Nasal and oral contribution to inhaled and exhaled nitric oxide: a study in tracheotomized patients

Törnberg, Daniel C.; Marteus, H; Schedin, Ulla; Alving, Kjell; Lundberg, Jon O.; Weitzberg, Eddie

doi:10.1183/09031936.02.00273502

Cited by 52 publications

(36 citation statements)

References 36 publications

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“…There is a mandatory external quality control (QC) Procedure for NIOX MINO that includes a Daily QC and a Full QC. The nNO levels are considerably higher than lower airway levels [23,24]. In contrast to the lower airways, nNO levels in patients with upper airway inflammation are rather decreased than increased when compared with healthy controls [25][26][27].…”

Section: Discussionmentioning

confidence: 88%

Correlation of Nasal Nitric Oxide Measurement with Computed Tomography Findings in Chronic Rhinosinusitis

Dabholkar

Saberwal

Velankar

et al. 2013

Indian J Otolaryngol Head Neck Surg

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Nitric oxide (NO) is a biological messenger produced by mammalian cells serving various functions including regulation of blood flow, platelet function, immunity, and neurotransmission. The paranasal sinuses and nasal mucosa are a major source of exhaled NO. The aim of the study is to compare the nasal NO (nNO) levels in patients with chronic rhinosinusitis with those of common cold patients and controls and to correlate CT scores with nNO levels. The nasal concentration of NO was measured by electroluminescence in 13 healthy volunteers, in 13 patients suffering from common cold and 13 patients with chronic rhinosinusitis. The concentration of NO was correlated with symptom scores, endoscopic findings and CT findings. The measured levels of NO did not differ between healthy volunteers and common cold patients, but they were significantly lower in patients suffering from chronic rhinosinusitis. As NO is a regulator of mucociliary activity and has bacteriostatic and antiviral effects, the decreased concentration of nNO in patients suffering from sinusitis suggests that lack of NO may contribute to the pathogenesis of this disease. Thus, nNO, which is easily measured, provides a valuable non-invasive objective measure of chronic rhinosinusitis.

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Section: Discussionmentioning

confidence: 88%

Correlation of Nasal Nitric Oxide Measurement with Computed Tomography Findings in Chronic Rhinosinusitis

Dabholkar

Saberwal

Velankar

et al. 2013

Indian J Otolaryngol Head Neck Surg

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“…It is, however, important to note that this assumption may only be true under the exact conditions of this study. For example, at a different flow rate the relative contribution from the sinuses and nose may differ and the sinus contribution seems to be larger during inhalation compared to exhalation [23]. Nevertheless, using the methods described here, it may be possible to better separate sinus NO from nasal mucosal NO release.…”

Section: Discussionmentioning

confidence: 99%

Assessment of nasal and sinus nitric oxide output using single-breath humming exhalations

Maniscalco¹,

Weitzberg²,

Sundberg³

et al. 2003

European Respiratory Journal

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Nasal nitric oxide (NO) levels increase greatly during humming compared to silent exhalation. In this study, the physiological and anatomical factors that regulate NO release during humming have been characterised in 10 healthy subjects and in a model of the sinus and the nose.Single-breath humming caused a large initial peak in nasal NO output, followed by a progressive decline. The NO peak decreased in a step-wise manner during repeated consecutive humming manoeuvres but recovered completely after a silent period of 3 min. Topical nasal application of an NO synthase inhibitor reduced nasal NO by w50% but had no effect on the increase evoked by humming. Silently exhaled nasal NO measured immediately after repeated humming manoeuvres was between 5-50% lower than basal silent NO exhalation, suggesting variable continuous contribution from the sinuses to nasal NO. Among the factors known to influence normal sinus ventilation, ostium size was the most critical during humming, but humming frequency was also of importance.In conclusion, humming results in a large increase in nasal nitric oxide, which is caused by a rapid gas exchange in the paranasal sinuses. Combined nasal nitric oxide measurement with and without humming could be of use to estimate sinus ventilation and to better separate nasal mucosal nitric oxide output from sinus nitric oxide in health and disease. Eur Respir J 2003; 22: 323-329. This study was supported by a grant from the Swedish Heart-Lung Foundation, the Swedish Research Council and by a grant from University Federico II "Progetto scambi internazionali".Nitric oxide (NO) is released into the airway lumen [1], in particular in the upper airways [2][3][4]. The exact origin of NO found in nasal air and the relative contribution from different sources within the nasal airways are not known. The paranasal sinuses are major sources of NO in adult healthy subjects [5] and the concentrations in a healthy sinus may be very high, ranging 5-20 parts per million (ppm) [5]. The sinuses communicate with the nasal cavity through the ostia and the rate of gas exchange between these cavities is dependent on several factors, such as the size of the ostia, the volume of the sinus, the nasal airflow and intra-nasal pressure [6,7]. Proper ventilation is essential for maintenance of sinus integrity, and blockage of the ostium is a central event in the pathogenesis of sinusitis [8,9]. During normal ventilation, the time required to exchange all air in the sinuses is y30 min, with large inter-individual variation [7,10]. Sinus ventilation is much slower in patients with sinus disorders [10].Recently, the current authors have shown that nasal NO levels increase greatly during humming compared to normal silent nasal exhalation, probably by speeding up the sinus gas exchange, thereby increasing nasal NO output [11]. In a twocompartment model of the nose and sinus the authors demonstrated that pulsating airflow, created by humming, causes a dramatic increase in gas exchange between these cavities [11].In the ...

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“…However, it has been shown that oral NO production exists and is dependent on intake of nitrate, which is reduced to nitrite and further to NO by bacteria in the oral cavity [24]. Recently, the authors observed that the oral cavity and oropharynx contributes to approximately half of the NO levels in orally exhaled air, shown by measuring NO production from tracheotomised patients [25]. The authors therefore cannot disregard the fact that the increase in oral eNO after endotoxin challenge derives from NO produced in the mouth.…”

Section: Discussionmentioning

confidence: 99%

Exhaled NO and plasma cGMP increase after endotoxin infusion in healthy volunteers

Soop¹,

Sollevi²,

Weitzberg³

et al. 2003

Eur Respir J

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Nitric oxide (NO) is believed to be involved in the pathophysiology of sepsis. This study evaluated the activity of the NO pathway in a human endotoxin model.At baseline and after endotoxin, on-line measurements of exhaled NO (eNO) were made using a chemiluminescence technique with a single-breath method. NO-free air was inhaled prior to exhalation against a resistance. NO in orally and nasally exhaled air and in rectal gas was investigated. Plasma nitrite, nitrate, and guanosine 39, 59-monophosphate (cGMP) and the events after diclophenac administration were also studied.Endotoxin infusion resulted in tachycardia and fever. An early increase in oral eNO concentration was observed and oral eNO decreased after diclophenac administration. NO exhaled nasally, NO in rectum gas and nitrite/nitrate levels remained unchanged over the study period. cGMP increased after 4 h.These findings suggest an early increase in nitric oxide production from the lungs, probably due to increased activity of the constitutive nitric oxide synthase upon endotoxin stimulation. In contrast, nitric oxide production in the upper airways, measured as nasally exhaled nitric oxide and nitric oxide in rectal gas, remained unchanged. Further studies will elucidate if exhaled nitric oxide is a valuable marker of sepsis-induced lung injury and if monitoring of treatment is possible. Eur Respir J 2003; 21: 594-599.

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Nasal and oral contribution to inhaled and exhaled nitric oxide: a study in tracheotomized patients

Cited by 52 publications

References 36 publications

Correlation of Nasal Nitric Oxide Measurement with Computed Tomography Findings in Chronic Rhinosinusitis

Correlation of Nasal Nitric Oxide Measurement with Computed Tomography Findings in Chronic Rhinosinusitis

Assessment of nasal and sinus nitric oxide output using single-breath humming exhalations

Exhaled NO and plasma cGMP increase after endotoxin infusion in healthy volunteers

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