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Ann Allergy Asthma Immunol. 2017 Apr;118(4):445-451. doi: 10.1016/j.anai.2017.02.004.

Biomarkers of oxidative stress and antioxidants in severe asthma: A Prospective Case-Control Study.

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Birmingham Regional Severe Asthma Service, Heartlands Hospital and University of Birmingham, Birmingham, England.
Respiratory Department, James Cook University Hospital, Middlesbrough, England.
Medical Innovation Development Research Unit, Heartlands Hospital, Birmingham, England.
Biochemistry Department, Heartlands Hospital, Birmingham, England.
Department of Allergy and Immunology, Heart of England NHS Foundation Trust and Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, England.
Birmingham Regional Severe Asthma Service, Heartlands Hospital and University of Birmingham, Birmingham, England. Electronic address:



Bronchial airway inflammation is the hallmark of asthma, which may be driven by an imbalance between oxidative stress and antioxidant defenses. Antioxidants deficiency may play a role, but this has remained unconfirmed.


To evaluate the oxidative stress burden and antioxidants defenses in patients with increasing asthma severity.


This prospective case-control study compared fractional exhaled nitric oxide (FeNO), exhaled breath condensate nitrite/nitrate (EBC-NOx), spirometry, and serum vitamins and trace elements among patients with and without asthma.


Sixty participants were recruited (30 with severe asthma number; 23 women [76.7%]; mean age, 41.4 years; mean forced expiratory volume in 1 second [FEV1], 2.2 L [72.2% predicted]; mean inhaled corticosteroid dosage, 2,540 μg/d; 18/30 [60%] receiving maintenance oral corticosteroids; 15 with mild asthma; all corticosteroids naïve; 9 women [60%]; mean age, 34.6 years; mean FEV1, 3.48 L [100.5% predicted]; 15 healthy controls; 12 women [80%]; mean age, 37.6 years; and mean FEV1, 3.53 L [111.7% predicted]). The mean FeNO levels increased significantly with increasing asthma severity (P = .01), but the EBC-NOx levels did not change significantly (P = .90). Paradoxically, vitamin A and vitamin E increased with increased disease severity, with vitamin E levels increasing significantly (P = .07 and P < .001, respectively). There was no significant difference between groups in the levels of copper (P = .37), zinc (P = .97), or selenium (P = .90).


FeNO but not EBC-NOx is increased significantly with asthma severity with no evidence of vitamins or trace elements deficiency in severe asthma. Impaired oxidative stress defenses in severe asthma may be driven by factors other than vitamins or trace elements deficiency.

[Indexed for MEDLINE]

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