Flow dependency and off-line measurement of exhaled NO in children |
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Authors: | J. G. C. van  Amsterdam,P. Zanen,S. Somer,H. van  Loveren,A. Opperhuizen, P. A. Steerenberg |
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Affiliation: | Laboratory of Health Effects Research,;Antonius Hospital Nieuwegein and;Laboratory for Pathology and Immunobiology, National Institute of Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, the Netherlands |
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Abstract: | Levels of exhaled nitric oxide (eNO) are flow-dependent, and the choice of an optimal flow rate for off-line and on-line eNO measurement has raised much debate. Recently, a flow rate of 50 ml/s was recommended, but children younger than 5–6 years are not capable of stabilizing their expiratory flow at low flow rates. The power of off-line eNO values to discriminate between normal and atopic children was therefore evaluated at different exhalation flow rates. At flow rates of both 8.3 ml/s and of 350 ml/s, children (8–12 years) sensitive to house dust mite have two-fold higher eNO values (p < 0.001) as compared with children lacking such a sensitivity. The power of eNO to discriminate between normal and atopic subjects was similar at the two flow rates (no difference in AUC of receiver operation curves, p = 0.89). All children from 4.5 to 5 years of age (n = 29) could perform a single off-line exhalation manoeuvre at high (>350 ml/s) but not at low (8.3 ml/s) flow rates. At high exhalation flow rate, eNO was 7.1 ± 2.4 (mean ± SD) median, 6.5 p.p.b. with a mean variation coefficient of 5.5%. Depending on their developmental level, about half of the younger children (35–46 months of age) could perform an off-line exhalation manoeuvre at high flow rate with good reproducibility (mean variation coefficient of 6.6%). It is concluded that an exhalation flow rate of 350 ml/s is feasible to determine off-line eNO-values in children from 3.5 years of age, and that this high flow rate does not compromise the power of eNO to detect allergic disease. |
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Keywords: | exhaled NO flow rate nitric oxide |
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