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1 Dept of Paediatrics/Respiratory Medicine, 3 Dept of Epidemiology and Biostatistics, 4 Central Instrumentation Dept, Erasmus MC University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands. 2 Dept of Paediatrics/Respiratory Medicine, University Hospital Padova, Padova, Italy
CORRESPONDENCE: J.C. de Jongste, Erasmus Medical Center - Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands. Fax: 31 104636801. E-mail: dejongste@lons.azr.nl
Keywords: children, dynamic flow restriction, exhaled nitric oxide, normal values, off-line, on-line
Received: February 15, 2002
Accepted May 31, 2002
M.W.H. Pijnenburg was supported by a grant from the Dutch Asthma Foundation and L. Ghiro was supported by a grant of the Italian Nitric Oxide Club (INOC).
Fractional exhaled nitric oxide concentration (FEno) depends on exhalation flow; however, children often are unable to perform controlled flow procedures. Therefore, a device was developed for off-line FEno sampling, with dynamic flow restriction (DFR).
The authors compared off-line with on-line FEno, assessed feasibility, and obtained normal values for FEno in children aged 4–8 yrs. Subjects inhaled nitric oxide (NO)-free air and exhaled into the device, where DFR kept exhalation flow constant at 50 mL·s–1. Dead space air was discarded. Exhaled air was collected in a 150 mL mylar balloon. On-line measurements were performed and values compared with off-line FEno in 19 adult volunteers. Seventy-nine children performed off-line sampling. All samples were analysed with a chemiluminescence NO-analyser. Normal values were obtained in 34 healthy children.
There was an excellent correlation between on- and off-line values. Bland and Altman plots showed good agreement between on- and off-line FEno. Seventy-four out of 79 children were able to perform a correct off-line procedure. Geometric mean±sem FEno in healthy children was 4.9±1.2 parts per billion (ppb) for male children and 7.6±1.1 ppb for female children.
It can be concluded that off-line fraction of exhaled nitric oxide measurements with dynamic flow restriction are feasible in young children and correspond to on-line values.
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