Exhaled nitric oxide correlates with airway eosinophils in childhood asthma

Background: Exhaled nitric oxide has been proposed as a marker for airway inflammation in asthma. The aim of this study was to compare exhaled nitric oxide levels with inflammatory cells and mediators in bronchoalveolar lavage fluid from asthmatic and normal children.

Methods: Children were recruited from elective surgical lists and a non-bronchoscopic bronchoalveolar lavage (BAL) was performed after induction of anaesthesia. Exhaled nitric oxide (parts per billion) was measured by two techniques: tidal breathing and restricted breath.

Results: Median (interquartile range) exhaled nitric oxide measured by restricted breath was increased in asthmatics compared with normal children (24.3 (10.5–66.5) v 9.7 (6.5–16.5), difference between medians 14.6 (95% CI 5.1 to 29.9), p=0.001). In asthmatic children exhaled nitric oxide correlated significantly with percentage eosinophils (r=0.78, p<0.001 (tidal breathing) and r=0.78, p<0.001 (restricted breath)) and with eosinophilic cationic protein (r=0.53, p<0.01 restricted breath)), but not with other inflammatory cells in the BAL fluid. The area under the receiver operator characteristic curves for the prediction of the presence of eosinophilic airways inflammation by exhaled nitric oxide (tidal and restricted) was 0.80 and 0.87, respectively.

Conclusions: Exhaled nitric oxide correlates closely with percentage eosinophils in BAL fluid in asthmatic children and is therefore likely to be a useful non-invasive marker of airway inflammation.

Bystander Narratives: The Fiction of J.M. Coetzee and the Holocaust

J.M. Coetzee’s novels are suffused with a pervasive, though often oblique, Holocaust awareness. Direct references to the event and to the historical era to which it belongs, subtle stylistic and thematic echoes of Holocaust writing, and the recurrent mobilization of Holocaust imagery in Coetzee’s novels all contribute to suggest the significance of the event to the author’s work and thought. Providing Coetzee with a lens through which to view the contemporary situation, both local and global, the Holocaust offers Coetzee a means by which difficult and complex questions of ethics and historiographical truth may be approached. Above all, the Holocaust and its representation contribute to Coetzee’s exploration of the dilemmas of translating the traumatic lived experience of atrocity – including, but not limited to, life in apartheid South Africa – into narrative form. Taken as a whole, Coetzee’s oeuvre initially anticipates and later responds to, in characteristically oblique fashion, the narrative project(s) facing post-apartheid South Africa as the newly-democratic nation sought to make sense of its past through a variety of means, the most important of which was the country’s Truth and Reconciliation Commission. Implicitly challenging the TRC’s findings as well as its narrative assumptions, the Coetzean oeuvre accordingly invites being read as offering a continuous and evolving counter-narrative to the TRC and its construction of a narrative of the apartheid past for the post-apartheid nation. In utilizing the Holocaust, its representations, and the reception thereof to frame his response to apartheid, Coetzee implicates both in a critique of the Western model of modernity, suggesting, in the process, the importance of reconfiguring modernity in a more ethical shape.