Published ahead of print on May 3, 2007, doi:10.1164/rccm.200609-1346OC
© 2007 American Thoracic Society doi: 10.1164/rccm.200609-1346OC
Reference Ranges for Exhaled Nitric Oxide Derived from a Random Community Survey of Adults1 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
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