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Published ahead of print on May 3, 2007, doi:10.1164/rccm.200609-1346OC
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American Journal of Respiratory and Critical Care Medicine Vol 176. pp. 238-242, (2007)
© 2007 American Thoracic Society
doi: 10.1164/rccm.200609-1346OC

Original Article

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

Justin Travers1, Suzanne Marsh1, Sarah Aldington1, Mathew Williams1, Philippa Shirtcliffe1, Alison Pritchard1, Mark Weatherall2 and Richard Beasley1,3

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 (FENO) 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 FENO measurements.

Objectives: To derive reference ranges for FENO and to determine which factors in health and disease influence FENO 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: FENO 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 FENO 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 FENO levels, and several reference ranges are presented adjusting for these factors. Asthma and allergic rhinitis were associated with higher FENO. Measurement of FENO 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 FENO 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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