FE(NO): Relationship to exhalation rates and online versus bag collection in healthy adolescents

Measurement of exhaled nitric oxide (FE(No)) is a noninvasive and practical method for assessing airway inflammation. We conducted this investigation to determine the most appropriate flow rate for FE(NO) measurement and to obtain normal values for FE(NO). We determined which expiratory flow was easy to sustain, generated reproducible values, and provided good correlation between offline and online measurements. Thirty-two healthy subjects (15-18 yr old) underwent spirometry and FE(NO) measurements, using a chemiluminescent NO analyzer at expiratory flow rates of 46, 31, 23, 15, 10, 7, 5, and 4 ml/s. The major findings were as follows: (1) Fe(NO) increased as flow rates decreased, with strong correlation between Fe(NO) values and flow rates at the four highest flows (0.85-0.93, p < 0.001); (2) there were no significant differences and good agreement between offline bag and online Fe(NO) values for the four highest flows (p < 0.09-0.83); (3) online Fe(NO) values increased with age 15-17 yr at all flow rates, but decreased at age 18 yr; and (4) using multiple regression, significant predictors of Fe(NO) were flow, body surface area, age, and FEF_25-75. On the basis of these results, we provide Fe(NO) values for healthy adolescents and propose that the ideal flow rate for children is between 30 and 50 ml/s.