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Wang R, Fowler SJ, Turner SW, Drake S, Healy L, Lowe L, Wardman H, Bennett M, Custovic A, Simpson A, Murray CS. Defining the normal range of fractional exhaled nitric oxide in children: one size does not fit all. ERJ Open Res 2022; 8:00319-2022. [PMID: 36105153 PMCID: PMC9465007 DOI: 10.1183/23120541.00319-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/03/2022] [Indexed: 11/05/2022] Open
Abstract
Background The normal range of fractional exhaled nitric oxide (F ENO) is influenced by demographic factors. However, single, fixed cut-off values are used for clinical interpretation in children despite rapid growth. We aimed to define the normal range of F ENO during childhood and evaluate its utility in a diagnostic setting. Method F ENO percentile charts were developed using data from nonasthmatic children in a population-based birth cohort (Manchester Asthma and Allergy Study). Children were skin prick tested, F ENO measured at the ages of 8, 11, 13-16 and 18 years and clinical information collected. This chart was externally validated in the Study of Eczema and Asthma to Observe the Influence of Nutrition (SEATON) cohort before being prospectively tested in symptomatic, treatment-naïve patients with suspected asthma in a diagnostic setting (Rapid Access Diagnostics for Asthma study). Results Height, weight, body mass index and age were predictive of F ENO in univariate analysis using 1220 F ENO measurements. Only height remained significant after adjustment in the overall, nonatopic and atopic populations, and was included in the predictive equations for 50th, 75th 90th and 98th percentiles. The proposed percentile lines corresponded to the 57th (95% CI 53rd-61st), 80th (76th-83rd), 90th (87th-92nd) and 98th (96th-99th) percentiles in the SEATON cohort (660 measurements). When tested in 73 symptomatic treatment-naïve children and young adults (median (interquartile range) age: 11 (8-14) years), an F ENO >90th percentile gave a 96% specificity and positive predictive value of 97%, identifying 59% of children who were subsequently diagnosed with asthma after extensive testing. Conclusion We developed a height-based F ENO percentile chart which quantifies the probability of asthma in symptomatic children and merits further validation towards clinical implementation.
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Affiliation(s)
- Ran Wang
- Division of Immunology, Immunity to infection & Respiratory Medicine, School of Biological Sciences, The University of Manchester. Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Stephen J. Fowler
- Division of Immunology, Immunity to infection & Respiratory Medicine, School of Biological Sciences, The University of Manchester. Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Stephen W. Turner
- Women and Children's Division, NHS Grampian, Aberdeen, UK
- Child Health, University of Aberdeen, Aberdeen, UK
| | - Sarah Drake
- Division of Immunology, Immunity to infection & Respiratory Medicine, School of Biological Sciences, The University of Manchester. Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Laura Healy
- Division of Immunology, Immunity to infection & Respiratory Medicine, School of Biological Sciences, The University of Manchester. Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Lesley Lowe
- Division of Immunology, Immunity to infection & Respiratory Medicine, School of Biological Sciences, The University of Manchester. Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Hannah Wardman
- University of Manchester, Centre for Primary Care and Health Services Research, Manchester, UK
| | - Miriam Bennett
- Division of Immunology, Immunity to infection & Respiratory Medicine, School of Biological Sciences, The University of Manchester. Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Adnan Custovic
- Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, UK
| | - Angela Simpson
- Division of Immunology, Immunity to infection & Respiratory Medicine, School of Biological Sciences, The University of Manchester. Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
- Joint senior authors
| | - Clare S. Murray
- Division of Immunology, Immunity to infection & Respiratory Medicine, School of Biological Sciences, The University of Manchester. Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
- Joint senior authors
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2
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Bandara SMR, Samita S, Kiridana AM, Herath HMMTB. Elevated nitric oxide and carbon monoxide concentration in nasal-paranasal sinus air as a diagnostic tool of migraine: a case - control study. BMC Neurol 2021; 21:407. [PMID: 34702215 PMCID: PMC8547087 DOI: 10.1186/s12883-021-02434-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 10/07/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND A recent study showed that 60-s paranasal air suction results in an immediate pain relief in acute migraine. This is the study to assess the Nitric Oxide (NO) and Carbon Monoxide (CO) concentration in nasal-paranasal sinus air of migraine patients and to compare it with healthy controls. METHODOLOGY The NO and CO levels of air sucked out from nasal-paranasal sinuses of 20 migraine adolescent and young adults among school students, aged 16 -19 years, and 22 healthy similar aged school students as controls were measured as key responses using a portable NO and a portable CO analyzer. RESULTS Patients had comparatively high values compared to the controls for paranasal NO (both left and right sides), paranasal CO (both left and right sides), Fraction Exhaled NO (FeNO) and Fraction Exhaled CO (FeCO). Patients had median paranasal NO contents of 132.5 ppb and 154 ppb on left and right sides respectively compared to 36 ppb and 34.5 ppb corresponding values in controls (P < 0.0001). Similar pattern was observed with paranasal CO (P < 0.0001). FeNO and FeCO content were also higher in patients (P < 0.0001). Receiver characteristic operating curves of all gas measurements showed that they all could classify patients and controls effectively and NO was the most effective followed by paranasal CO. After air suction, the mean pain scores of general headache and tenderness dropped by a very large margin in migraine patients (P < 0.0001). CONCLUSIONS Suctioned out high nasal-paranasal sinus NO and CO levels can be used to distinguish migraine patients from healthy subjects. In fact, suctioned out paranasal NO measurements of both sides with a cutoff point of 50 ppb provided a perfect classification of patients and controls. Increased sinus NO and CO during acute episode of migraine is an observation we had and we agree that further studies are needed to conclude that NO and CO can be a causative molecule for migraine headache. TRAIL REGISTRATION Clinical Trial Government Identification Number - 1548/2016. Ethical Clearance Granted Institute - Medical Research Institute, Colombo, Sri Lanka (No 38/2016). Sri Lanka Clinical Trial Registration number: SLCTR/ 2017/018 (29/06/2017). Approval Granting Organization to use the device in the clinical trial- National Medicines Regulatory Authority Sri Lanka (16/06/2018), The device won award at Geneva international inventers exhibition in 2016 and President award in 2018 in Sri Lanka. It is a patented device in Sri Lanka and patent number was SLKP/1/18295. All methods were carried out in accordance with CONSORT 2010 guidelines.
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Affiliation(s)
| | - S Samita
- University of Peradeniya, Peradeniya, Sri Lanka
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3
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Garcia E, Zhang Y, Rappaport EB, Berhane K, Muchmore P, Silkoff PE, Molshatzki N, Gilliland FD, Eckel SP. Patterns and determinants of exhaled nitric oxide trajectories in schoolchildren over a 7-year period. Eur Respir J 2020; 56:13993003.00011-2020. [PMID: 32299857 DOI: 10.1183/13993003.00011-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 03/24/2020] [Indexed: 11/05/2022]
Abstract
Fractional exhaled nitric oxide (F ENO50 ), a marker of allergic airway inflammation, is used in respiratory research and asthma clinical care; however, its trajectory with increasing age during childhood has not been well characterised. We examined F ENO50 longitudinally during a period of important somatic growth to describe trajectories across childhood and adolescence in healthy participants and evaluate clinical factors as potential determinants of trajectories.F ENO50 was collected at six visits over 8 years in a population-based cohort of 1791 schoolchildren without asthma (median age at entry 8.4 years). Smooth sex-specific F ENO50 trajectories were estimated using generalised additive mixed models, with participant-level random effects. We evaluated whether sex-specific trajectories were influenced by race/ethnicity, body mass index (BMI) percentile, allergic rhinitis or puberty.Different F ENO50 patterns were observed by sex in later childhood and several factors were associated with either F ENO50 level or change in F ENO50 as participants aged. F ENO50 -age trajectories were similar by sex until age ∼11.5 years, after which males had greater F ENO50 change than females. This divergence in F ENO50 -age trajectories coincides with puberty. Males with higher starting BMI percentile had attenuated F ENO50 -age slopes. Among males, F ENO50 levels were lower in non-Hispanic white subjects. Among both sexes, participants with rhinitis had higher F ENO50 F ENO50 levels within individuals tracked over time; however, there was considerable variation in F ENO50 patterns across participants.F ENO50 trajectories from longitudinal data provide evidence of sex differences coinciding with puberty, suggesting potential hormone link. Improved understanding of determinants of F ENO50 trajectories is needed to realise the potential for using individualised predicted F ENO50 trajectories.
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Affiliation(s)
- Erika Garcia
- Dept of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yue Zhang
- Dept of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Edward B Rappaport
- Dept of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kiros Berhane
- Dept of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Patrick Muchmore
- Dept of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Noa Molshatzki
- Dept of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Frank D Gilliland
- Dept of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sandrah P Eckel
- Dept of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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4
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Ben Fraj S, Miladi A, Guezguez F, Ben Rejeb M, Bouguila J, Gargouri I, Rouatbi S, Latiri I, Ben Saad H. Does Ramadan Fasting Affect Spirometric Data of Healthy Adolescents? CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2019; 13:1179556519862280. [PMID: 31384137 PMCID: PMC6659188 DOI: 10.1177/1179556519862280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/17/2019] [Indexed: 01/06/2023]
Abstract
Purpose: Several studies raised the effects of Ramadan fasting on healthy adults
spirometric data, but none was performed in children. The aim of this study
was to compare the spirometric data of a group of faster adolescents
(n = 26) with an age-matched non-faster one (n = 10). Methods: This comparative quasi-experimental study, including 36 healthy males aged 12
to 15 years, was conducted during the summer 2015 (Ramadan: June 18 to July
16). Three sessions (Before-Ramadan [Before-R], Mid-Ramadan [Mid-R],
After-Ramadan [After-R]) were selected for spirometry measurements.
Spirometry was performed around 5.5 to 3.5 h before sunset and the
spirometric data were expressed as percentages of local spirometric
norms. Results: The two groups of fasters and non-fasters had similar ages and weights
(13.35 ± 0.79 vs 12.96 ± 0.45 years, 46.8 ± 9.2 vs 41.7 ± 12.6 kg,
respectively). There was no effect of Ramadan fasting on forced vital
capacity (FVC), forced expiratory volume in 1 s (FEV1),
FEV1/FVC, peak expiratory flow, and maximal mid-expiratory
flow. For example, during the Before-R, Mid-R, and After-R sessions, there
was no significant difference between the fasters and non-fasters mean FVC
(101 ± 11 vs 99 ± 14, 101 ± 12 vs 102 ± 14, 103 ± 11 vs 104 ± 13,
respectively) or FEV1 (101 ± 13 vs 96 ± 16, 98 ± 11 vs 97 ± 16,
101 ± 10 vs 98 ± 16, respectively). Conclusions: Ramadan fasting had no interaction effect with the spirometric data of
Tunisian healthy male adolescents.
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Affiliation(s)
- Selma Ben Fraj
- Laboratoire de Physiologie et Explorations Fonctionnelles, Faculté de Médecine de Sousse, Université de Sousse, Sousse, Tunisie
| | - Amira Miladi
- Laboratoire de Physiologie et Explorations Fonctionnelles, Faculté de Médecine de Sousse, Université de Sousse, Sousse, Tunisie
| | - Fatma Guezguez
- Laboratoire de Physiologie et Explorations Fonctionnelles, Faculté de Médecine de Sousse, Université de Sousse, Sousse, Tunisie.,Department of Physiology and Functional Exploration, Farhat HACHED University Hospital, Sousse, Tunisia.,Heart Failure (LR12SP09) Research Laboratory, Farhat HACHED University Hospital, Sousse, Tunisia
| | - Mohamed Ben Rejeb
- Department of Prevention and Care Safety, Sahloul Hospital, Sousse, Tunisia
| | - Jihène Bouguila
- Department of Pediatrics, Farhat HACHED University Hospital, Sousse, Tunisia
| | - Imen Gargouri
- Department of Pulmonary, Farhat HACHED University Hospital, Sousse, Tunisia
| | - Sonia Rouatbi
- Laboratoire de Physiologie et Explorations Fonctionnelles, Faculté de Médecine de Sousse, Université de Sousse, Sousse, Tunisie.,Department of Physiology and Functional Exploration, Farhat HACHED University Hospital, Sousse, Tunisia.,Heart Failure (LR12SP09) Research Laboratory, Farhat HACHED University Hospital, Sousse, Tunisia
| | - Imed Latiri
- Laboratoire de Physiologie et Explorations Fonctionnelles, Faculté de Médecine de Sousse, Université de Sousse, Sousse, Tunisie.,Department of Physiology and Functional Exploration, Farhat HACHED University Hospital, Sousse, Tunisia.,Heart Failure (LR12SP09) Research Laboratory, Farhat HACHED University Hospital, Sousse, Tunisia
| | - Helmi Ben Saad
- Laboratoire de Physiologie et Explorations Fonctionnelles, Faculté de Médecine de Sousse, Université de Sousse, Sousse, Tunisie.,Department of Physiology and Functional Exploration, Farhat HACHED University Hospital, Sousse, Tunisia.,Heart Failure (LR12SP09) Research Laboratory, Farhat HACHED University Hospital, Sousse, Tunisia
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5
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Saito M, Kikuchi Y, Lefor AK. School-aged asthma children with high fractional exhaled nitric oxide levels and lung dysfunction are at high risk of prolonged lung dysfunction. Asia Pac Allergy 2019; 9:e8. [PMID: 30740356 PMCID: PMC6365655 DOI: 10.5415/apallergy.2019.9.e8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 01/23/2019] [Indexed: 01/06/2023] Open
Abstract
Background Long-term management of bronchial asthma based on the fractional exhaled nitric oxide (FeNO) value alone is not conclusive yet. Therefore, we combined FeNO testing and spirometry, a commonly used test in routine practice, to evaluate acute exacerbation and respiratory function in children with bronchial asthma. Objective We combined FeNO testing and spirometry, commonly used in routine practice, to evaluate acute exacerbations and respiratory function in children with bronchial asthma. Methods Subjects were school aged children 7 years and older with bronchial asthma who underwent FeNO testing in January 2015 to May 2016. We evaluated the changes in the frequency of acute exacerbations and respiratory function in the 30 subsequent months. Subjects were divided into 2 groups: those with initial FeNO levels ≥ 21 parts per billion (ppb) (high FeNO) and < 20 ppb (normal FeNO) groups. Results There were 48 children (33 boys) in the high FeNO group and 68 children (46 boys) in the normal FeNO group. Spirometry was conducted on 83 children (72%) prior to the initial FeNO test, revealing no difference in the ratio of detecting lung dysfunction between the 2 groups. The observation period was 25.8 ± 0.7 and 24.7 ± 0.6 months for the high and normal FeNO groups, respectively. The children in the high FeNO group with lung dysfunction in the initial FeNO test continued to exhibit lung dysfunction at the test at 30 months. In the normal FeNO group, even if lung dysfunction was observed at the initial FeNO, it improved within the 20-month point, and the improvement was maintained thereafter. Conclusion Children with bronchial asthma with high FeNO levels and lung dysfunction are at a higher risk of prolonged lung dysfunction.
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Affiliation(s)
- Mari Saito
- Department of Pediatrics, Haga Red Cross Hospital, Tochigi, Japan
| | - Yutaka Kikuchi
- Department of Pediatrics, Haga Red Cross Hospital, Tochigi, Japan
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6
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The Effects of Aging on Exhaled Nitric Oxide (FeNO) in a North African Population. Lung 2019; 197:73-80. [DOI: 10.1007/s00408-018-0188-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 12/16/2018] [Indexed: 11/25/2022]
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7
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Menou A, Babeanu D, Paruit HN, Ordureau A, Guillard S, Chambellan A. Normal values of offline exhaled and nasal nitric oxide in healthy children and teens using chemiluminescence. J Breath Res 2017; 11:036008. [PMID: 28579561 DOI: 10.1088/1752-7163/aa76ef] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Nitric oxide (NO) can be used to detect respiratory or ciliary diseases. Fractional exhaled nitric oxide (FeNO) measurement can reflect ongoing eosinophilic airway inflammation and has a diagnostic utility as a test for asthma screening and follow-up while nasal nitric oxide (nNO) is a valuable screening tool for the diagnosis of primary ciliary dyskinesia. The possibility of collecting airway gas samples in an offline manner offers the advantage to extend these measures and improve the screening and management of these diseases, but normal values from healthy children and teens remain sparse. METHODS Samples were consecutively collected using the offline method for eNO and nNO chemiluminescence measurement in 88 and 31 healthy children and teens, respectively. Offline eNO measurement was also performed in 30 consecutive children with naïve asthma and/or respiratory allergy. RESULTS The normal offline eNO value was determined by the following regression equation -8.206 + 0.176 × height. The upper limit of the norm for the offline eNO value was 27.4 parts per billion (ppb). A separate analysis was performed in children, pre-teens and teens, for which offline eNO was 13.6 ± 4.7 ppb, 16.3 ± 13.7 ppb and 20.0 ± 7.2 ppb, respectively. The optimal cut-off value of the offline eNO to predict asthma or respiratory allergies was 23.3 ppb, with a sensitivity and specificity of 77% and 91%, respectively. Mean offline nNO was determined at 660 ppb with the lower limit of the norm at 197 ppb. CONCLUSION 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.
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Affiliation(s)
- A Menou
- Faculte des Sciences, Université de Nantes, Nantes, France
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8
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Blake TL, Chang AB, Chatfield MD, Petsky HL, Rodwell LT, Brown MG, Hill DC, McElrea MS. Does Ethnicity Influence Fractional Exhaled Nitric Oxide in Healthy Individuals?: A Systematic Review. Chest 2017; 152:40-50. [PMID: 28215791 DOI: 10.1016/j.chest.2017.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/21/2016] [Accepted: 02/01/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Fractional exhaled nitric oxide (Feno) is used clinically as a biomarker of eosinophilic airway inflammation. Awareness of the factors influencing Feno values is important for valid clinical interpretation. METHODS We undertook a systematic review of PubMed, Cochrane Library, Scopus, and Web of Science databases and reference lists of included articles to evaluate whether ethnicity influences Feno values, and to determine if this influence affects clinical interpretation according to current guidelines. We included all studies that performed online Feno measurements on at least 25 healthy, non-Caucasian individuals, and examined the effect of ethnicity on Feno. RESULTS From 62 potential studies, 12 studies were included. One study recruited only children (< 12 years of age), six studies recruited children and/or adolescents, four studies recruited adults only, and a single study involved children, adolescents, and adults. In total, 16 different ethnic populations representing 11 ethnicities were studied. Ethnicity was considered a significant influencing factor in 10 of the included studies. We found the geometric mean Feno to be above the normal healthy range in two studies. We also identified five studies in which at least 5% of participants had Feno results above the age-specific inflammatory ranges. CONCLUSIONS Ethnicity influences Feno values, and for some ethnic groups this influence likely affects clinical interpretation according to current guidelines. There is a need to establish healthy Feno reference ranges for specific ethnic groups to improve clinical application.
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Affiliation(s)
- Tamara L Blake
- Queensland University of Technology, Centre for Children's Health Research, South Brisbane, QLD, Australia; Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Chermside, QLD, Australia; Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia.
| | - Anne B Chang
- Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Chermside, QLD, Australia; Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia; Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Mark D Chatfield
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Helen L Petsky
- Queensland University of Technology, Centre for Children's Health Research, South Brisbane, QLD, Australia
| | - Leanne T Rodwell
- Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia
| | - Michael G Brown
- Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Deb C Hill
- Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Chermside, QLD, Australia
| | - Margaret S McElrea
- Queensland University of Technology, Centre for Children's Health Research, South Brisbane, QLD, Australia; Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Chermside, QLD, Australia; Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia
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9
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Mallol J, Aguirre V, Córdova P, Cortez E, Gallardo A, Riquelme C. Fraction of exhaled nitric oxide in healthy Chilean schoolchildren aged 8-15 years. Allergol Immunopathol (Madr) 2015; 43:528-32. [PMID: 25456527 DOI: 10.1016/j.aller.2014.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 07/23/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND The fraction of exhaled nitric oxide (FENO) measured using portable devices is increasingly used in the clinical setting to assess asthmatic children. However, there is little and variable information on the reference values obtained using these devices in healthy children from different populations. METHODS 190 healthy non-smoker children (8-15 years old) were randomly selected from public schools participating in this study. The objective was to determine FENO reference values for healthy Chilean schoolchildren. Healthy individuals were identified by medical interview and parent questionnaire on the use of asthma medications, and current and past symptoms of asthma, rhinoconjunctivitis and eczema. FENO was measured at schools using a portable device with electrochemical sensor (NIO MINOX). Reference values of FENO were expressed as geometric mean and upper limit of the 95% reference interval (right-sided). The relationship of FENO with gender, age, height, body mass, and other factors was assessed by multiple regression, and the difference between groups was contrasted by ANOVA. RESULTS The FENO geometric mean was 15.4ppb with a 95% reference interval upper limit (right-sided), of 27.4ppb (90%CI 25.6-29.2). The 5th and 95th percentiles were 9.0ppb and 28.0ppb, respectively. Height was the only factor significantly associated to FENO (p=0.022). There was no significant difference in mean FENO regarding age, gender, weight, parent reported rhinoconjunctivitis and eczema. CONCLUSION This study suggests that FENO values higher than 27ppb are likely to be abnormal and would reflect airway inflammation in children as those in the present study.
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Sfaxi I, Ben Saad H, Rouatbi S. Fraction of exhaled nitric oxide in healthy elderly Tunisian subjects. Nitric Oxide 2015; 50:88-97. [PMID: 26344327 DOI: 10.1016/j.niox.2015.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/29/2015] [Accepted: 08/31/2015] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Exhaled-fraction-of-nitric-oxide (FeNO) norms are absent in healthy elderly North-African subjects. OBJECTIVES i) to identify FeNO influencing factors of elderly Tunisians older 50 years and more; ii) to assess the applicability of some published FeNO norms for elderly in local population; iii) to set-up FeNO norms and to prospectively evaluate their validity in two elderly validation-groups (healthy and asthmatic subjects). METHODS A convenience sample of healthy and asthmatic elderly Tunisians was recruited. Subjects responded to a medical questionnaire and then FeNO levels were measured by an online method (Medisoft, Sorinnes (Dinant), Belgium). Clinical, anthropometric and spirometric data were collected. Three groups of subjects were identified: group I (healthy-elderly; n = 100, 57 females); group II (healthy-validation; n = 17, 4 females) and group III (asthmatic-validation; n = 10, 9 females). ANOVA was performed to compare the three groups' data. RESULTS No significant factor, among those evaluated, influenced Tunisian elderly FeNO values. The available published FeNO norms did not reliably predict FeNO in Tunisian elderly population. The mean ± SD (minimum-maximum) of FeNO (ppb) for group I was 14 ± 6 (3-34). For Tunisian people, each elderly FeNO value higher than 34 ppb will be considered as abnormal. There was no statistical significant difference between FeNO (ppb) mean values of group I and groups II (15 ± 8) or III (18 ± 13). No subject of group II had a FeNO value higher than 34 ppb. Thirty percent of group III subjects had a FeNO value higher than 34 ppb. CONCLUSION In practice, FeNO value of more than 34 ppb is considered abnormal in elderly Tunisian population.
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Affiliation(s)
- Ines Sfaxi
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia; Department of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia.
| | - Helmi Ben Saad
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia; Department of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia; Research Laboratory N° LR14ES05: Interactions of the Cardiopulmonary System, Faculty of Medicine of Sousse, University of Sousse, Tunisia
| | - Sonia Rouatbi
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, 4000 Sousse, Tunisia; Department of Physiology and Functional Explorations, Farhat HACHED Hospital, Sousse, Tunisia
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11
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Fraction of exhaled nitric oxide (FeNO ) norms in healthy Tunisian adults. BIOMED RESEARCH INTERNATIONAL 2014; 2014:269670. [PMID: 24991544 PMCID: PMC4065671 DOI: 10.1155/2014/269670] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/23/2014] [Accepted: 04/23/2014] [Indexed: 11/30/2022]
Abstract
Aims. To establish FeNO norms for healthy Tunisian adults aged 18–60 years and to prospectively assess their reliability. Methods. This was a cross-sectional analytical study. A convenience sample of healthy Tunisian adults was recruited. Subjects responded to a medical questionnaire, and then FeNO levels were measured by an online method (Medisoft, Sorinnes (Dinant), Belgium). Clinical, anthropometric, and plethysmographic data were collected. All analyses were performed on natural logarithm values of FeNO. Results. 257 adults (145 males) were retained. The proposed reference equation to predict FeNO value is lnFeNO (ppb) = 3.47−0.56× height (m). After the predicted FeNO value for a given adult was computed, the upper limit of normal could be obtained by adding 0.60 ppb. The mean ± SD (minimum-maximum) of FeNO (ppb) for the total sample was 13.54 ± 4.87 (5.00–26.00). For Tunisian and Arab adults of any age and height, any FeNO value greater than 26.00 ppb may be considered abnormal. Finally, in an additional group of adults prospectively assessed, we found no adult with a FeNO higher than 26.00 ppb. Conclusion. The present FeNO norms enrich the global repository of FeNO norms that the clinician can use to choose the most appropriate norms.
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