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Reference Ranges for Exhaled Nitric Oxide Derived from a Random Community Survey of Adults

¹ Medical Research Institute of New Zealand, Wellington, New Zealand; ² Wellington School of Medicine and Health Sciences, Wellington, New Zealand; and ³ University of Southampton, Southampton, United Kingdom

Correspondence and requests for reprints should be addressed to Professor Richard Beasley, D.Sc., Medical Research Institute of New Zealand, P.O. Box 10055, Wellington, 6143 NZ. E-mail: richard.beasley{at}mrinz.ac.nz

Rationale: Measurement of the fraction of nitric oxide in exhaled breath (FE_NO) has been proposed as a noninvasive marker of airway inflammation. Before the widespread use of this test, there is a need to develop reference ranges to allow clinicians to interpret FE_NO measurements.

Objectives: To derive reference ranges for FE_NO and to determine which factors in health and disease influence FE_NO levels.

Methods: Subjects aged between 25 and 75 years were drawn from a random sample of the predominantly white population of Wellington, New Zealand.

Measurements and Main Results: FE_NO was measured using an online nitric oxide monitor in accordance with international guidelines. A detailed respiratory questionnaire and pulmonary function tests were performed. The geometric mean FE_NO was 17.9 parts per billion (ppb) with a 90% confidence interval for an individual prediction (reference range) for normal subjects of 7.8 to 41.1 ppb. Sex, atopy, and smoking status significantly affected FE_NO levels, and several reference ranges are presented adjusting for these factors. Asthma and allergic rhinitis were associated with higher FE_NO. Measurement of FE_NO had poor discriminant ability to identify steroid-naive subjects with asthma.

Conclusions: The reference ranges presented may be used to assist in the interpretation of FE_NO measurements in white adults.

Key Words: asthma • nitric oxide • prediction equations • reference values • rhinitis

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Measurement of exhaled nitric oxide (FENO) has been proposed as a noninvasive marker of airway inflammation. Reference ranges have yet to be developed, which severely limits the ability of clinicians to interpret FENO measurements. What This Study Adds to the Field This study presents reference ranges for FENO derived from a random population sample. It also presents the association between FENO and disease states, and its utility in the diagnosis of asthma.

 

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