OCCASIONAL REVIEW

Exhaled nitric oxide measurements: clinical application and interpretation

D R Taylor¹, M W Pijnenburg², A D Smith¹, J C D Jongste²

¹ Department of Medical and Surgical Sciences, Dunedin School of Medicine, University of Otago, P O Box 913, Dunedin, New Zealand
² Department of Paediatric Respiratory Medicine, Erasmus MC - Sophia Children’s Hospital, University Medical Centre, P O Box 2060, 3000 CB Rotterdam, The Netherlands

Correspondence to:
Correspondence to:
Professor D R Taylor
Department of Medical and Surgical Sciences, Dunedin School of Medicine, University of Otago, P O Box 913, Dunedin, New Zealand; robin.taylor{at}stonebow.otago.ac.nz

The use of exhaled nitric oxide measurements (F_ENO) in clinical practice is now coming of age. There are a number of theoretical and practical factors which have brought this about. Firstly, F_ENO is a good surrogate marker for eosinophilic airway inflammation. High F_ENO levels may be used to distinguish eosinophilic from non-eosinophilic pathologies. This information complements conventional pulmonary function testing in the assessment of patients with non-specific respiratory symptoms. Secondly, eosinophilic airway inflammation is steroid responsive. There are now sufficient data to justify the claim that F_ENO measurements may be used successfully to identify and monitor steroid response as well as steroid requirements in the diagnosis and management of airways disease. F_ENO measurements are also helpful in identifying patients who do/do not require ongoing treatment with inhaled steroids. Thirdly, portable nitric oxide analysers are now available, making routine testing a practical possibility. However, a number of issues still need to be resolved, including the diagnostic role of F_ENO in preschool children and the use of reference values versus individual F_ENO profiles in managing patients with difficult or severe asthma.

Abbreviations: AHR, airway hyperresponsiveness; CF, cystic fibrosis; COPD, chronic obstructive pulmonary disease; F_ENO, exhaled nitric oxide; FEV₁, forced expiratory volume in 1 second; ICS, inhaled corticosteroids; NO, nitric oxide; PCD, primary ciliary dyskinesia

Keywords: exhaled nitric oxide; asthma; diagnosis; monitoring; treatment

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