Reference Ranges and Determinant Factors for Fractional Exhaled Nitric Oxide in a Healthy Saudi Adult Population

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Abstract

Background

Fractional exhaled nitric oxide (FENO) has emerged as a promising marker in respiratory research. The aim of this study was to determine the reference range values of FENO for healthy Saudi adults and the factors associated with FENO levels.

Material/Methods

This cross-sectional study was conducted at the Department of Physiology, King Saud University, Riyadh, Saudi Arabia, from January 2016 to August 2017. A total of 429 healthy Saudi adults were initially recruited. The final selection included 412 participants, consisting of 307 men and 105 women. FENO measurements were performed according to the current recommendations of the American Thoracic Society.

Results

We observed that the FENO levels of women were significantly lower than those of men (18.6 vs. 21.3, P=0.009). In women, the measured FENO ranged from 5.7 ppb to 42 ppb, and in men from 5.0 ppb to 55.0 ppb. The mean FENO level in the entire study population was 20.6, with a range of 5.0 ppb to 55.0 ppb. The difference became non-significant when we calculated the FENO after adjusting for body surface area by different percentile distributions. Multiple linear regression analysis showed that body surface area and weight were significant predictors of FENO levels.

Conclusions

In this study, FENO levels were significantly affected by demographic variables. Therefore, it is important to consider the factors influencing FENO values to make a valid clinical interpretation.

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Most cited references 26

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Lebrikizumab treatment in adults with asthma.

Jonathan Corren, Robert F Lemanske, Nicola A Hanania … (2011)

Many patients with asthma have uncontrolled disease despite treatment with inhaled glucocorticoids. One potential cause of the variability in response to treatment is heterogeneity in the role of interleukin-13 expression in the clinical asthma phenotype. We hypothesized that anti-interleukin-13 therapy would benefit patients with asthma who had a pretreatment profile consistent with interleukin-13 activity. We conducted a randomized, double-blind, placebo-controlled study of lebrikizumab, a monoclonal antibody to interleukin-13, in 219 adults who had asthma that was inadequately controlled despite inhaled glucocorticoid therapy. The primary efficacy outcome was the relative change in prebronchodilator forced expiratory volume in 1 second (FEV(1)) from baseline to week 12. Among the secondary outcomes was the rate of asthma exacerbations through 24 weeks. Patient subgroups were prespecified according to baseline type 2 helper T-cell (Th2) status (assessed on the basis of total IgE level and blood eosinophil count) and serum periostin level. At baseline, patients had a mean FEV(1) that was 65% of the predicted value and were taking a mean dose of inhaled glucocorticoids of 580 μg per day; 80% were also taking a long-acting beta-agonist. At week 12, the mean increase in FEV(1) was 5.5 percentage points higher in the lebrikizumab group than in the placebo group (P = 0.02). Among patients in the high-periostin subgroup, the increase from baseline FEV(1) was 8.2 percentage points higher in the lebrikizumab group than in the placebo group (P = 0.03). Among patients in the low-periostin subgroup, the increase from baseline FEV(1) was 1.6 percentage points higher in the lebrikizumab group than in the placebo group (P = 0.61). Musculoskeletal side effects were more common with lebrikizumab than with placebo (13.2% vs. 5.4%, P = 0.045). Lebrikizumab treatment was associated with improved lung function. Patients with high pretreatment levels of serum periostin had greater improvement in lung function with lebrikizumab than did patients with low periostin levels. (Funded by Genentech; ClinicalTrials.gov number, NCT00930163 .).

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Height, age, and atopy are associated with fraction of exhaled nitric oxide in a large adult general population sample.

Lauren Lissner, Kjell Torén, Dag S. Thelle … (2006)

The fraction of exhaled nitric oxide (Feno) is elevated in subjects with asthma and atopy, and it has been proposed to be a noninvasive marker of airway inflammation. In addition to asthma and atopy, there is limited information about the determinants of Feno in a general population. Cross-sectional. A random adult general population sample. A total of 2,200 subjects, 1,111 women and 1,089 men, aged 25 to 75 years. The subjects were examined with regard to Feno, pulmonary function, anthropometric variables, and blood samples for Ig E, and completed a respiratory questionnaire. The associations between different determinants and Feno were analyzed with multiple linear regression models. The median value of Feno was 16.0 parts per billion (ppb), ranging from 2.4 to 199 ppb. Height, age, atopy, reporting of asthma symptoms in the last month, and reported use of inhaled steroids were positively associated with Feno. Current smokers had lower values of Feno. Gender was not associated with Feno. In this random adult population sample, height, but not gender, was associated with Feno. Furthermore, asthma symptoms in the last month, reported use of inhaled steroids, and atopy were positively and independently associated with Feno, while there was a negative association with smoking.

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Current evidence and future research needs for FeNO measurement in respiratory diseases.

Leif Bjermer, Kjell Alving, Zuzana Diamant … (2014)

Although not yet widely implemented, fraction of exhaled nitric oxide (FeNO) has emerged in recent years as a potentially useful biomarker for the assessment of airway inflammation both in undiagnosed patients with non-specific respiratory symptoms and in those with established airway disease. Research to date essentially suggests that FeNO measurement facilitates the identification of patients exhibiting T-helper cell type 2 (Th2)-mediated airway inflammation, and effectively those in whom anti-inflammatory therapy, particularly inhaled corticosteroids (ICS), is beneficial. In some studies, FeNO-guided management of patients with established airway disease is associated with lower exacerbation rates, improvements in adherence to anti-inflammatory therapy, and the ability to predict risk of future exacerbations or decline in lung function. Despite these data, concerns regarding the applicability and utility of FeNO in clinical practice still remain. This article reviews the current evidence, both supportive and critical of FeNO measurement, in the diagnosis and management of asthma and other inflammatory airway diseases. It additionally provides suggestions regarding the practical application of FeNO measurement: how it could be integrated into routine clinical practice, how its utility could be assessed and its true value to both clinicians and patients could be established. Although some unanswered questions remain, current evidence suggests that FeNO is potentially a valuable tool for improving the personalised management of inflammatory airway diseases.

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Author and article information

Journal

Journal ID (nlm-ta): Med Sci Monit Basic Res

Journal ID (iso-abbrev): Med Sci Monit Basic Res

Journal ID (publisher-id): Medical Science Monitor Basic Research

Title: Medical Science Monitor Basic Research

Publisher: International Scientific Literature, Inc.

ISSN (Print): 2325-4394

ISSN (Electronic): 2325-4416

Publication date Collection: 2020

Publication date (Electronic): 24 August 2020

Volume: 26

Pages: e926382-1-e926382-7

Affiliations

[1 ]Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia

[2 ]Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan

Author notes

Corresponding Author: Syed Shahid Habib, e-mail: sshahid@ 123456ksu.edu.sa

[A]

Study Design

[B]

Data Collection

[C]

Statistical Analysis

[D]

Data Interpretation

[E]

Manuscript Preparation

[F]

Literature Search

[G]

Funds Collection

Conflict of interest

None.

Article

Publisher ID: 926382

DOI: 10.12659/MSMBR.926382

PMC ID: 7466833

PubMed ID: 32830193

SO-VID: 425053fe-e674-4448-8d79-1374c4127f65

License:

This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International ( CC BY-NC-ND 4.0)

Reference Ranges and Determinant Factors for Fractional Exhaled Nitric Oxide in a Healthy Saudi Adult Population

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Abstract

Background

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Conclusions

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Karger: Nutrition and Dietetics

Most cited references 26

Lebrikizumab treatment in adults with asthma.

Height, age, and atopy are associated with fraction of exhaled nitric oxide in a large adult general population sample.

Current evidence and future research needs for FeNO measurement in respiratory diseases.

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