Published ahead of print on May 3, 2007, doi:10.1164/rccm.200609-1346OC Am. J. Respir. Crit. Care Med., Volume 176, Number 3, August 2007, 238-242 A more recent version of this article appeared on August 1, 2007
Submitted on September 20, 2006 Reference Ranges for Exhaled Nitric Oxide Derived from a Random Community Survey of AdultsJustin Travers1,1 Medical Research Institute of New Zealand, Wellington, New Zealand, 2 Wellington School of Medicine and Health Sciences, Wellington, New Zealand, 3 Medical Research Institute of New Zealand, Wellington, New Zealand; University of Southampton, Southampton, United Kingdom * To whom correspondence should be addressed. 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 non-invasive marker of airways inflammation. Prior to 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 Caucasian population of Wellington, New Zealand. Measurements: FENO was measured using a NIOXTM analyzer in accordance with international guidelines. A detailed respiratory questionnaire and pulmonary function tests were performed. Main Results: The mean FENO was 17.9 parts per billion (ppb) with a 90% CI for an individual prediction (reference range) for normal subjects of 7.8 - 41.1 ppb. Gender, 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 Caucasian adults. Key words: asthma, nitric oxide, prediction equations, reference values, rhinitis
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