Comparability of a hand‐held nitric oxide analyser with online and offline chemiluminescence‐based nitric oxide measurement

Schiller, Barbara; Hammer, Jürg; Barben, Juerg; Trachsel, Daniel

doi:10.1111/j.1399-3038.2009.00853.x

Cited by 39 publications

(39 citation statements)

References 35 publications

(52 reference statements)

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“…The measurement of FeNO has been standardised for clinical use in a joint guideline from the ATS and ERS [98]. The conventional chemiluminescence FeNO analyser, the hand-held device and offline FeNO measurements have been shown to produce similar results in children older than 5 years of age with a success rate of >70% and with an overall coefficient of repeatability of around 1.6-3.2 ppb [99][100][101][102][103][104]. A low FeNO (<20 ppb) in children with asthma not treated with ICSs indicates that eosinophilic inflammation and responsiveness to corticosteroids are less likely.…”

Section: Exhaled Nitric Oxide Fractionmentioning

confidence: 99%

Monitoring asthma in childhood: lung function, bronchial responsiveness and inflammation

et al. 2015

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This review focuses on the methods available for measuring reversible airways obstruction, bronchial hyperresponsiveness (BHR) and inflammation as hallmarks of asthma, and their role in monitoring children with asthma. Persistent bronchial obstruction may occur in asymptomatic children and is considered a risk factor for severe asthma episodes and is associated with poor asthma outcome. Annual measurement of forced expiratory volume in 1 s using office based spirometry is considered useful. Other lung function measurements including the assessment of BHR may be reserved for children with possible exercise limitations, poor symptom perception and those not responding to their current treatment or with atypical asthma symptoms, and performed on a higher specialty level. To date, for most methods of measuring lung function there are no proper randomised controlled or large longitudinal studies available to establish their role in asthma management in children.Noninvasive biomarkers for monitoring inflammation in children are available, for example the measurement of exhaled nitric oxide fraction, and the assessment of induced sputum cytology or inflammatory mediators in the exhaled breath condensate. However, their role and usefulness in routine clinical practice to monitor and guide therapy remains unclear, and therefore, their use should be reserved for selected cases. @ERSpublications Review on the role of lung function, measurement of BHR and airway inflammation in monitoring of children with asthma

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Section: Exhaled Nitric Oxide Fractionmentioning

confidence: 99%

Monitoring asthma in childhood: lung function, bronchial responsiveness and inflammation

et al. 2015

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“…One study 63 noted that the direction of disagreement was different in children aged over and under 12 years. l The back-transformed Bland-Altman statistics 63 and range of ratios reported 62 indicate a wide range of agreement and suggest that the devices are not interchangeable.…”

Section: In Childrenmentioning

confidence: 99%

“…Six studies [reported across nine studies and one sponsor's submission (Fukuhara 2013)] were carried out in adults, [50][51][52][53][54][55][56][57]64 three were carried out in an unspecified age group [58][59][60] (two of which had potentially largely overlapping cohorts and will be considered as one study) 58,59 and three were carried out in children. [61][62][63] All studies included at least some asthmatic patients, except that by de Laurentiis et al 57 Mean FeNO values varied across the studies (from 7 ppb in a healthy cohort of patients 52,53 to 64.3 ppb in an asthmatic cohort 54 ). Devices studied in adults/unspecified age groups were the EndoNO (SERES, Aix en Provence, France), N-6008 (SIR, Madrid, Spain), NA623N (CHEST Inc., Tokyo, Japan), NOA 280i (Sievers, Boulder, CO, USA), CLD 88sp (ECO MEDICS, Dürnten, Switzerland), NOA (Sievers, Boulder, CO, USA) and LR2000 (Logan Research Ltd, Rochester, UK), whereas devices tested in children were the CLD 88 and CLD 77 (ECO MEDICS).…”

Section: Niox Mino Compared With Other Chemiluminescent Devices In Admentioning

confidence: 99%

Measurement of exhaled nitric oxide concentration in asthma: a systematic review and economic evaluation of NIOX MINO, NIOX VERO and NObreath

Harnan

Tappenden

Essat

et al. 2015

Health Technol Assess

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BackgroundHigh fractions of exhaled nitric oxide (FeNO) in the breath of patients with symptoms of asthma are correlated with high levels of eosinophils and indicate that a patient is likely to respond to inhaled corticosteroids. This may have a role in the diagnosis and management of asthma.ObjectiveTo assess the diagnostic accuracy, clinical effectiveness and cost-effectiveness of the hand-held electrochemical devices NIOX MINO®(Aerocrine, Solna, Sweden), NIOX VERO®(Aerocrine) and NObreath®(Bedfont Scientific, Maidstone, UK) for the diagnosis and management of asthma.Data sourcesSystematic searches were carried out between March 2013 and April 2013 from database inception. Databases searched included MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, Science Citation Index Expanded and Conference Proceedings Citation Index – Science. Trial registers such as ClinicalTrials.gov and themetaRegister of Controlled Trials were also searched in March 2013. All searches were updated in September 2013.Review methodsA rapid review was conducted to assess the equivalence of hand-held and chemiluminescent FeNO monitors. Systematic reviews of diagnostic accuracy and management efficacy were conducted. A systematic review of economic analyses was also conducted and two de novo health economic models were developed. All three reviews were undertaken according to robust high-quality methodology.ResultsThe rapid review (27 studies) found varying levels of agreement between monitors (Bland–Altman 95% limits of agreement up to ±10 parts per billion), with better agreement at lower FeNO values. Correlation was good (generallyr > 0.9). The diagnostic accuracy review identified 22 studies in adults (all ages) and four in children. No studies used NObreath or NIOX VERO and seven used NIOX MINO. Estimates of diagnostic accuracy varied widely. FeNO used in combination with another test altered diagnostic accuracy only slightly. High levels of heterogeneity precluded meta-analysis. Limited observations included that FeNO may be more reliable and useful as a rule-in than as a rule-out test; lower cut-off values in children and in smokers may be appropriate; and FeNO may be less reliable in the elderly. The management review identified five randomised controlled trials in adults, one in pregnant asthmatics and seven in children. Despite clinical heterogeneity, exacerbation rates were lower in all studies but not generally statistically significantly so. Effects on inhaled corticosteroid (ICS) use were inconsistent, possibly because of differences in management protocols, differential effectiveness in adults and children and differences in population severity. One UK diagnostic model and one management model were identified. Aerocrine also submitted diagnostic and management models. All had significant limitations including short time horizons and the selective use of efficacy evidence. The de novo diagnostic model suggested that the expected difference in quality-adjusted life-year (QALY) gains between diagnostic options is likely to be very small. Airway hyper-responsiveness by methacholine challenge test is expected to produce the greatest QALY gain but with an expected incremental cost-effectiveness ratio (ICER) compared with FeNO (NObreath) in combination with bronchodilator reversibility of £1.125M per QALY gained. All remaining options are expected to be dominated. The de novo management model indicates that the ICER of guidelines plus FeNO monitoring using NObreath compared with guidelines alone in children is expected to be approximately £45,200 per QALY gained. Within the adult subgroup, FeNO monitoring using NObreath compared with guidelines alone is expected to have an ICER of approximately £2100 per QALY gained. The results are particularly sensitive to assumptions regarding changes in ICS use over time, the number of nurse visits for FeNO monitoring and duration of effect.ConclusionsLimitations of the evidence base impose considerable uncertainty on all analyses. Equivalence of devices was assumed but not assured. Evidence for diagnosis is difficult to interpret in the context of inserting FeNO monitoring into a diagnostic pathway. Evidence for management is also inconclusive, but largely consistent with FeNO monitoring resulting in fewer exacerbations, with a small or zero reduction in ICS use in adults and a possible increased ICS use in children or patients with more severe asthma. It is unclear which specific management protocol is likely to be most effective. The economic analysis indicates that FeNO monitoring could have value in diagnostic and management settings. The diagnostic model indicates that FeNO monitoring plus bronchodilator reversibility dominates many other diagnostic tests. FeNO-guided management has the potential to be cost-effective, although this is largely dependent on the duration of effect. The conclusions drawn from both models require strong technical value judgements with respect to several aspects of the decision problem in which little or no empirical evidence exists. There are many potential directions for further work, including investigations into which management protocol is best and long-term follow-up in both diagnosis and management studies.Study registrationThis study is registered as PROSPERO CRD42013004149.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…To date, NIOX MINO Ò has been compared with three chemiluminescence NO analyzers, the NIOX Ò , Ecomedics and Sievers NOA280i [18][19][20][21][22][23][24][25][26][27][28][29][30]. All these studies showed agreement between the FeNO values obtained with the devices being studied, with a clinically acceptable level of agreement shown with NIOX [19-22, 25, 26] and Ecomedics [29].…”

Section: Discussionmentioning

confidence: 96%

Validation of a New Portable Exhaled Nitric Oxide Analyzer, NIOX VERO®: Randomized Studies in Asthma

Alving

Anolik

Crater³

et al. 2017

Pulm Ther

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Comparability of a hand‐held nitric oxide analyser with online and offline chemiluminescence‐based nitric oxide measurement

Cited by 39 publications

References 35 publications

Monitoring asthma in childhood: lung function, bronchial responsiveness and inflammation

Monitoring asthma in childhood: lung function, bronchial responsiveness and inflammation

Measurement of exhaled nitric oxide concentration in asthma: a systematic review and economic evaluation of NIOX MINO, NIOX VERO and NObreath

Validation of a New Portable Exhaled Nitric Oxide Analyzer, NIOX VERO®: Randomized Studies in Asthma

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