Measurement of Fractional Exhaled Nitric Oxide by a New Portable Device: Comparison with the Standard Technique

Pisi, Roberta; Aiello, Marina; Tzani, Panagiota; Marangio, Emilio; Olivieri, Dario; Chetta, Alfredo

doi:10.3109/02770903.2010.485667

Cited by 46 publications

(48 citation statements)

References 19 publications

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“…However, another study 44 reported a correction factor that should be used to convert NIOX MINO values to Niox values. Three 50,51,54,65 of the remaining four studies demonstrate how cut-off points derived using measurements from different devices can be very different, with 7 ppb, 9 ppb and 10 ppb differences. One of these studies 65 compared NObreath with the Niox chemiluminescent device directly and found a 10-ppb difference between cut-off points that provide the highest AUC (15 ppb and 25 ppb respectively) and very different sensitivity and specificity values at these cut-off points.…”

Section: Nobreath Compared With Chemiluminescent Devices In Adults Anmentioning

confidence: 99%

“…However, all nine of the studies that provided some relevant information with respect to test failure rates came from the review of the equivalence of devices. Eight studies 39,45,46,48,49,63,64,67 examined NIOX MINO and two studies 65,67 used NObreath. The definition of a test failure was reasonably consistent across the body of literature.…”

Section: Test Failure Ratesmentioning

confidence: 99%

“…54,60,65,66 All studies were carried out in adults or in an unspecified age group likely to be adults and all included some asthmatic patients and reported good correlation coefficients. Only one study compared NObreath with the Niox chemiluminescent device; 65 this study reported a small statistically significant difference between the devices [intervention arm: geometric mean 22.6 ppb (geometric standard error of the mean 1.075), control arm: geometric mean 24.6 ppb (geometric standard error of the mean 1.073 ppb); p = 0.0002] and a good level of agreement with Bland-Altman analysis. However, the cut-off points with the best combination of sensitivity and specificity derived in this study for each device differed by 10 ppb (25 ppb for NObreath, 15 ppb for Niox; see Areas under the curve, cut-off points and correction equations), indicating that even small differences in agreement may have potentially large effects on derived sensitivity and specificity.…”

Section: Nobreath Compared With Chemiluminescent Devices In Adults Anmentioning

confidence: 99%

“…Nine studies 39,45,46,48,49,[63][64][65]67 were included in the review of test failure rates and are described in Table 20. The review intended to draw evidence from studies included in the review of equivalence of devices, the diagnostic accuracy review and the review of the efficacy of FeNO-guided management for asthma.…”

Section: Test Failure Ratesmentioning

confidence: 99%

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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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Section: Nobreath Compared With Chemiluminescent Devices In Adults Anmentioning

confidence: 99%

Section: Test Failure Ratesmentioning

confidence: 99%

Section: Nobreath Compared With Chemiluminescent Devices In Adults Anmentioning

confidence: 99%

Section: Test Failure Ratesmentioning

confidence: 99%

See 2 more Smart Citations

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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“…The eNO was measured through an electrochemical analyser NObreath ® (Bedfont Scientific Ltd., Rochester, Kent, UK; measurement range: 1-300 ppb, at a constant flow rate of 50 mL s -1 ) according to the American Thoracic Society and European Respiratory Society guidelines (ATS/ERS, 2005). The NObreath was recently evaluated by Antus et al (2010), who assessed its ability in performing reliable, reproducible eNO measurements: it showed a good agreement with previously calibrated instruments (Pisi et al, 2010).…”

Section: Instrumentation and Quality Assurancementioning

confidence: 99%

Physiological Responses to Acute Airborne Particle Exposure during Maximal Aerobic Power

Buonanno

Stabile

Lecce

et al. 2016

Aerosol Air Qual. Res.

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The effect of the exposure to airborne particles on the physical performances achieved by athletes was investigated. Respiratory and cardiovascular parameters of nine subjects (volunteers, regularly performing physical activity) were measured during their high-intensity exercise performed indoor on a cycle ergometer. A steady-state concentration of airborne particles was generated through incense burning.Two different particle exposure scenarios were tested: low (no source in operation) and high exposure (particle generation from incense burning phenomena). Alveolar-deposited surface area doses received by subjects during low and high exposure tests were measured equal to 22.7 ± 8.58 and 1.18 ± 0.22 × 10 3 mm 2 , respectively. Oxygen uptake at the peak of the physical activity resulted statistically higher during high exposure tests, whereas lower peak heart rate values were measured for such scenario.In terms of mechanical efficiency, a higher peak metabolic power was recognized for subjects performing tests in high exposure conditions: results were statistically different (about 1%) with respect to low exposure tests. On the other hand, measurements of exhaled nitric oxide (parameter associated to airway inflammations) performed during the tests showed no significant differences between the two exposure scenarios.

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Electrochemical Sensors for Nitric Oxide Detection in Biological Applications

Scafa

et al. 2014

Electroanalysis

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Nitric oxide (NO) plays an important role in physiological processes and it has been confirmed some human diseases are related to its biological function. Electrochemical sensors provide an efficient way to explore the NO function in biological processes. This review details different kinds of electrochemical sensors used for NO concentration detection between 2008 and 2013 together with their application in biological samples. Four commonly used electrodes and different assisted analysis membranes used for contributions towards the development of the novel sensors were summarized. Electrochemical sensors employed to measure NO concentration in a single cell, cell culture, tissue homogenate, organ, in vivo, human being, as well as in plant were also detailed. The trends of developing novel NO sensors were outlooked in the last part.

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Measurement of Fractional Exhaled Nitric Oxide by a New Portable Device: Comparison with the Standard Technique

Abstract: FeNO measurements obtained by the new portable FeNO analyzer are reliable because they are directly comparable with those obtained by the stationary standard device. The use of portable instruments may facilitate the FeNO measurement in primary care.

Cited by 46 publications

References 19 publications

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

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

Physiological Responses to Acute Airborne Particle Exposure during Maximal Aerobic Power

Electrochemical Sensors for Nitric Oxide Detection in Biological Applications

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