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Exhaled NO reference limits in a large population-based sample using the Lambda-Mu-Sigma method
Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res, Edificio Nascente,Piso 2, P-4200450 Porto, Portugal;Porto Hlth Sch, Dept Cardiovasc & Resp Sci, Porto, Portugal.ORCID iD: 0000-0002-7897-1101
Univ Porto, Fac Med, Ctr Hlth Technol & Serv Res, Edificio Nascente,Piso 2, P-4200450 Porto, Portugal.ORCID iD: 0000-0002-0233-830X
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Lung- allergy- and sleep research.ORCID iD: 0000-0001-5093-6980
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2018 (English)In: Journal of applied physiology, ISSN 8750-7587, E-ISSN 1522-1601, Vol. 125, no 5, p. 1620-1626Article in journal (Refereed) Published
Abstract [en]

Absolute values are used in the interpretation of the fraction of exhaled nitric oxide (FeNO), but it has been suggested that equations to calculate reference values may be a practical and clinically useful approach. We hypothesize that the application of the Lambda-Mu-Sigma (LMS) method may improve FeNO reference equations and their interpretation. Our aims were to develop FeNO reference equations with the LMS method and to describe the difference between this method and the absolute fixed cut-offs of the current recommendations. We utilized the United States National Health and Nutrition Examination Surveys 2007-2012 and included healthy individuals with no respiratory diseases and blood eosinophils <300/mm(3) (n = 8,340). Natural log-transformed FeNO was modeled using the LMS method, imbedded in the generalized additive models for location, scale, and shape models. A set of FeNO reference equations was developed. The explanatory variables were sex, age, height, smoking habits, and race/ethnicity. A significant proportion of individuals with normal FeNO given by the equations were classified as having intermediate levels by the current recommendations. Further lower predicted FeNO compared with previous linear models was seen. In conclusion, we suggest a novel model for the prediction of reference FeNO values that can contribute to the interpretation of FeNO in clinical practice. This approach should be further validated in large samples with an objective measurement of atopy and a medical diagnosis of asthma and rhinitis. NEW & NOTEWORTHY Novel reference equations and fraction of exhaled nitric oxide (FeNO)-predicted values to improve interpretation of FeNO in clinical practice are presented. These may increase the accuracy of ruling out airway inflammation in patients with asthma or suspected asthma.

Place, publisher, year, edition, pages
2018. Vol. 125, no 5, p. 1620-1626
Keywords [en]
asthma, exhaled nitric oxide, healthy, reference values
National Category
Public Health, Global Health, Social Medicine and Epidemiology Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:uu:diva-372464DOI: 10.1152/japplphysiol.00093.2018ISI: 000451445900026PubMedID: 30161011OAI: oai:DiVA.org:uu-372464DiVA, id: diva2:1276001
Funder
Swedish Foundation for Strategic Research EU, Horizon 2020, POCI-01-0145-FEDER-007746Swedish Heart Lung FoundationSwedish Asthma and Allergy AssociationAvailable from: 2019-01-07 Created: 2019-01-07 Last updated: 2019-01-07Bibliographically approved

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Malinovschi, AndreiJanson, ChristerAlving, Kjell

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Jacinto, TiagoAmaral, RitaMalinovschi, AndreiJanson, ChristerAlving, Kjell
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Journal of applied physiology
Public Health, Global Health, Social Medicine and EpidemiologyRespiratory Medicine and Allergy

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