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Karvonen T, Lehtimäki L. Effect of exhalation flow rates and level of nitric oxide output on accuracy of linear approximation of pulmonary nitric oxide dynamics. J Breath Res 2021; 15. [PMID: 33784646 DOI: 10.1088/1752-7163/abf3ab] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/30/2021] [Indexed: 11/11/2022]
Abstract
The method of Tsoukias and George (T and G) is a commonly used linear approximation of pulmonary nitric oxide (NO) dynamics that can be used to calculate bronchial NO output (JawNO) and alveolar NO concentration (CANO). We aimed to investigate how flow rate range in exhaled NO measurements and levels of pulmonary NO parameters affect the accuracy of the T and G method. This study has three parts. (a) A theoretical part demonstrating how different exhalation flow rates and NO parameter levels affect the accuracy of the T and G method, (b) testing how exhalation flow rate range affects the method in a sample of asthmatic and healthy subjects, and (c) a meta-analysis of published literature to test whether minimum flow rate has an association with the NO parameter values. We found that both the chosen exhalation flow rates and magnitude of the pulmonary NO parameters affect the accuracy of the T and G method. Underestimation ofJawNO increased with lower flow rates and higher bronchial diffusion factor of NO (DawNO), while overestimation of CANO increased with higher DawNO and bronchial wall NO concentration (CawNO) and lower CANO. Of the NO parameters, CANO was the most prone to bias and high DawNO was the most significant factor causing the bias. Furthermore, we found that using 40 ml s-1as the lowest flow rate in our sample and 50 ml s-1in the meta-analysis compared to 100 ml s-1resulted in higher CANO, but JawNO was not statistically significantly affected. We have provided objective evidence that not only the flow rates used but also the magnitude of NO output in the test subjects affect the accuracy of the T and G method. We suggest that flow rates below 100 ml s-1should not be used with the T and G method to maintain accuracy.
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Affiliation(s)
- Tuomas Karvonen
- Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Lauri Lehtimäki
- Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
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2
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Karvonen T, Lehtimäki L. Flow-independent nitric oxide parameters in asthma: a systematic review and meta-analysis. J Breath Res 2019; 13:044001. [PMID: 31239409 DOI: 10.1088/1752-7163/ab2c99] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Fractional exhaled nitric oxide (FENO) has been proposed as a non-invasive marker of inflammation in the lungs. Measuring FENO at several flow rates enables the calculation of flow independent NO-parameters that describe the NO-exchange dynamics of the lungs more precisely. The purpose of this study was to compare the NO-parameters between asthmatics and healthy subjects in a systematic review and meta-analysis. METHODS A systematic search was performed in Ovid Medline, Web of Science, Scopus and Cochrane Library databases. All studies with asthmatic and healthy control groups with at least one NO-parameter calculated were included. RESULTS From 1137 identified studies, 33 were included in the meta-analysis. All NO-parameters (alveolar NO concentration (CANO), bronchial flux of NO (JawNO), bronchial mucosal NO concentration (CawNO) and bronchial wall NO diffusion capacity (DawNO)) were found increased in glucocorticoid-treated and glucocorticoid-naïve asthma. JawNO and CANO were most notably increased in both study groups. Elevation of DawNO and CawNO seemed less prominent in both asthma groups. DISCUSSION We found that all the NO-parameters are elevated in asthma as compared to healthy subjects. However, results were highly heterogenous and the evidence on CawNO and DawNO is still quite feeble due to only few studies reporting them. To gain more knowledge on the NO-parameters in asthma, nonlinear methods and standardized study protocols should be used in future studies.
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Affiliation(s)
- Tuomas Karvonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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3
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Kuo Y, Fu-Sheng Wu F, Lee Y, Rong-Yei Lin T, Crane J, Siebers R. Effect of Betel (Areca) Nut Chewing on Fractional Exhaled Nitric Oxide: A Pilot Study. THE INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE 2018; 9:205-2088. [PMID: 30325361 PMCID: PMC6466991 DOI: 10.15171/ijoem.2018.1334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/06/2018] [Indexed: 11/09/2022]
Abstract
Betel (areca) nuts are extensively chewed in many countries. This has been associated with respiratory symptoms. We aimed to determine whether betel nut chewing is associated with acute changes in fractional exhaled nitric oxide, a non-invasive marker of airway inflammation. Betel nut chewing resulted in an immediate significant decline in fractional exhaled nitric oxide levels that persisted for up to 180 minutes. This effect has to be taken into account in epidemiological studies, reference ranges, and patient preparation.
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Affiliation(s)
- YiChieh Kuo
- Show Chwan Memorial Hospital, Changhua City, Taiwan.,Chung Chou University of Science and Technology, Changhua, Taiwan
| | - Francis Fu-Sheng Wu
- Show Chwan Memorial Hospital, Changhua City, Taiwan.,Chung Chou University of Science and Technology, Changhua, Taiwan.,School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - YingChung Lee
- Chung Chou University of Science and Technology, Changhua, Taiwan
| | | | - Julian Crane
- School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Robert Siebers
- School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand.
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4
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Lassmann-Klee PG, Lehtimäki L, Lindholm T, Malmberg LP, Sovijärvi ARA, Piirilä P. Influence of mouthwashes on extended exhaled nitric oxide (F ENO) analysis. Scandinavian Journal of Clinical and Laboratory Investigation 2018; 78:450-455. [PMID: 30345835 DOI: 10.1080/00365513.2018.1497802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Fractional exhaled nitric oxide (FENO) is used to assess eosinophilic inflammation of the airways. FENO values are influenced by the expiratory flow rate and orally produced NO. We measured FENO at four different expiratory flow levels after two different mouthwashes: tap water and carbonated water. Further, we compared the alveolar NO concentration (CANO), maximum airway NO flux (J'awNO) and airway NO diffusion (DawNO) after these two mouthwashes. FENO was measured in 30 volunteers (healthy or asthmatic) with a chemiluminescence NO-analyser at flow rates of 30, 50, 100 and 300 mL/s. A mouthwash was performed before the measurement at every flow rate. The carbonated water mouthwash significantly reduced FENO compared to the tap water mouthwash at all expiratory flows: 50 mL/s (p < .001), 30 mL/s (p = .001), 100 mL/s (p < .001) and 300 mL/s (p = .004). J'awNO was also significantly reduced (p = .017), however, there were no significant differences in CANO and DawNO. In conclusion, a carbonated water mouthwash can significantly reduce oropharyngeal NO compared to a tap water mouthwash at expiratory flows of 30-300 mL/s without affecting the CANO and DawNO. Therefore, mouthwashes need to be taken into account when comparing FENO results.
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Affiliation(s)
- Paul Guenther Lassmann-Klee
- a Unit of Clinical Physiology, Helsinki University Central Hospital and University of Helsinki , Helsinki , Finland
| | - Lauri Lehtimäki
- b Allergy Centre, Tampere University Hospital and Faculty of Medicine and Life Sciences , University of Tampere , Tampere , Finland
| | - Tuula Lindholm
- c Laboratory of Clinical Physiology , Finnish Institute of Occupational Health , Helsinki , Finland
| | - L Pekka Malmberg
- d Laboratory of Clinical Physiology , Skin and Allergy Hospital , Helsinki , Finland
| | - Anssi Raimo Antero Sovijärvi
- a Unit of Clinical Physiology, Helsinki University Central Hospital and University of Helsinki , Helsinki , Finland
| | - Päivi Piirilä
- a Unit of Clinical Physiology, Helsinki University Central Hospital and University of Helsinki , Helsinki , Finland
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5
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Lassmann-Klee PG, Lindholm T, Metsälä M, Halonen L, Sovijärvi ARA, Piirilä P. Reduction of F ENO by tap water and carbonated water mouthwashes: magnitude and time course. Scandinavian Journal of Clinical and Laboratory Investigation 2018; 78:153-156. [PMID: 29304558 DOI: 10.1080/00365513.2017.1419574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Fractional exhaled nitric oxide (FENO) assesses eosinophilic inflammation of the airways, but FENO values are also influenced by oral nitric oxide (NO). The aim of this pilot study was to measure FENO and compare the effect of two different mouthwashes on FENO and analyse the duration of the effect. FENO was measured in 12 randomized volunteers (healthy or asthmatic subjects) with a NIOX VERO® analyser at an expiratory flow rate of 50 mL/s. After a baseline measurement, a mouthwash was performed either with tap water or carbonated water and was measured during 20 min in 2 min intervals. The procedure was repeated with the other mouthwash. We found that both mouthwashes reduced FENO immediately at the beginning compared to the baseline (p < .001). The carbonated water mouthwash effect lasted 12 min (p ranging from <0.001 to <0.05). The tap water mouthwash reduced FENO statistically significantly only for 2 min compared with the baseline. We conclude that a single carbonated water mouthwash can significantly reduce the oropharyngeal NO contribution during a 12 min time interval.
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Affiliation(s)
- Paul Guenther Lassmann-Klee
- a Unit of Clinical Physiology , Helsinki University Central Hospital, University of Helsinki , Helsinki , Finland
| | - Tuula Lindholm
- b Laboratory of Clinical Physiology , Finnish Institute of Occupational Health , Helsinki , Finland
| | - Markus Metsälä
- c Department of Chemistry , University of Helsinki , Helsinki , Finland
| | - Lauri Halonen
- c Department of Chemistry , University of Helsinki , Helsinki , Finland
| | - Anssi Raimo Antero Sovijärvi
- a Unit of Clinical Physiology , Helsinki University Central Hospital, University of Helsinki , Helsinki , Finland
| | - Päivi Piirilä
- a Unit of Clinical Physiology , Helsinki University Central Hospital, University of Helsinki , Helsinki , Finland
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6
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Heijkenskjöld Rentzhog C, Janson C, Berglund L, Borres MP, Nordvall L, Alving K, Malinovschi A. Overall and peripheral lung function assessment by spirometry and forced oscillation technique in relation to asthma diagnosis and control. Clin Exp Allergy 2017; 47:1546-1554. [PMID: 28940832 DOI: 10.1111/cea.13035] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 06/21/2017] [Accepted: 08/19/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Classic spirometry is effort dependent and of limited value in assessing small airways. Peripheral airway involvement, and relation to poor control, in asthma, has been highlighted recently. Forced oscillation technique (FOT) offers an effort-independent assessment of overall and peripheral lung mechanics. We studied the association between lung function variables, obtained either by spirometry or multifrequency (5, 11 and 19 Hz) FOT, and asthma diagnosis and control. METHODS Spirometry measures, resistance at 5 (R5) and 19 Hz (R19), reactance at 5 Hz (X5), resonant frequency (fres ), resistance difference between 5-19 Hz (R5-R19) and Asthma Control Test scores were determined in 234 asthmatic and 60 healthy subjects (aged 13-39 years). We used standardized lung function variables in logistic regression analyses, unadjusted and adjusted for age, height, gender and weight. RESULTS Lower FEV1 /FVC (OR [95% CI] 0.47 [0.32, 0.69]) and FEF50 (0.62 [0.46, 0.85]) per standard deviation increase, and higher R5 (3.31 [1.95, 5.62]) and R19 (2.54 [1.65, 3.91]) were associated with asthma diagnosis. Independent predictive effects of FEV1 /FVC and R5 or R19, respectively, were found for asthma diagnosis. Lower FEV1 /FVC and altered peripheral FOT measures (X5, fres and R5-R19) were associated with uncontrolled asthma (P-values < .05). CONCLUSIONS Resistance FOT measures were equally informative as spirometry, related to asthma diagnosis, and, furthermore, offered additive information to FEV1 /FVC, supporting a complementary role for FOT. Asthma control was related to FOT measures of peripheral airways, suggesting a potential use in identifying such involvement. Further studies are needed to determine a clinical value and relevant reference values in children, for the multifrequency FOT measurements.
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Affiliation(s)
| | - C Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - L Berglund
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - M P Borres
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - L Nordvall
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - K Alving
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - A Malinovschi
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
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7
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Karvonen T, Kankaanranta H, Saarelainen S, Moilanen E, Lehtimäki L. Comparison of feasibility and estimates of central and peripheral nitric oxide parameters by different mathematical models. J Breath Res 2017; 11:047102. [DOI: 10.1088/1752-7163/aa7cc0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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8
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Horváth I, Barnes PJ, Loukides S, Sterk PJ, Högman M, Olin AC, Amann A, Antus B, Baraldi E, Bikov A, Boots AW, Bos LD, Brinkman P, Bucca C, Carpagnano GE, Corradi M, Cristescu S, de Jongste JC, Dinh-Xuan AT, Dompeling E, Fens N, Fowler S, Hohlfeld JM, Holz O, Jöbsis Q, Van De Kant K, Knobel HH, Kostikas K, Lehtimäki L, Lundberg J, Montuschi P, Van Muylem A, Pennazza G, Reinhold P, Ricciardolo FLM, Rosias P, Santonico M, van der Schee MP, van Schooten FJ, Spanevello A, Tonia T, Vink TJ. A European Respiratory Society technical standard: exhaled biomarkers in lung disease. Eur Respir J 2017; 49:49/4/1600965. [PMID: 28446552 DOI: 10.1183/13993003.00965-2016] [Citation(s) in RCA: 369] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 01/09/2017] [Indexed: 12/19/2022]
Abstract
Breath tests cover the fraction of nitric oxide in expired gas (FeNO), volatile organic compounds (VOCs), variables in exhaled breath condensate (EBC) and other measurements. For EBC and for FeNO, official recommendations for standardised procedures are more than 10 years old and there is none for exhaled VOCs and particles. The aim of this document is to provide technical standards and recommendations for sample collection and analytic approaches and to highlight future research priorities in the field. For EBC and FeNO, new developments and advances in technology have been evaluated in the current document. This report is not intended to provide clinical guidance on disease diagnosis and management.Clinicians and researchers with expertise in exhaled biomarkers were invited to participate. Published studies regarding methodology of breath tests were selected, discussed and evaluated in a consensus-based manner by the Task Force members.Recommendations for standardisation of sampling, analysing and reporting of data and suggestions for research to cover gaps in the evidence have been created and summarised.Application of breath biomarker measurement in a standardised manner will provide comparable results, thereby facilitating the potential use of these biomarkers in clinical practice.
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Affiliation(s)
- Ildiko Horváth
- Dept of Pulmonology, National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Peter J Barnes
- National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital, London, UK
| | | | - Peter J Sterk
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieann Högman
- Centre for Research & Development, Uppsala University/Gävleborg County Council, Gävle, Sweden
| | - Anna-Carin Olin
- Occupational and Environmental Medicine, Sahlgrenska Academy and University Hospital, Goteborg, Sweden
| | - Anton Amann
- Innsbruck Medical University, Innsbruck, Austria
| | - Balazs Antus
- Dept of Pathophysiology, National Korányi Institute of Pulmonology, Budapest, Hungary
| | | | - Andras Bikov
- Dept of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Agnes W Boots
- Dept of Pharmacology and Toxicology, University of Maastricht, Maastricht, The Netherlands
| | - Lieuwe D Bos
- Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul Brinkman
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Caterina Bucca
- Biomedical Sciences and Human Oncology, Universita' di Torino, Turin, Italy
| | | | | | - Simona Cristescu
- Dept of Molecular and Laser Physics, Institute for Molecules and Materials, Radboud University, Nijmegen, The Netherlands
| | - Johan C de Jongste
- Dept of Pediatrics/Respiratory Medicine, Erasmus MC-Sophia Childrens' Hospital, Rotterdam, The Netherlands
| | | | - Edward Dompeling
- Dept of Paediatrics/Family Medicine Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Niki Fens
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Stephen Fowler
- Respiratory Research Group, University of Manchester Wythenshawe Hospital, Manchester, UK
| | - Jens M Hohlfeld
- Clinical Airway Research, Fraunhofer Institute of Toxicology and Experimental Medicine (ITEM), Hannover, Germany.,Medizinische Hochschule Hannover, Hannover, Germany
| | - Olaf Holz
- Clinical Airway Research, Fraunhofer Institute of Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Quirijn Jöbsis
- Department of Paediatric Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Kim Van De Kant
- Dept of Paediatrics/Family Medicine Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hugo H Knobel
- Philips Research, High Tech Campus 11, Eindhoven, The Netherlands
| | | | | | - Jon Lundberg
- Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Montuschi
- Pharmacology, Catholic University of the Sacred Heart, Rome, Italy
| | - Alain Van Muylem
- Hopital Erasme Cliniques Universitaires de Bruxelles, Bruxelles, Belgium
| | - Giorgio Pennazza
- Faculty of Engineering, University Campus Bio-Medico, Rome, Italy
| | - Petra Reinhold
- Institute of Molecular Pathogenesis, Friedrich Loeffler Institut, Jena, Germany
| | - Fabio L M Ricciardolo
- Clinic of Respiratory Disease, Dept of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Philippe Rosias
- Dept of Paediatrics/Family Medicine Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands.,Dept of Pediatrics, Maasland Hospital, Sittard, The Netherlands
| | - Marco Santonico
- Faculty of Engineering, University Campus Bio-Medico, Rome, Italy
| | - Marc P van der Schee
- Dept of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Thomy Tonia
- European Respiratory Society, Lausanne, Switzerland
| | - Teunis J Vink
- Philips Research, High Tech Campus 11, Eindhoven, The Netherlands
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9
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Status of selected ion flow tube MS: accomplishments and challenges in breath analysis and other areas. Bioanalysis 2016; 8:1183-201. [PMID: 27212131 DOI: 10.4155/bio-2016-0038] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
This article reflects our observations of recent accomplishments made using selected ion flow tube MS (SIFT-MS). Only brief descriptions are given of SIFT-MS as an analytical method and of the recent extensions to the underpinning analytical ion chemistry required to realize more robust analyses. The challenge of breath analysis is given special attention because, when achieved, it renders analysis of other air media relatively straightforward. Brief overviews are given of recent SIFT-MS breath analyses by leading research groups, noting the desirability of detection and quantification of single volatile biomarkers rather than reliance on statistical analyses, if breath analysis is to be accepted into clinical practice. A 'strengths, weaknesses, opportunities and threats' analysis of SIFT-MS is made, which should help to increase its utility for trace gas analysis.
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10
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Smith D, Spanel P. Pitfalls in the analysis of volatile breath biomarkers: suggested solutions and SIFT-MS quantification of single metabolites. J Breath Res 2015; 9:022001. [PMID: 25830501 DOI: 10.1088/1752-7155/9/2/022001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The experimental challenges presented by the analysis of trace volatile organic compounds (VOCs) in exhaled breath with the objective of identifying reliable biomarkers are brought into focus. It is stressed that positive identification and accurate quantification of the VOCs are imperative if they are to be considered as discreet biomarkers. Breath sampling procedures are discussed and it is suggested that for accurate quantification on-line real time sampling and analysis is desirable. Whilst recognizing such real time analysis is not always possible and sample collection is often required, objective recognition of the pitfalls involved in this is essential. It is also emphasized that mouth-exhaled breath is always contaminated to some degree by orally generated compounds and so, when possible, analysis of nose-exhaled breath should be performed. Some difficulties in breath analysis are mitigated by the choice of analytical instrumentation used, but no single instrument can provide solutions to all the analytical challenges. Analysis and interpretation of breath analysis data, however acquired, needs to be treated circumspectly. In particular, the excessive use of statistics to treat imperfect mass spectrometry/mobility spectra should be avoided, since it can result in unjustifiable conclusions. It is should be understood that recognition of combinations of VOCs in breath that, for example, apparently describe particular cancer states, will not be taken seriously until they are replicated in other laboratories and clinics. Finally, the inhibiting notion that single biomarkers of infection and disease will not be identified and utilized clinically should be dispelled by the exemplary and widely used single biomarkers NO and H2 and now, as indicated by recent selected ion flow tube mass spectroscopy (SIFT-MS) results, triatomic hydrogen cyanide and perhaps pentane and acetic acid. Hopefully, these discoveries will provide encouragement to research workers to be more open-minded on this important and desirable issue.
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Affiliation(s)
- David Smith
- Institute for Science and Technology in Medicine, School of Medicine, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent ST4 7QB, UK
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11
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Heijkenskjöld-Rentzhog C, Nordvall L, Janson C, Borres MP, Alving K, Malinovschi A. Alveolar and exhaled NO in relation to asthma characteristics--effects of correction for axial diffusion. Allergy 2014; 69:1102-11. [PMID: 24894594 DOI: 10.1111/all.12430] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Inflammation in the small airways might contribute to incomplete asthma disease control despite intensive treatment in some subgroups of patients. Exhaled NO (FeNO) is a marker of inflammation in asthma and the estimated NO contribution from small airways (CalvNO ) is believed to reflect distal inflammation. Recent studies recommend adjustments of CalvNO for trumpet model and axial diffusion (TMAD-adj). This study aimed to investigate the clinical correlates of CalvNO , both TMAD-adjusted and unadjusted. METHODS Asthma symptoms, asthma control, lung function, bronchial responsiveness, blood eosinophils, atopy and treatment level were assessed in 410 subjects, aged 10-35 years. Exhaled NO was measured at different flow-rates and CalvNO calculated, with TMAD-adjustment according to Condorelli. RESULTS Trumpet model and axial diffusion-adjusted CalvNO was not related to daytime wheeze (P = 0.27), FEF50 (P = 0.23) or bronchial responsiveness (P = 0.52). On the other hand, unadjusted CalvNO was increased in subjects with daytime wheeze (P < 0.001), decreased FEF50 (P = 0.02) and with moderate-to-severe compared to normal bronchial responsiveness (P < 0.001). All these characteristics correlated with increased FeNO (all P < 0.05). Unadjusted CalvNO was positively related to bronchial NO flux (J'awNO ) (r = 0.22, P < 0.001) while TMAD-adjCalvNO was negatively related to J'awNO (r = -0.38, P < 0.001). CONCLUSIONS Adjusted CalvNO was not associated with any asthma characteristics studied in this large asthma cohort. However, both FeNO and unadjusted CalvNO related to asthma symptoms, lung function and bronchial responsiveness. We suggest a potential overadjustment by current TMAD-corrections, validated in healthy or unobstructed asthmatics. Further studies assessing axial diffusion in asthmatics with different degrees of airway obstruction and the validity of proposed TMAD-corrections are warranted.
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Affiliation(s)
| | - L. Nordvall
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - C. Janson
- Department of Medical Sciences: Respiratory Medicine and Allergology; Uppsala University; Uppsala Sweden
| | - M. P. Borres
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - K. Alving
- Department of Women's and Children's Health; Uppsala University; Uppsala Sweden
| | - A. Malinovschi
- Department of Medical Sciences: Clinical Physiology; Uppsala University; Uppsala Sweden
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12
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Bjerg A, Lötvall J. Sniffing out steroid responsiveness in asthma using an electronic nose. Clin Exp Allergy 2014; 43:1198-9. [PMID: 24152151 DOI: 10.1111/cea.12192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- A Bjerg
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Göteborg, Sweden
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13
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Roos AB, Mori M, Grönneberg R, Österlund C, Claesson HE, Wahlström J, Grunewald J, Eklund A, Erjefält JS, Lundberg JO, Nord M. Elevated exhaled nitric oxide in allergen-provoked asthma is associated with airway epithelial iNOS. PLoS One 2014; 9:e90018. [PMID: 24587191 PMCID: PMC3938593 DOI: 10.1371/journal.pone.0090018] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 12/03/2013] [Indexed: 01/01/2023] Open
Abstract
Background Fractional exhaled nitric oxide is elevated in allergen-provoked asthma. The cellular and molecular source of the elevated fractional exhaled nitric oxide is, however, uncertain. Objective To investigate whether fractional exhaled nitric oxide is associated with increased airway epithelial inducible nitric oxide synthase (iNOS) in allergen-provoked asthma. Methods Fractional exhaled nitric oxide was measured in healthy controls (n = 14) and allergic asthmatics (n = 12), before and after bronchial provocation to birch pollen out of season. Bronchoscopy was performed before and 24 hours after allergen provocation. Bronchial biopsies and brush biopsies were processed for nitric oxide synthase activity staining with nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d), iNOS immunostaining, or gene expression analysis of iNOS by real-time PCR. NADPH-d and iNOS staining were quantified using automated morphometric analysis. Results Fractional exhaled nitric oxide and expression of iNOS mRNA were significantly higher in un-provoked asthmatics, compared to healthy controls. Allergic asthmatics exhibited a significant elevation of fractional exhaled nitric oxide after allergen provocation, as well as an accumulation of airway eosinophils. Moreover, nitric oxide synthase activity and expression of iNOS was significantly increased in the bronchial epithelium of asthmatics following allergen provocation. Fractional exhaled nitric oxide correlated with eosinophils and iNOS expression. Conclusion Higher fractional exhaled nitric oxide concentration among asthmatics is associated with elevated iNOS mRNA in the bronchial epithelium. Furthermore, our data demonstrates for the first time increased expression and activity of iNOS in the bronchial epithelium after allergen provocation, and thus provide a mechanistic explanation for elevated fractional exhaled nitric oxide in allergen-provoked asthma.
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Affiliation(s)
- Abraham B. Roos
- Department of Medicine, Solna, Respiratory Medicine Unit, Karolinska Institutet, Stockholm, Sweden
- Department of Experimental Medical Science, Lund University, Lund, Sweden
- * E-mail:
| | - Michiko Mori
- Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Reidar Grönneberg
- Department of Medicine, Solna, Respiratory Medicine Unit, Karolinska Institutet, Stockholm, Sweden
| | - Christina Österlund
- Department of Medicine, Division of Hematology, Karolinska Institutet, Stockholm, Sweden
| | - Hans-Erik Claesson
- Department of Medicine, Division of Hematology, Karolinska Institutet, Stockholm, Sweden
| | - Jan Wahlström
- Department of Medicine, Solna, Respiratory Medicine Unit, Karolinska Institutet, Stockholm, Sweden
| | - Johan Grunewald
- Department of Medicine, Solna, Respiratory Medicine Unit, Karolinska Institutet, Stockholm, Sweden
| | - Anders Eklund
- Department of Medicine, Solna, Respiratory Medicine Unit, Karolinska Institutet, Stockholm, Sweden
| | - Jonas S. Erjefält
- Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Jon O. Lundberg
- Department of Physiology and Pharmacology, Section of Pharmacological Nitric Oxide Research, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Nord
- Department of Medicine, Solna, Respiratory Medicine Unit, Karolinska Institutet, Stockholm, Sweden
- Safety Science, Global Regulatory Affairs & Patient Safety, AstraZeneca Global Medicines Development, Mölndal, Sweden
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Ludviksdottir D, Diamant Z, Alving K, Bjermer L, Malinovschi A. Clinical aspects of using exhaled NO in asthma diagnosis and management. CLINICAL RESPIRATORY JOURNAL 2012; 6:193-207. [DOI: 10.1111/crj.12001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | | | - Kjell Alving
- Department of Women's and Children's Health; Uppsala University; Uppsala; Sweden
| | - Leif Bjermer
- Department of Respiratory Diseases and Allergology; Skane University; Lund; Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences: Clinical Physiology; Uppsala University; Uppsala; Sweden
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