ERS technical standard: Global Lung Function Initiative reference values for exhaled nitric oxide fraction (FENO50)
Högman M. Bowerman C. Chavez L. Dressel H. Malinovschi A. Radtke T. Stanojevic S. Steenbruggen I. Turner S. Dinh-Xuan A.T. Amaral R. Backer V. Cameli P. Duong-Quy S. Leung T.F. Gehring U. Hall G. Hong S.-J. Hua-Huy T. Jacinto T. Jeebhay M. Martins C. McSharry C. Olin A.-C. Olivieri M. Bejarano D.P. Rodriguez R. Smit L.A.M. Song W.-J. Vinnikov D.
January 2024European Respiratory Society
European Respiratory Journal
2024#63Issue 1
Background Elevated exhaled nitric oxide fraction at a flow rate of 50 mL·s−1 (FENO50) is an important indicator of T-helper 2-driven airway inflammation and may aid clinicians in the diagnosis and monitoring of asthma. This study aimed to derive Global Lung Function Initiative reference equations and the upper limit of normal for FENO50. Methods Available individual FENO50 data were collated and harmonised using consensus-derived variables and definitions. Data collected from individuals who met the harmonised definition of “healthy” were analysed using the generalised additive models of location, scale and shape (GAMLSS) technique. Results Data were retrospectively collated from 34 782 individuals from 34 sites in 15 countries, of whom 8022 met the definition of healthy (19 sites, 11 countries). Overall, height, age and sex only explained 12% of the between-subject variability of FENO50 (R2=0.12). FENO device was neccessary as a predictor of FENO50, such that the healthy range of values and the upper limit of normal varied depending on which device was used. The range of FENO50 values observed in healthy individuals was also very wide, and the heterogeneity was partially explained by the device used. When analysing a subset of data in which FENO50 was measured using the same device and a stricter definition of health (n=1027), between-site heterogeneity remained. Conclusion Available FENO50 data collected from different sites using different protocols and devices were too variable to develop a single all-age reference equation. Further standardisation of FENO devices and measurement are required before population reference values might be derived. Copyright
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Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, University Hospital Zurich, Zurich, Switzerland
Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
Lung Function Department, Isala Hospital, Zwolle, Netherlands
Women and Children Division, NHS Grampian, Aberdeen, United Kingdom
Child Health, University of Aberdeen, Aberdeen, United Kingdom
Cochin University Hospital, Respiratory Physiology, Paris, France
Uppsala University, Sweden
Rigs Hospitalet, Denmark
Azienda Ospedaliera Universitaria Senese, Italy
Lam Dong Medical College, Viet Nam
The Chinese University of Hong Kong, Hong Kong
Utrecht University, Netherlands
Telethon Kids, Australia
Asan Medical Center, South Korea
Cochin Hospital, India
CINTESIS, Portugal
University of Cape Town, South Africa
University of Porto, Portugal
Glasgow University, United Kingdom
University of Gothenburg, Sweden
University of Verona, Italy
Neumolab, Portugal
InselBern, Switzerland
al-Farabi Kazakh National University, Kazakhstan
Department of Medical Sciences
Michael G. DeGroote School of Medicine
Department of Community Health and Epidemiology
Division of Occupational and Environmental Medicine
Department of Medical Sciences
Lung Function Department
Women and Children Division
Child Health
Cochin University Hospital
Uppsala University
Rigs Hospitalet
Azienda Ospedaliera Universitaria Senese
Lam Dong Medical College
The Chinese University of Hong Kong
Utrecht University
Telethon Kids
Asan Medical Center
Cochin Hospital
CINTESIS
University of Cape Town
University of Porto
Glasgow University
University of Gothenburg
University of Verona
Neumolab
InselBern
al-Farabi Kazakh National University
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