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BMC Pulmonary Medicine

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Open Access 01-12-2017 | Research article

Reference values of fractional excretion of exhaled nitric oxide among non-smokers and current smokers

Authors: Kjell Torén, Nicola Murgia, Linus Schiöler, Björn Bake, Anna-Carin Olin

Published in: BMC Pulmonary Medicine | Issue 1/2017

Abstract

Background

Fractional exhaled nitric oxide (FE_NO) is used to assess of airway inflammation; diagnose asthma and monitor adherence to advised therapy. Reliable and accurate reference values for FE_NO are needed for both non-smoking and current smoking adults in the clinical setting. The present study was performed to establish reference adult FE_NO values among never-smokers, former smokers and current smokers.

Methods

FE_NO was measured in 5265 subjects aged 25–75 years in a general-population study, using a chemiluminescence (Niox ™) analyser according to the guidelines of the American Thoracic Society and the European Respiratory Society. Atopy was based on the presence of immunoglobulin E (IgE) antibodies to common inhalant allergens (measured using Phadiatop® test). Spirometry without bronchodilation was performed and forced vital capacity (FVC), forced expired volume in 1 s (FEV₁) and the ratio of FEV₁ to FVC values were obtained. After excluding subjects with asthma, chronic bronchitis, spirometric airway obstruction and current cold, 3378 subjects remained. Equations for predictions of FE_NO values were modelled using nonparametric regression models.

Results

FE_NO levels were similar in never-smokers and former smokers, and these two groups were therefore merged into a group termed “non-smokers”. Reference equations, including the 5th and 95th percentiles, were generated for female and male non-smokers, based on age, height and atopy. Regression models for current smokers were unstable. Hence, the proposed reference values for current smokers are based on the univariate distribution of FE_NO and fixed cut-off limits.

Conclusions

Reference values for FE_NO among respiratory healthy non-smokers should be outlined stratified for gender using individual reference values. For current smokers separate cut-off limits are proposed.

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Title: Reference values of fractional excretion of exhaled nitric oxide among non-smokers and current smokers
Authors: Kjell Torén
Nicola Murgia
Linus Schiöler
Björn Bake
Anna-Carin Olin
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: BMC Pulmonary Medicine / Issue 1/2017
Electronic ISSN: 1471-2466
DOI: https://doi.org/10.1186/s12890-017-0456-9

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