Therapeutic Role of Nitric Oxide in Respiratory Disease

Thomas E. Siddons, BSc, Mohammed Asif, MA, BMBCh, FRCS, and Tim W. Higenbottam, MD, MA, BSc, FRCP, University of Sheffield, Sheffield, United Kingdom

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Adverse Effects of NO

Formation of NO 2

In air, NO reacts with oxygen to form nitrogen dioxide (NO2). In order to reduce the formation of NO2, the amount of time that NO is in contact with oxygen should be minimized.Otherwise, NO2 can induce acute lung injury, particularly pneumonitis or pulmonary edema.[26]

Acute Rebound Phenomenon

Patients who receive continuous inhaled NO for periods longer than 24 hours (particularly ARDS patients) need to be slowly weaned off the agent. There have been several reported cases of rebound hypertension, and the mechanism of this phenomenon is unknown. However, NO release from cultured endothelial cells has been shown to function as a negative feedback modulator by inhibiting nitric oxide synthase (NOS).[27] Therefore, inhaled nitric oxide may downregulate NOS III activity and cause this rebound effect.

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