Modelling the production of nitric oxide within the human airways

The measurement of exhaled nitric oxide (NO) is well established for monitoring of airway inflammation in bronchial asthma. It is known that the concentration of NO determined as steady state (plateau) value at a constant expiratory flow rate depends on the flow rate chosen. This suggests that the exhaled NO is released within the conducting airways, whereas alveolar NO levels are negligible. The processes involved can be described through a lung model comprising an alveolar compartment and an airway compartment thought of as a pipe. This concept has been formulated mathematically and the models proposed in the literature are essentially equivalent. NO plateau levels obtained at different flow rates allow the estimation of 1) an effective airway wall NO concentration that represents the driving force for NO release, 2) an airway diffusing capacity for NO which depends on factors impeding or facilitating NO transport, including an increase in NO-producing surface area. Clinical studies will have to assess whether the knowledge of these or related parameters offers a significant advantage over the determination of exhaled NO at a single flow rate.