This practice management article will discuss only online point-of-service use of FeNO in an ambulatory practice. Static or dynamic nasal nitric oxide levels obtained with humming, and offline collection and the tidal breathing method of exhaled NO measurement will not be discussed. Information on these are available for those interested in the American Thoracic Society (ATS)/ European Respiratory Society (ERS) consensus state-ment. Table summarizes the clinical role of exhaled nitric oxide. There is international consensus regarding the testing methodology. Normative reference equations and values are now available. The measurement of FeNO is highly reproducible, responsive to changes in the underlying disciting its reproducibility, association with markers of asthma severity, and its role in inhaled corticosteroid (ICS) therapy.
ease state, and predictive of response to therapeutic intervention with antiinflammatory medications. The test is easy to perform from the patient’s perspective. The clinical interpretation of the results depends on the specific clinical question and circumstances of the patient involved. There are still questions to be answered regarding the clinical interpretation of FeNO findings in specific situations. In our pulmonary function laboratory, there have been > 1,800 tests performed safely in children and adults with no reported adverse events, and the demand continues to increase (Fig 1). Several excellent review articles on the clinical application of exhaled nitric oxide have been cited. The National Asthma Education and Preventive Program supports the use of FeNO in asthma patients.
Nitric oxide (NO) is a widely distributed endogenous regulatory molecule in the body synthesized from L-arginine by the enzyme NO synthase (NOS). NO in the airway is measured by its reaction with ozone, which is detected by chemiluminescence. NO was first described as a vascular smooth muscle relaxant and was subsequently found to be present in the expired breath of animals and humans. This led to the observation that FeNO is elevated in asthmatic patients. The level of FeNO decreases after the administration of ICSs and systemic corticosteroids.11 NO is continuously produced in the airway by NOS.
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