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Updated: Aug 18, 2026
A Novel Inhalation Mask System to Deliver High Concentrations of Nitric Oxide Gas in Spontaneously Breathing Subjects
Published on: May 4, 2021
Measurement of exhaled nitric oxide in young children during tidal breathing through a facemask
Peter Fleng Daniel1, Bent Klug, Niels Henrik Valerius
1Department of Pediatrics, Copenhagen University Hospital, Hvidovre, Denmark. fleng@dadlnet.dk
Insights
Measuring exhaled nitric oxide (eNO) in young children is now more reliable. A new facemask with a one-way valve improves accuracy for assessing airway inflammation in pediatric patients.
Area of Science:
- Respiratory Medicine
- Pediatric Pulmonology
- Biomedical Engineering
Background:
- Exhaled nitric oxide (eNO) is a valuable non-invasive biomarker for assessing airway inflammation.
- Current eNO measurement techniques are challenging to implement in preschool-aged children.
- Developing pediatric-friendly methods is crucial for early diagnosis and management of respiratory conditions.
Purpose of the Study:
- To evaluate four methods for measuring eNO during tidal breathing in young children.
- To assess the feasibility and reproducibility of these methods in a pediatric population.
- To identify a reliable technique for eNO measurement in children aged 2-7 years.
Main Methods:
- eNO was measured during tidal breathing in 24 children (2-7 years) using facemasks with and without a one-way nasal valve.
- Measurements were performed both on-line and off-line, without expiratory flow control.
- Comparisons were made with the standard single breath on-line method in 11 older children (8-12 years).
Main Results:
- Facemasks with a one-way valve resulted in significantly lower eNO levels (4.6-3.9 ppb) compared to those without (6.9-6.5 ppb).
- On-line measurements with the one-way valve demonstrated significantly lower variability (9.6% CV) than other methods (18.8-29.3% CV).
- eNO measurements using the one-way valve facemask closely matched the standard method in both levels (7.0 vs. 6.9 ppb) and reproducibility (9.8% vs. 7.1% CV).
Conclusions:
- Reproducible eNO measurements are achievable in young children without expiratory flow control by using a facemask with a nasal one-way valve.
- The one-way valve likely reduces nasal nitric oxide admixture, enhancing measurement reliability.
- This method offers a promising, non-invasive approach for evaluating airway inflammation in pediatric populations.
Abstract:
Measurement of exhaled nitric oxide (eNO) offers a non-invasive means for assessment of airway inflammation. The currently available methods are difficult to apply in preschool children. We evaluated four methods potentially applicable for eNO measurement during tidal breathing in young children. eNO was assessed during tidal breathing in 24 children, 2-7 yr old, using a facemask which separated nasal and oral airflow. Facemasks with and without a one-way valve allowing exhalation through the nose were used. Expiratory flow control was not attempted. Measurements of eNO were performed both on-line and off-line. In 11 children, 8-12 yr old, measurements were compared with the standard single breath on-line method. eNO was significantly lower applying the one-way valve in on-line and off-line measurements in comparison with measurements without the valve [4.6 and 3.9 parts per billion (ppb) vs. 6.9 ppb and 6.5 ppb]. The mean within subject coefficient of variation (CV) was significantly lower in on-line measurements with the one-way valve (9.6%) compared with the other three methods (18.8, 27.7 and 29.3% respectively). Measurements with a facemask fitted with a one-way valve yielded similar eNO levels as the standard single breath method (7.0 ppb vs. 6.9 ppb) and reproducibility (9.8% vs. 7.1%). In conclusion, reproducible measurements of eNO can be obtained without control of expiration flow using a facemask fitted with a one-way valve on the nasal compartment. The likely explanation to this is that the one-way valve reduces the admixture of nasal NO, thereby improving the reliability of eNO measurements.
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