Gaston B","year":"1993","journal-title":"Endothelium"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/thorax.58.3.242"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.119.5.1322"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200411-1498OC"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.164.5.2012125"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1081\/JAS-120033990"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2004.023374"},{"key":"e_1_2_8_13_1","first-page":"CD011439","article-title":"Exhaled nitric oxide levels to guide treatment for children with asthma","volume":"11","author":"Petsky HL","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.00003914"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00408-013-9551-8"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.9120-11ST"},{"key":"e_1_2_8_17_1","volume-title":"National Asthma Education and Prevention Program, Third Expert Panel on the Diagnosis and Management of Asthma","author":"Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma","year":"2007"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201908-1590ST"},{"key":"e_1_2_8_19_1","unstructured":"2019 Elsevier R Wilmott A Bush R Deterding Kendig's disorders of the respiratory tract in\u00a0Children"},{"key":"e_1_2_8_20_1","unstructured":"Asthma: diagnosis monitoring and chronic asthma management. NICE guidelines;2017.\u00a0"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1067\/mai.2000.109618"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/00130832-200502000-00010"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1843.2010.01740.x"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1067\/mai.2002.122635"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2008.11.016"},{"key":"e_1_2_8_26_1","unstructured":"Control for Disease Control and Prevention\u00a0 CDC statistical data regarding the use of long\u2010term control medication among persons with active asthma;2014.\u00a0https:\/\/www.cdc.gov\/asthma\/asthma_stat\/longterm_medication.htm"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1067\/mai.2001.111590"}],"container-title":["Pediatric Pulmonology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ppul.25333","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ppul.25333","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ppul.25333","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,2]],"date-time":"2023-09-02T00:54:53Z","timestamp":1693616093000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ppul.25333"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,17]]},"references-count":26,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021,6]]}},"alternative-id":["10.1002\/ppul.25333"],"URL":"https:\/\/doi.org\/10.1002\/ppul.25333","archive":["Portico"],"relation":{},"ISSN":["8755-6863","1099-0496"],"issn-type":[{"value":"8755-6863","type":"print"},{"value":"1099-0496","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,17]]},"assertion":[{"value":"2020-07-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-02-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-17","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}