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1 Dept of Paediatrics, Division Paediatric Respiratory Medicine, and 2 Dept of Epidemiology and Biostatistics, Erasmus University and University Hospital/Sophia Children's Hospital, Rotterdam and 3 Dept of Paediatrics, University Hospital Maastricht, the Netherlands
CORRESPONDENCE: J.C. de Jongste, Sophia Children's Hospital, Room Sp-2465, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
Keywords: asthma, breath-hold, children, exhaled air, nitric oxide, off-line sampling
Received: April 26, 1999
Accepted January 24, 2001
This study was supported by a research grant of the Netherlands Asthma Foundation (NAF 94.14).
Measurement of nitric oxide in exhaled air is a noninvasive method to assess airway inflammation in asthma. This study was undertaken to establish the reference range of exhaled NO in healthy school-aged children and to determine the influence of ambient NO, noseclip and breath-holding on exhaled NO, using an off-line balloon sampling method.
All children attending a primary school (age range 8–13 yrs) underwent NO measurements on two occasions with high and low ambient NO. Each time, the children performed four expiratory manoeuvres into NO-impermeable balloons, with and without 10 s of breath-holding and with and without wearing a noseclip. Exhalation flow and pressure were not controlled. NO was measured within 4 h after collection, by means of chemiluminescence. All children completed a questionnaire on respiratory and allergic disorders, and performed flow/volume spirometry.
With low ambient NO, the mean exhaled NO value of 72 healthy children with negative questionnaires and normal lung function was 5.1±0.2 parts per billion (ppb) versus a mean of 6.8±0.3 ppb in the remaining 49 children with positive questionnaires for asthma and allergy, and/or recent symptoms of cold (p=0.001). Exhaled and ambient NO were significantly related, especially with ambient NO >10 ppb (r=0.86, p=0.0001 versus r=0.34, p=0.004 for ambient values <10 ppb). The use of a noseclip, with low ambient NO and without breath-holding, caused a small decrease in exhaled NO values (p=0.001). The effect of breath-holding on exhaled NO depended on ambient NO. With ambient NO >10 ppb, exhaled NO decreased, whereas with ambient NO <10 ppb, exhaled NO increased after 10 s breath-hold.
It is concluded that off-line sampling in balloons is a simple and, hence, attractive method for exhaled nitric oxide measurements in children which differentiates between groups with and without self-reported asthma, allergy and colds, when ambient nitric oxide is <10 parts per billion. Wearing a noseclip and breath-holding affected measured values and should, therefore be standardized or, preferably, avoided.
This article has been cited by other articles:
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  D R Taylor, M W Pijnenburg, A D Smith, and J C D Jongste Exhaled nitric oxide measurements: clinical application and interpretation. Thorax, September 1, 2006; 61(9): 817 - 827. [Abstract] [Full Text] [PDF]
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 P L P Brand and R J Roorda Usefulness of monitoring lung function in asthma Arch. Dis. Child., November 1, 2003; 88(11): 1021 - 1025. [Abstract] [Full Text] [PDF]
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Members of the Task Force:, E. Baraldi, J.C. de Jongste, B. Gaston, K. Alving, P.J. Barnes, H. Bisgaard, A. Bush, C. Gaultier, H. Grasemann, et al. Measurement of exhaled nitric oxide in children, 2001: E. Baraldi and J.C. de Jongste on behalf of the Task Force Eur. Respir. J., July 1, 2002; 20(1): 223 - 237. [Abstract] [Full Text] [PDF]
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