Normal values of offline exhaled and nasal nitric oxide in healthy children and teens using chemiluminescence

Menou, Awen; Babeanu, Diane; Paruit, Henri-Nicolas; Ordureau, Aline; Guillard, S.; Chambellan, Arnaud

doi:10.1088/1752-7163/aa76ef

Cited by 17 publications

(19 citation statements)

References 58 publications

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“…In females, nNO is higher than in males, while FeNO is lower in females than in males. The sex difference of nNO levels remains debatable: some studies reported results consistent with ours,21 others did not 3136. However, the sex difference in the current study can be reasonably explained.…”

Section: Discussionsupporting

confidence: 51%

Nasal Nitric Oxide Is Correlated With Nasal Patency and Nasal Symptoms

Ren

Zhang

et al. 2019

Allergy Asthma Immunol Res

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Purpose Nitric oxide (NO) is an important endogenous mediator in both upper and lower respiratory systems. The purpose of the present study was to extract nasal NO (nNO) normal range of Chinese adults and the internal influencing factors. The differences in nNO levels between rhinitis and asymptomatic atopic subjects, and the diagnostic value of nNO in allergic rhinitis (AR) were further investigated. Methods One thousand adults were recruited from the general public. Participants were divided into different subgroups according to the questionnaires and skin prick tests. In all of these subjects, nNO, fractional exhaled NO (FeNO) and nasal airflow resistance were measured. The normal ranges of nNO and FeNO, the differences between subgroups, and the correlations between NO (nNO and FeNO) and other internal factors were analyzed. Results Both nNO and FeNO levels were significantly higher in AR patients than in healthy and asymptomatic atopic subjects. The nNO levels were significantly lower in asymptomatic atopic subjects than in normal adults. FeNO levels were significantly higher in non-AR patients than in the healthy and asymptomatic atopic adults. The cutoff value of nNO for the diagnosis of AR was 117.5 ppb (sensitivity, 50.9%; specificity, 63.9%). The nNO levels were correlated with FeNO levels, total nasal resistance measured at 75Pa, nasal volume within 0–7 cm from the anterior nares (V 0–7cm ) and nasal symptom visual analogue scale (VAS) scores, while the FeNO levels were correlated with age, height, weight, body surface area, nasal volume of V 0–7cm and the nasal symptom VAS score. Conclusions The nNO level can be significantly different between healthy and AR patients and may be significantly correlated with nasal symptoms and nasal patency of rhinitis patients. However, the clinical value of nNO is still in the exploration stage.

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Section: Discussionsupporting

confidence: 51%

Nasal Nitric Oxide Is Correlated With Nasal Patency and Nasal Symptoms

Ren

Zhang

et al. 2019

Allergy Asthma Immunol Res

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“…However, there are some limitations in the measurement of nNO to monitor nasal inflammation in AR patients. Firstly, there is no consensus regarding the reference values for nNO levels obtained with different measurement techniques 15, 16, 17, 18. Secondly, detection of nNO concentrations could be influenced by medications, such as vasoconstrictors and intranasal steroid treatments, 19 and finally, nNO levels may be low in AR patients with nasal polyps.…”

Section: Introductionmentioning

confidence: 99%

“…Secondly, detection of nNO concentrations could be influenced by medications, such as vasoconstrictors and intranasal steroid treatments, 19 and finally, nNO levels may be low in AR patients with nasal polyps. These limitations make interpretations based on a single measure difficult in clinical practice 15, 16, 17, 18, 19, 20, 21…”

Section: Introductionmentioning

confidence: 99%

Nasal nitric oxide is a useful biomarker for acute unilateral maxillary sinusitis in pediatric allergic rhinitis: A prospective observational cohort study

Wen

Lin

Yang

et al. 2019

World Allergy Organization Journal

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Background Nasal nitric oxide (nNO) could be a biomarker for nasal passage inflammation and sinus ostial patency. We have aimed to investigate the nNO concentration and the effect of antibiotic therapy in children with perennial allergic rhinitis (PAR) children with/without acute bacterial sinusitis. Methods We enrolled a cohort of 90 and 31 children with PAR, without and with acute unilateral maxillary sinusitis, and 79 normal children. Acute bacterial maxillary sinusitis was diagnosed based on clinical signs and symptoms, radiographic examination and nasal fibroendoscopy. Rhinitis control assessment test (RCAT), rhinomanometry, nNO and fractional exhaled NO (FENO) measurements were performed before and 2 weeks after antibiotic therapy. Results We found significantly higher mean nNO levels, FENO values, and total nasal resistance in children with PAR than in normal children ( p < 0.05). Acute unilateral maxillary sinusitis was associated with lower lesion-side nNO levels, higher FENO values, total nasal resistance, and poor RCAT scores ( p < 0.05). In multivariate analysis, age, IgE, and acute maxillary sinusitis were significant factors influencing nNO levels in children with PAR. The lesion-side nNO levels, FENO values, total nasal resistance, and RCAT scores were reversed after antibiotic therapy ( p < 0.05). The lesion-side nNO levels were significantly correlated to nasal obstructive scores ( r = 0.59, p < 0.05) and expiratory nasal resistance ( r = −0.54, p < 0.05) in the acute maxillary sinusitis. A cut-off nNO value of 538 ppb showed 100% sensitivity and 94.9% specificity, to predict PAR from normal children. An nNO value of 462 ppb showed 100% sensitivity and 100% specificity to discriminate between the lesion-side and the unaffected sinus-side in PAR children with acute unilateral maxillary sinusitis. Conclusions We conclude that the obstruction of NO from the sinus into the nasal passage is the likely explanation for the decreased lesion-side nNO levels in acute unilateral maxillary sinusitis. nNO is a non-invasive biomarker with high sensitivity to diagnose and monitor treatment responses of PAR patients with acute rhinosinusitis. Both nNO and FENO levels return to baseline following antibiotic therapy, supporting the “one airway one disease” concept.

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“…5 However, these guidelines and other studies considered only patients older than 4 years of age, and the method used was the "online" method, where the individual must maintain a flow of 50 mL/s. [11][12][13][14][15][16] In 2005, the ATS/ERS made some recommendations for the standardization of measurements of eNO with the "online" and "offline" methods, and the "offline" measurement of eNO at tidal volume is mentioned as an alternative to the other methods described. 7 By the end of the 1990s, some studies were published concerning toddlers and preschoolers with wheezing in which eNO was measured with the "offline" method at tidal volume using chemiluminescence equipment, and it was shown that preschoolers presented higher values of eNO during wheezing episodes (14.1 +-1.8 ppb), which improved after steroid treatment, reducing eNO levels up to 52%.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, there are several studies that have reported reference values with the "offline" method at different respiratory flows and even in children less than 2 years of age. 9,12,13,16,[19][20][21][22] Even so, the main limitation to reproduce this technique is the availability of chemiluminescence equipment, which is expensive and difficult to access for most centers. 23 The present study demonstrates that the measurements of eNO obtained by the "offline" technique through breathing at tidal volume can be analyzed by electrochemical devices, and the results are interchangeable with those analyzed using the gold-standard chemiluminescence equipment.…”

Section: Discussionmentioning

confidence: 99%

Offline exhaled nitric oxide in children: chemiluminescence vs. electrochemical devices

Rangel

Madrid

Valderrabano

et al. 2020

Preprint

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Background: Exhaled nitric oxide (eNO) is a noninvasive marker of airway inflammation that can be measured by the "online" or "offline" technique. There are few articles that measure "offline" eNO in children at tidal volume and to our knowledge there is no article that compares the concordance and correlation between 2 different technologies measured offline at tidal volume. Objective: is to report the concordance and correlation of the eNO results obtained with a chemiluminescence vs. an electrochemical device by the "offline" technique at tidal volume. Methods: A cross-sectional, observational and prospective study was conducted in the National Institute of Respiratory Diseases, Mexico City. Healthy children and those with any lung disease between 1 and 11 years of age were included. The exhaled air sample was obtained at tidal volume by attaching a mask with a connection to a Mylar® bag. Results: 36 children were studied. The average (±SD) age of the study population was 6 ± 2.6 years; 25% of subjects included were healthy, and the rest had lung disease. The concordance correlation coefficient between the two measuring devices was 0.98 (p<0.001), with an average difference of 1.46 ± 3.5 ppb and 95% limits of agreement from-5.3 ppb to 8.3 ppb. The linear regression model equation for the estimation of eNO was eNO,cl = (eNO,eq• 1.0718)-0.1343, (r2 = 0.97) Conclusion: The measurement of eNO by the "offline" method at tidal volume can be analyzed by electrochemical devices, and the results are interchangeable with those analyzed by chemiluminescence technology.

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Normal values of offline exhaled and nasal nitric oxide in healthy children and teens using chemiluminescence

Abstract: The use of offline eNO and nNO normal values should favour the widespread screening of respiratory diseases in children of school age in their usual environment.

Cited by 17 publications

References 58 publications

Nasal Nitric Oxide Is Correlated With Nasal Patency and Nasal Symptoms

Nasal Nitric Oxide Is Correlated With Nasal Patency and Nasal Symptoms

Nasal nitric oxide is a useful biomarker for acute unilateral maxillary sinusitis in pediatric allergic rhinitis: A prospective observational cohort study

Offline exhaled nitric oxide in children: chemiluminescence vs. electrochemical devices

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