Effect of atmospheric nitric oxide (NO) on measurements of exhaled NO in asthmatic children

Baraldi, Eugenio; Azzolin, Nicoletta M.; Dario, Cinzia; Carra, S; Ongaro, Riccardo; Biban, Paolo; Zacchello, Franco

doi:10.1002/(sici)1099-0496(199807)26:1<30::aid-ppul6>3.0.co;2-m

Cited by 35 publications

(24 citation statements)

References 21 publications

(38 reference statements)

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“…Previous studies on the effect of ambient NO on eNO vary remarkably. Some authors found no influence of ambient NO on eNO values [23][24][25][26][27], others found important effects [28][29][30][31][32]. This study found a strong positive relationship between ambient NO concentrations and eNO in balloons.…”

Section: Discussionsupporting

confidence: 48%

Off-line sampling of exhaled air for nitric oxide measurement in children: methodological aspects

Schellekens¹,

Kroesbergen²,

Hop³

et al. 2001

Eur Respir J

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Measurement of nitric oxide in exhaled air is a noninvasive method to assess airway inflammation in asthma. This study was undertaken to establish the reference range of exhaled NO in healthy school-aged children and to determine the influence of ambient NO, noseclip and breath-holding on exhaled NO, using an off-line balloon sampling method.All children attending a primary school (age range 8-13 yrs) underwent NO measurements on two occasions with high and low ambient NO. Each time, the children performed four expiratory manoeuvres into NO-impermeable balloons, with and without 10 s of breath-holding and with and without wearing a noseclip. Exhalation flow and pressure were not controlled. NO was measured within 4 h after collection, by means of chemiluminescence. All children completed a questionnaire on respiratory and allergic disorders, and performed flow/volume spirometry.With low ambient NO, the mean exhaled NO value of 72 healthy children with negative questionnaires and normal lung function was 5.1¡0.2 parts per billion (ppb) versus a mean of 6.8¡0.3 ppb in the remaining 49 children with positive questionnaires for asthma and allergy, and/or recent symptoms of cold (p~0.001). Exhaled and ambient NO were significantly related, especially with ambient NO w10 ppb (r~0.86, p~0.0001 versus r~0.34, p~0.004 for ambient values v10 ppb). The use of a noseclip, with low ambient NO and without breath-holding, caused a small decrease in exhaled NO values (p~0.001). The effect of breath-holding on exhaled NO depended on ambient NO. With ambient NO w10 ppb, exhaled NO decreased, whereas with ambient NO v10 ppb, exhaled NO increased after 10 s breath-hold.It is concluded that off-line sampling in balloons is a simple and, hence, attractive method for exhaled nitric oxide measurements in children which differentiates between groups with and without self-reported asthma, allergy and colds, when ambient nitric oxide is v10 parts per billion. Wearing a noseclip and breath-holding affected measured values and should, therefore be standardized or, preferably, avoided. Eur Respir J 2001; 17: 898-903.

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Section: Discussionsupporting

confidence: 48%

Off-line sampling of exhaled air for nitric oxide measurement in children: methodological aspects

Schellekens¹,

Kroesbergen²,

Hop³

et al. 2001

Eur Respir J

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“…Several studies investigated the correlation between FENO and ambient NO using different sampling techniques, resulting in conflicting data [25][26][27] contaminate dead space of the airways, thus giving false high FENO values after expiration in a reservoir. Inspiration of NO-free air or discarding dead space air have been proposed as methods to eliminate this disturbing factor [3].…”

Section: Discussionmentioning

confidence: 99%

Exhaled nitric oxide measurements with dynamic flow restriction in children aged 4-8 yrs

Pijnenburg

Lissenberg²,

Hofhuis³

et al. 2002

European Respiratory Journal

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Fractional exhaled nitric oxide concentration (FENO) depends on exhalation flow; however, children often are unable to perform controlled flow procedures. Therefore, a device was developed for off-line FENO sampling, with dynamic flow restriction (DFR).The authors compared off-line with on-line FENO, assessed feasibility, and obtained normal values for FENO in children aged 4-8 yrs. Subjects inhaled nitric oxide (NO)-free air and exhaled into the device, where DFR kept exhalation flow constant at 50 mL?s -1 . Dead space air was discarded. Exhaled air was collected in a 150 mL mylar balloon. On-line measurements were performed and values compared with off-line FENO in 19 adult volunteers. Seventy-nine children performed off-line sampling. All samples were analysed with a chemiluminescence NO-analyser. Normal values were obtained in 34 healthy children.There was an excellent correlation between on-and off-line values. Bland and Altman plots showed good agreement between on-and off-line FENO. Seventy-four out of 79 children were able to perform a correct off-line procedure. Geometric mean¡SEM FENO in healthy children was 4.9 ¡ 1.2 parts per billion (ppb) for male children and 7.6 ¡ 1.1 ppb for female children.It can be concluded that off-line fraction of exhaled nitric oxide measurements with dynamic flow restriction are feasible in young children and correspond to on-line values. Eur Respir J 2002; 20: 919-924.

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“…As FENO is flow-dependent, there will be a scatter of data due to variation in flows. Contamination of inspired air with high NO levels from the nose or environment can partly be overcome by measuring whilst ambient NO isv10 ppb, or, preferably, by using NO-free air or scrubber systems to clean ambient air for inhalation [75].…”

Section: Off-line Uncontrolled Single Exhalations Into a Reservoirmentioning

confidence: 99%

Measurement of exhaled nitric oxide in children, 2001: E. Baraldi and J.C. de Jongste on behalf of the Task Force

Baraldi¹,

Jongste²,

Gaston³

et al. 2002

European Respiratory Journal

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Effect of atmospheric nitric oxide (NO) on measurements of exhaled NO in asthmatic children

Cited by 35 publications

References 21 publications

Off-line sampling of exhaled air for nitric oxide measurement in children: methodological aspects

Off-line sampling of exhaled air for nitric oxide measurement in children: methodological aspects

Exhaled nitric oxide measurements with dynamic flow restriction in children aged 4-8 yrs

Measurement of exhaled nitric oxide in children, 2001: E. Baraldi and J.C. de Jongste on behalf of the Task Force

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