Clinical application of nasal nitric oxide measurement in allergic rhinitis

Ambrosino, Pasquale; Parrella, Paolo; Formisano, Roberto; Papa, Antimo; Spedicato, Giorgio Alfredo; Minno, Matteo Nicola Dario Di; Motta, Andréa; Maniscalco, Mauro

doi:10.1016/j.anai.2020.07.003

Cited by 16 publications

(20 citation statements)

References 80 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The rationale for using FeNO in the decisional process of ICS prescription is complex and only partially elucidated [ 44 ]. In brief, eosinophilic airway inflammation derives from the activation of mast cells and antigen-specific T helper 2 cells, with the concomitant production of cytokines, such as interleukin (IL)-4, IL-5 and IL-13 [ 10 ]. Their release regulates the expression of the inducible isoform of NO synthase (iNOS), thus determining an increased NO production in an allergic environment [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Past observation that the nitric oxide (NO) concentration in exhaled air generally increases in chronic inflammatory airway diseases [ 10 , 11 ] has led the European Respiratory Society (ERS) and the American Thoracic Society (ATS) to agree on highly standardised procedures to measure fractional exhaled NO (FeNO) [ 12–14 ]. Thus, FeNO has become an important non-invasive support to monitor compliance and efficacy of steroids in chronic airway diseases, especially asthma [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Performance of fractional exhaled nitric oxide in predicting response to inhaled corticosteroids in chronic cough: a meta-analysis

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background. Chronic cough is a disabling condition with a high proportion of diagnostic and therapeutic failures. Fractional exhaled nitric oxide (FeNO) has been considered a useful biomarker for predicting inhaled corticosteroids (ICS) response. We evaluated the relationship between FeNO and ICS response in chronic cough by performing a systematic review with meta-analysis. Methods. PubMed, Web of Science, Scopus and EMBASE databases were systematically searched. Differences were expressed as Odds Ratio (OR) with 95% confidence intervals (95%CI). Pooled sensitivity, specificity, positive (PLR) and negative likelihood ratio (NLR), and area under the hierarchical summary receiver operating characteristic curve (HSROC AUC ) were estimated. Results. Nine articles on 740 chronic-cough patients showed that the response rate to ICS was 87.4% (95%CI: 83.8–91.0) in 317 patients with a high FeNO and 46.3% (95%CI: 41.6–51.0) in 423 controls, with an attributable proportion of 47.0% and a diagnostic OR of 9.1 (95%CI: 3.7–22.4, p < .001). The pooled estimate of diagnostic indexes resulted in a sensitivity of 68.5% (95%CI: 46.7–84.4) and specificity of 81.9% (95%CI: 63.0–92.3), with a HSROC AUC of 0.82 (95%CI: 0.64–0.90). In a realistic scenario with a pre-test probability set at 30%, based on a pooled PLR of 3.79 (95%CI: 1.24–7.47) and NLR of 0.38 (95%CI: 0.22–0.66), the post-test probability was 62% with a high FeNO and 14% if the test was negative. Subgroup analyses confirmed a better performance for the recommended FeNO cut-off greater than 25 ppb. Meta-regression and sensitivity analyses showed no impact of major demographic and clinic variables on results. Conclusions. A high FeNO before starting ICS therapy may help identify chronic-cough patients responding to treatment, with a better performance ofhigher cut-off values. Further studies are needed to evaluate the real usefulness of this biomarker to guide cough therapy and optimise strategies in different healthcare settings (community, hospital, rehabilitation). Key messages Chronic cough is a disabling condition with a high proportion of diagnostic and therapeutic failures. Fractional exhaled nitric oxide (FeNO) may be a useful biomarker for identifying chronic cough patients who respond to steroid treatment. A FeNO cut-off lower than 25 ppb should be considered irrelevant for this clinical application.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Performance of fractional exhaled nitric oxide in predicting response to inhaled corticosteroids in chronic cough: a meta-analysis

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…The diagnostic values of nasal NO in allergic rhinitis were reported in various patient populations [35,58,60,73,[78][79][80]. Because the measurement of nasal NO is noninvasive, easy to perform, and economical, it has become a popular and valuable test for the diagnosis of AR even in children [81].…”

Section: Increased Inos Activities In Armentioning

confidence: 99%

“…The existing data regarding the measurements of nasal NO have provided clear evidence with clinical relevance [ 59 , 60 ]. We examined the local gradients of nasal NO concentrations by using direct online sampling methods, and we compared the levels in different areas inside the nasal cavity [ 61 ].…”

Section: Monitoring Of No In the Human Sinonasal Pathwaysmentioning

confidence: 99%

The Functional Diversity of Nitric Oxide Synthase Isoforms in Human Nose and Paranasal Sinuses: Contrasting Pathophysiological Aspects in Nasal Allergy and Chronic Rhinosinusitis

Kawasumi

Takeno

Ishikawa

et al. 2021

IJMS

View full text Add to dashboard Cite

The human paranasal sinuses are the major source of intrinsic nitric oxide (NO) production in the human airway. NO plays several roles in the maintenance of physiological homeostasis and the regulation of airway inflammation through the expression of three NO synthase (NOS) isoforms. Measuring NO levels can contribute to the diagnosis and assessment of allergic rhinitis (AR) and chronic rhinosinusitis (CRS). In symptomatic AR patients, pro-inflammatory cytokines upregulate the expression of inducible NOS (iNOS) in the inferior turbinate. Excessive amounts of NO cause oxidative damage to cellular components, leading to the deposition of cytotoxic substances. CRS phenotype and endotype classifications have provided insights into modern treatment strategies. Analyses of the production of sinus NO and its metabolites revealed pathobiological diversity that can be exploited for useful biomarkers. Measuring nasal NO based on different NOS activities is a potent tool for specific interventions targeting molecular pathways underlying CRS endotype-specific inflammation. We provide a comprehensive review of the functional diversity of NOS isoforms in the human sinonasal system in relation to these two major nasal disorders’ pathologies. The regulatory mechanisms of NOS expression associated with the substrate bioavailability indicate the involvement of both type 1 and type 2 immune responses.

show abstract

“…10 The measurement of NO in the respiratory tract provides information on the degree of eosinophilic inflammation and it can complete the clinical and non-invasive management of allergic diseases. [11][12][13] To this purpose, NO evaluation in AR could be useful in addition to an objective nasal flow assessment through anterior active rhinomanometry (AAR). 14 The bronchial asthma management could similarly benefit from eFeNO measurement in addition to spirometry.…”

Section: Introductionmentioning

confidence: 99%

The Role of Nasal Nitric Oxide and Anterior Active Rhinomanometry in the Diagnosis of Allergic Rhinitis and Asthma: A Message for Pediatric Clinical Practice

Brindisi¹,

Vittori²,

Nola³

et al. 2021

JAA

View full text Add to dashboard Cite

Background Allergic rhinitis (AR) and asthma are two common atopic diseases, often associated with a common ethiopathogenesis characterized by a Th2 inflammatory response with the release of many biomarkers, such as nitric oxide (NO). Purpose To evaluate and compare inflammatory (nFeNO and eFeNO) and functional (mNF and FEV1) parameters in AR children with or without asthma in comparison to controls. Secondly, we aimed to identify nFeNO cut-off values and verify their reliability to predict the presence of rhinitis or asthma alone or in combination. Patients and Methods We enrolled 160 children (6–12 years of age) with AR and/or asthma divided into four groups: controls, AR, asthma, and AR + asthma. All children underwent the following inflammatory and functional measurements: nFeNO, eFeNO, mNF and FEV1. Results We observed that levels of nFeNO were extremely higher in children with AR and even more in those with AR + asthma in respect to controls. Notably, all the pathological conditions, especially AR + asthma, showed significantly lower values of mNF compared to healthy children. A negative correlation linked mNF and nFeNO. Then, we found eFeNO values significantly higher in all the pathological groups compared to controls, with major values of this marker in patients affected by asthma and AR + asthma, as well as FEV1 values significantly lower in all the disease groups, especially in children with asthma and AR+ asthma. ROC curve analysis showed that nFeNO was a great predictor for rhinitis alone or with asthma, revealing an accurate cut-off of 662 ppb. Conclusion nFeNO measurement is non-invasive, easy to perform, economic and a valuable test in case of AR alone or in association with asthma. Thus, it should be used in patients with rhinitis, together with anterior active rhinomanometry (AAR) to diagnose and estimate the degree of nasal obstruction but also in children with asthma to assess their nasal involvement and improve the therapeutic management.

show abstract

Clinical application of nasal nitric oxide measurement in allergic rhinitis

Cited by 16 publications

References 80 publications

Performance of fractional exhaled nitric oxide in predicting response to inhaled corticosteroids in chronic cough: a meta-analysis

Performance of fractional exhaled nitric oxide in predicting response to inhaled corticosteroids in chronic cough: a meta-analysis

The Functional Diversity of Nitric Oxide Synthase Isoforms in Human Nose and Paranasal Sinuses: Contrasting Pathophysiological Aspects in Nasal Allergy and Chronic Rhinosinusitis

The Role of Nasal Nitric Oxide and Anterior Active Rhinomanometry in the Diagnosis of Allergic Rhinitis and Asthma: A Message for Pediatric Clinical Practice

Contact Info

Product

Resources

About