Am. J. Respir. Crit. Care Med., Volume 162, Number 2, August 2000, 539-545

FE_NO: Relationship to Exhalation Rates and Online versus Bag Collection in Healthy Adolescents

NIRANJAN KISSOON, LAURIE J. DUCKWORTH, KATHRYN V. BLAKE, SUZANNE P. MURPHY, CHRISTOPHER L. TAYLOR, and PHILIP E. SILKOFF

University of Florida HSC/Jacksonville, Nemours Children's Clinic, and Wolfson Children's Hospital, Jacksonville, Florida; and National Jewish Medical and Research Center, Denver, Colorado

Measurement of exhaled nitric oxide (FE_NO) is a noninvasive and practical method for assessing airway inflammation. We conducted this investigation to determine the most appropriate flow rate for FE_NO measurement and to obtain normal values for FE_NO. We determined which expiratory flow was easy to sustain, generated reproducible values, and provided good correlation between offline and online measurements. Thirty-two healthy subjects (15- 18 yr old) underwent spirometry and FE_NO measurements, using a chemiluminescent NO analyzer at expiratory flow rates of 46, 31, 23, 15, 10, 7, 5, and 4 ml/s. The major findings were as follows: (1) FE_NO increased as flow rates decreased, with strong correlation between FE_NO values and flow rates at the four highest flows (0.85- 0.93, p < 0.001); (2) there were no significant differences and good agreement between offline bag and online FE_NO values for the four highest flows (p < 0.09-0.83); (3) online FE_NO values increased with age 15-17 yr at all flow rates, but decreased at age 18 yr; and (4) using multiple regression, significant predictors of FE_NO were flow, body surface area, age, and FEF_25-75. On the basis of these results, we provide FE_NO values for healthy adolescents and propose that the ideal flow rate for children is between 30 and 50 ml/s.

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