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Published in: BMC Pulmonary Medicine 1/2014

Open Access 01-12-2014 | Research article

Validation of a portable nitric oxide analyzer for screening in primary ciliary dyskinesias

Authors: Amanda Harris, Esther Bhullar, Kerry Gove, Rhiannon Joslin, Jennifer Pelling, Hazel J Evans, Woolf T Walker, Jane S Lucas

Published in: BMC Pulmonary Medicine | Issue 1/2014

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Abstract

Background

Nasal nitric oxide (nNO) levels are very low in primary ciliary dyskinesia (PCD) and it is used as a screening test.

Methods

We assessed the reliability and usability of a hand-held analyser in comparison to a stationary nitric oxide (NO) analyser in 50 participants (15 healthy, 13 PCD, 22 other respiratory diseases; age 6–79 years). Nasal NO was measured using a stationary NO analyser during a breath-holding maneuver, and using a hand-held analyser during tidal breathing, sampling at 2 ml/sec or 5 ml/sec. The three methods were compared for their specificity and sensitivity as a screen for PCD, their success rate in different age groups, within subject repeatability and acceptability. Correlation between methods was assessed.

Results

Valid nNO measurements were obtained in 94% of participants using the stationary analyser, 96% using the hand-held analyser at 5 ml/sec and 76% at 2 ml/sec. The hand-held device at 5 ml/sec had excellent sensitivity and specificity as a screening test for PCD during tidal breathing (cut-off of 30 nL/min,100% sensitivity, >95% specificity). The cut-off using the stationary analyser during breath-hold was 38 nL/min (100% sensitivity, 95% specificity). The stationary and hand-held analyser (5 ml/sec) showed reasonable within-subject repeatability(% coefficient of variation = 15).

Conclusion

The hand-held NO analyser provides a promising screening tool for PCD.
Appendix
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Literature
1.
go back to reference Lucas JS, Walker WT, Kuehni CE, Lazor R: Primary ciliary dyskinesia. Orphan Lung Diseases. Edited by: Courdier J-F. 2011, UK: European Respiratory Monograph; European Respiratory Society Publications, 201-217.CrossRef Lucas JS, Walker WT, Kuehni CE, Lazor R: Primary ciliary dyskinesia. Orphan Lung Diseases. Edited by: Courdier J-F. 2011, UK: European Respiratory Monograph; European Respiratory Society Publications, 201-217.CrossRef
2.
go back to reference Barbato A, Frischer T, Kuehni CE, Snijders D, Azevedo I, Baktai G, Bartoloni L, Eber E, Escribano A, Haarman E, Hesselmar B, Hogg C, Jorissen M, Lucas J, Nielsen KG, O'Callaghan C, Omran H, Pohunek P, Strippoli MP, Bush A: Primary ciliary dyskinesia: a consensus statement on diagnostic and treatment approaches in children. Eur Respir J. 2009, 34: 1264-1276. 10.1183/09031936.00176608.CrossRefPubMed Barbato A, Frischer T, Kuehni CE, Snijders D, Azevedo I, Baktai G, Bartoloni L, Eber E, Escribano A, Haarman E, Hesselmar B, Hogg C, Jorissen M, Lucas J, Nielsen KG, O'Callaghan C, Omran H, Pohunek P, Strippoli MP, Bush A: Primary ciliary dyskinesia: a consensus statement on diagnostic and treatment approaches in children. Eur Respir J. 2009, 34: 1264-1276. 10.1183/09031936.00176608.CrossRefPubMed
3.
go back to reference Bush A, Chodhari R, Collins N, Copeland F, Hall P, Harcourt J, Hariri M, Hogg C, Lucas J, Mitchison HM, O'Callaghan C, Phillips G: Primary ciliary dyskinesia: current state of the art. Arch Dis Child. 2007, 92: 1136-1140. 10.1136/adc.2006.096958.CrossRefPubMedPubMedCentral Bush A, Chodhari R, Collins N, Copeland F, Hall P, Harcourt J, Hariri M, Hogg C, Lucas J, Mitchison HM, O'Callaghan C, Phillips G: Primary ciliary dyskinesia: current state of the art. Arch Dis Child. 2007, 92: 1136-1140. 10.1136/adc.2006.096958.CrossRefPubMedPubMedCentral
4.
5.
go back to reference Kuehni CE, Frischer T, Strippoli MP, Maurer E, Bush A, Nielsen KG, Escribano A, Lucas JS, Yiallouros P, Omran H, Eber E, O'Callaghan C, Snijders D, Barbato A: Factors influencing age at diagnosis of primary ciliary dyskinesia in European children. Eur Respir J. 2010, 36: 1248-1258. 10.1183/09031936.00001010.CrossRefPubMed Kuehni CE, Frischer T, Strippoli MP, Maurer E, Bush A, Nielsen KG, Escribano A, Lucas JS, Yiallouros P, Omran H, Eber E, O'Callaghan C, Snijders D, Barbato A: Factors influencing age at diagnosis of primary ciliary dyskinesia in European children. Eur Respir J. 2010, 36: 1248-1258. 10.1183/09031936.00001010.CrossRefPubMed
6.
go back to reference Karadag B, James AJ, Gultekin E, Wilson NM, Bush A: Nasal and lower airway level of nitric oxide in children with primary ciliary dyskinesia. Eur Respir J. 1999, 13: 1402-1405. 10.1183/09031936.99.13614069.CrossRefPubMed Karadag B, James AJ, Gultekin E, Wilson NM, Bush A: Nasal and lower airway level of nitric oxide in children with primary ciliary dyskinesia. Eur Respir J. 1999, 13: 1402-1405. 10.1183/09031936.99.13614069.CrossRefPubMed
7.
go back to reference Wodehouse T, Kharitonov SA, Mackay IS, Barnes PJ, Wilson R, Cole PJ: Nasal nitric oxide measurements for the screening of primary ciliary dyskinesia. Eur Respir J. 2003, 21: 43-47. 10.1183/09031936.03.00305503.CrossRefPubMed Wodehouse T, Kharitonov SA, Mackay IS, Barnes PJ, Wilson R, Cole PJ: Nasal nitric oxide measurements for the screening of primary ciliary dyskinesia. Eur Respir J. 2003, 21: 43-47. 10.1183/09031936.03.00305503.CrossRefPubMed
8.
go back to reference Walker WT, Jackson CL, Lackie PM, Hogg C, Lucas JS: Nitric oxide in primary ciliary dyskinesia. Eur Respir J. 2012, 40: 1024-1032. 10.1183/09031936.00176111.CrossRefPubMed Walker WT, Jackson CL, Lackie PM, Hogg C, Lucas JS: Nitric oxide in primary ciliary dyskinesia. Eur Respir J. 2012, 40: 1024-1032. 10.1183/09031936.00176111.CrossRefPubMed
9.
go back to reference Leigh MW, Hazucha MJ, Chawla KK, Baker BR, Shapiro AJ, Brown DE, Lavange LM, Horton BJ, Qaqish B, Carson JL, Davis SD, Dell SD, Ferkol TW, Atkinson JJ, Olivier KN, Sagel SD, Rosenfeld M, Milla C, Lee HS, Krischer J, Zariwala MA, Knowles MR: Standardizing nasal nitric oxide measurement as a test for primary ciliary dyskinesia. Ann Am Thorac Soc. 2013, 10 (6): 574-581.CrossRefPubMedPubMedCentral Leigh MW, Hazucha MJ, Chawla KK, Baker BR, Shapiro AJ, Brown DE, Lavange LM, Horton BJ, Qaqish B, Carson JL, Davis SD, Dell SD, Ferkol TW, Atkinson JJ, Olivier KN, Sagel SD, Rosenfeld M, Milla C, Lee HS, Krischer J, Zariwala MA, Knowles MR: Standardizing nasal nitric oxide measurement as a test for primary ciliary dyskinesia. Ann Am Thorac Soc. 2013, 10 (6): 574-581.CrossRefPubMedPubMedCentral
10.
go back to reference Lucas JS, Walker WT: Nitric oxide is an important test in the diagnostic pathway for primary ciliary. Ann Am Thorac Soc. 2013, in press Lucas JS, Walker WT: Nitric oxide is an important test in the diagnostic pathway for primary ciliary. Ann Am Thorac Soc. 2013, in press
11.
go back to reference Boot JD, de Ridder L, de Kam ML, Calderon C, Mascelli MA, Diamant Z: Comparison of exhaled nitric oxide measurements between NIOX MINO electrochemical and Ecomedics chemiluminescence analyzer. Respir Med. 2008, 102: 1667-1667. 10.1016/j.rmed.2008.06.021.CrossRefPubMed Boot JD, de Ridder L, de Kam ML, Calderon C, Mascelli MA, Diamant Z: Comparison of exhaled nitric oxide measurements between NIOX MINO electrochemical and Ecomedics chemiluminescence analyzer. Respir Med. 2008, 102: 1667-1667. 10.1016/j.rmed.2008.06.021.CrossRefPubMed
12.
go back to reference Kim SH, Moon JY, Kwak HJ, Kim SI, Park DW, Kim JW, Kim TH, Sohn JW, Shin DH, Park SS, Yoon HJ: Comparison of two exhaled nitric oxide analyzers: the NIOX MINO hand-held electrochemical analyzer and the NOA280i stationary chemiluminescence analyzer. Respirology. 2012, 17: 830-834. 10.1111/j.1440-1843.2012.02163.x.CrossRefPubMed Kim SH, Moon JY, Kwak HJ, Kim SI, Park DW, Kim JW, Kim TH, Sohn JW, Shin DH, Park SS, Yoon HJ: Comparison of two exhaled nitric oxide analyzers: the NIOX MINO hand-held electrochemical analyzer and the NOA280i stationary chemiluminescence analyzer. Respirology. 2012, 17: 830-834. 10.1111/j.1440-1843.2012.02163.x.CrossRefPubMed
13.
go back to reference Schiller B, Hammer J, Barben J, Trachsel D: Comparability of a hand-held nitric oxide analyser with online and offline chemiluminescence-based nitric oxide measurement. Pediatr Allergy Immunol. 2009, 20: 679-685. 10.1111/j.1399-3038.2009.00853.x.CrossRefPubMed Schiller B, Hammer J, Barben J, Trachsel D: Comparability of a hand-held nitric oxide analyser with online and offline chemiluminescence-based nitric oxide measurement. Pediatr Allergy Immunol. 2009, 20: 679-685. 10.1111/j.1399-3038.2009.00853.x.CrossRefPubMed
14.
go back to reference Selby A, Clayton B, Grundy J, Pike K, Drew K, Raza A, Kurukulaaratchy R, Arshad SH, Roberts G: Are exhaled nitric oxide measurements using the portable NIOX MINO repeatable?. Respir Res. 2010, 11: 43-10.1186/1465-9921-11-43.CrossRefPubMedPubMedCentral Selby A, Clayton B, Grundy J, Pike K, Drew K, Raza A, Kurukulaaratchy R, Arshad SH, Roberts G: Are exhaled nitric oxide measurements using the portable NIOX MINO repeatable?. Respir Res. 2010, 11: 43-10.1186/1465-9921-11-43.CrossRefPubMedPubMedCentral
15.
go back to reference Maniscalco M, de Laurentiis G, Weitzberg E, Lundberg JO, Sofia M: Validation study of nasal nitric oxide measurements using a hand-held electrochemical analyser. Eur J Clin Invest. 2008, 38: 197-200. 10.1111/j.1365-2362.2008.01907.x.CrossRefPubMed Maniscalco M, de Laurentiis G, Weitzberg E, Lundberg JO, Sofia M: Validation study of nasal nitric oxide measurements using a hand-held electrochemical analyser. Eur J Clin Invest. 2008, 38: 197-200. 10.1111/j.1365-2362.2008.01907.x.CrossRefPubMed
16.
go back to reference Weschta M, Deutschle T, Riechelmann H: Nasal fractional exhaled nitric oxide analysis with a novel hand-held device. Rhinology. 2008, 46: 23-27.PubMed Weschta M, Deutschle T, Riechelmann H: Nasal fractional exhaled nitric oxide analysis with a novel hand-held device. Rhinology. 2008, 46: 23-27.PubMed
17.
go back to reference Montella S, Alving K, Maniscalco M, Sofia M, De SS, Raia V, Santamaria F: Measurement of nasal nitric oxide by hand-held and stationary devices. Eur J Clin Invest. 2011, 41: 1063-1070. 10.1111/j.1365-2362.2011.02501.x.CrossRefPubMed Montella S, Alving K, Maniscalco M, Sofia M, De SS, Raia V, Santamaria F: Measurement of nasal nitric oxide by hand-held and stationary devices. Eur J Clin Invest. 2011, 41: 1063-1070. 10.1111/j.1365-2362.2011.02501.x.CrossRefPubMed
18.
go back to reference Marthin JK, Nielsen KG: Hand-held tidal breathing nasal nitric oxide measurement–a promising targeted case-finding tool for the diagnosis of primary ciliary dyskinesia. PLoS One. 2013, 8: e57262-10.1371/journal.pone.0057262.CrossRefPubMedPubMedCentral Marthin JK, Nielsen KG: Hand-held tidal breathing nasal nitric oxide measurement–a promising targeted case-finding tool for the diagnosis of primary ciliary dyskinesia. PLoS One. 2013, 8: e57262-10.1371/journal.pone.0057262.CrossRefPubMedPubMedCentral
19.
go back to reference Bush A, Cole P, Hariri M, Mackay I, Phillips G, O'Callaghan C, Wilson R, Warner JO: Primary ciliary dyskinesia: diagnosis and standards of care. Eur Respir J. 1998, 12: 982-988. 10.1183/09031936.98.12040982.CrossRefPubMed Bush A, Cole P, Hariri M, Mackay I, Phillips G, O'Callaghan C, Wilson R, Warner JO: Primary ciliary dyskinesia: diagnosis and standards of care. Eur Respir J. 1998, 12: 982-988. 10.1183/09031936.98.12040982.CrossRefPubMed
20.
go back to reference American Thoracic Society; European Respiratory Society: ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide,2005. Am J Respir Crit Care Med. 2005, 171 (8): 912-30.CrossRef American Thoracic Society; European Respiratory Society: ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide,2005. Am J Respir Crit Care Med. 2005, 171 (8): 912-30.CrossRef
21.
go back to reference Mateos-Corral D, Coombs R, Grasemann H, Ratjen F, Dell SD: Diagnostic value of nasal nitric oxide measured with non-velum closure techniques for children with primary ciliary dyskinesia. J Pediatr. 2011, 159: 420-424. 10.1016/j.jpeds.2011.03.007.CrossRefPubMed Mateos-Corral D, Coombs R, Grasemann H, Ratjen F, Dell SD: Diagnostic value of nasal nitric oxide measured with non-velum closure techniques for children with primary ciliary dyskinesia. J Pediatr. 2011, 159: 420-424. 10.1016/j.jpeds.2011.03.007.CrossRefPubMed
22.
go back to reference Marthin JK, Nielsen KG: Choice of nasal nitric oxide technique as first-line test for primary ciliary dyskinesia. Eur Respir J. 2011, 37: 559-565. 10.1183/09031936.00032610.CrossRefPubMed Marthin JK, Nielsen KG: Choice of nasal nitric oxide technique as first-line test for primary ciliary dyskinesia. Eur Respir J. 2011, 37: 559-565. 10.1183/09031936.00032610.CrossRefPubMed
23.
go back to reference Pifferi M, Bush A, Caramella D, Di CM, Zangani M, Chinellato I, Macchia P, Boner AL: Agenesis of paranasal sinuses and nasal nitric oxide in primary ciliary dyskinesia. Eur Respir J. 2011, 37: 566-571. 10.1183/09031936.00068810.CrossRefPubMed Pifferi M, Bush A, Caramella D, Di CM, Zangani M, Chinellato I, Macchia P, Boner AL: Agenesis of paranasal sinuses and nasal nitric oxide in primary ciliary dyskinesia. Eur Respir J. 2011, 37: 566-571. 10.1183/09031936.00068810.CrossRefPubMed
Metadata
Title
Validation of a portable nitric oxide analyzer for screening in primary ciliary dyskinesias
Authors
Amanda Harris
Esther Bhullar
Kerry Gove
Rhiannon Joslin
Jennifer Pelling
Hazel J Evans
Woolf T Walker
Jane S Lucas
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2014
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/1471-2466-14-18

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