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Updated: Jun 20, 2026
Chemiluminescence-based Assays for Detection of Nitric Oxide and its Derivatives from Autoxidation and Nitrosated Compounds
Published on: February 16, 2022
Exhaled nitric oxide measurements in the first 2 years of life: methodological issues, clinical and epidemiological
Carmelo Gabriele1, Fernando M de Benedictis, Johan C de Jongste
1Department of Pediatrics, Salesi Children's Hospital, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy. carmelo.gabriele@ospedaliriuniti.marche.it.
Insights
Fractional exhaled nitric oxide (FeNO) measurement in infants shows potential for early detection of airway inflammation. Standardizing methods is crucial for accurate diagnosis and monitoring of conditions like asthma in young children.
Area of Science:
- Pediatric Respiratory Medicine
- Allergy and Immunology
- Biomarkers of Inflammation
Background:
- Fractional exhaled nitric oxide (FeNO) is a validated marker for eosinophilic airway inflammation in asthma.
- FeNO measurement techniques exist for infants, but methodological challenges impact reproducibility.
- Standardized FeNO measurement in infants (<2 years) is needed for reliable interpretation.
Purpose of the Study:
- To highlight the utility of FeNO in diagnosing and monitoring pediatric airway inflammation.
- To address methodological issues hindering reproducible FeNO measurements in infants.
- To explore the potential of FeNO as an early predictor of respiratory diseases in early life.
Main Methods:
- Review of existing FeNO measurement techniques (tidal and single breath) in infants.
- Discussion of factors influencing FeNO values (expiratory flow, ambient NO, nasal contamination, risk factors).
- Analysis of current evidence linking FeNO to atopy, recurrent wheezing, and other airway diseases.
Main Results:
- FeNO is increased in infants with a family history of atopy and recurrent wheezing, suggesting early eosinophilic inflammation.
- FeNO shows potential for assessing inflammation in primary ciliary dyskinesia, bronchopulmonary dysplasia, and cystic fibrosis.
- Several factors influencing FeNO require careful assessment and control for accurate interpretation.
Conclusions:
- Standardized FeNO measurement in infants is essential for accurate diagnosis and monitoring of airway inflammation.
- FeNO may serve as an early indicator of atopy and risk for developing persistent asthma.
- Further prospective studies are needed to validate FeNO's predictive value for childhood respiratory diseases.
Abstract:
Fractional exhaled nitric oxide (FeNO) is a useful tool to diagnose and monitor eosinophilic bronchial inflammation in asthmatic children and adults. In children younger than 2 years of age FeNO has been successfully measured both with the tidal breathing and with the single breath techniques. However, there are a number of methodological issues that need to be addressed in order to increase the reproducibility of the FeNO measurements within and between infants. Indeed, a standardized method to measure FeNO in the first 2 years of life would be extremely useful in order to meaningfully interpret FeNO values in this age group. Several factors related to the measurement conditions have been found to influence FeNO, such as expiratory flow, ambient NO and nasal contamination. Furthermore, the exposure to pre- and postnatal risk factors for respiratory morbidity has been shown to influence FeNO values. Therefore, these factors should always be assessed and their association with FeNO values in the specific study population should be evaluated and, eventually, controlled for.There is evidence consistently suggesting that FeNO is increased in infants with family history of atopy/atopic diseases and in infants with recurrent wheezing. These findings could support the hypothesis that eosinophilic bronchial inflammation is present at an early stage in those infants at increased risk of developing persistent respiratory symptoms and asthma. Furthermore, it has been shown that FeNO measurements could represent a useful tool to assess bronchial inflammation in other airways diseases, such as primary ciliary dyskinesia, bronchopulmonary dysplasia and cystic fibrosis. Further studies are needed in order to improve the reproducibility of the measurements, and large prospective studies are warranted in order to evaluate whether FeNO values measured in the first years of life can predict the future development of asthma or other respiratory diseases.
