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Asthma is a chronic lung disease that  typically causes cough, wheezing and shortness of breath. These symptoms are relatively non-specific, which  means they can be caused by a variety of other illnesses. For example, a person with congestive heart failure may have shortness of breath, coughing and wheezing, but the lung is not the primary problem. In this case fluid accumulates in the lungs because the heart does not pump efficiently A person with  asthma has similar symptoms, however the cause is a result of  swelling, inflammation  and increased mucus produced  by the airways. Inflammation is caused by allergies in most patients. What makes the diagnosis of asthma difficult is that all tests to diagnose asthma may be normal between attacks. These tests may  include a physical examination, chest radiograph and measurements  of the rate of  lung airflow.

They key feature that distinguishes asthma from other chronic lung disease is inflammation in the small airways. Inflammation is usually a response to infection or injury, but in asthmatics, the offending agent is an allergen. As a result of ongoing allergic reactions, a special type of cell accumulates in the lung to control the inflammation. When these cells become active they produce a variety of chemical substances that send signals to the surrounding lung to “calm down”. One of these substances is not a solid chemical but a gas called nitric oxide. Nitric oxide serves many functions in the body including regulation of blood flow and blood pressure. You may be familiar with nitric oxide as an air pollutant produced by burning fuels. Surprisingly, it is also produced in our bodies during allergic reactions and  infections. This is not the same substance as nitrous oxide, which is commonly used for pain relief during dental procedures.

A new technological breakthrough has now produced portable machines that can measure nitric oxide in the medical  office setting. If the measured amount of nitric oxide is normal during symptoms, then asthma is less likely the cause. When elevated, nitric oxide can also be used to monitor response to asthma  therapy. As a patient improves, the levels of nitric oxide drop towards normal. The test is useful for people with emphysema or chronic bronchitis, where elevated levels predict a good response to a class of drugs known as corticosteroids. Determining the  cause of chronic cough is a challenge. A normal level of nitric oxide makes cough variant asthma less likely.

The test takes about two minutes to perform. The test subject breathes in deeply through a sensor and then exhales at a constant rate for about fifteen seconds. It usually takes several attempts to keep a steady rate of exhalation to obtain a valid measurement. Children over the age of eight can usually perform the test and find the monitor graphics have the feel of a video game.  If your asthma is not responding to treatment, consider a nitric oxide test to be certain you have been given the correct diagnosis to guide treatment.