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Setting reference values for exhaled nitric oxide: a systematic review
Tiago Jacinto1, Kjell Alving, Ricardo Correia
1CINTESIS – Center for Research in Health Technologies and Information Systems, Faculty of Medicine, University of Porto, Porto, Portugal. tiagojacinto@med.up.pt
Interpreting fraction of exhaled nitric oxide (FeNO) values is challenging due to individual factors. Standardized methods are needed for reliable FeNO reference equations in clinical practice.
Area of Science:
- Pulmonary Medicine
- Respiratory Physiology
- Clinical Diagnostics
Background:
- Fraction of exhaled nitric oxide (FeNO) measurements are influenced by numerous patient-specific factors.
- This variability complicates the interpretation of FeNO values, particularly during initial respiratory symptom assessments.
Purpose of the Study:
- To systematically review existing studies on FeNO reference values.
- To identify individual-specific factors influencing FeNO measurements.
Main Methods:
- Systematic review of scientific literature.
- Inclusion of 15 studies from an initial pool of 3739 references.
- Analysis of factors influencing FeNO values, including age, height, atopy, smoking, weight, sex, and race.
Main Results:
- Significant determinants of FeNO values included age, height, atopy, smoking, weight, sex, and race.
- Methodological inconsistencies were noted, with inadequate reporting of statistical measures (R2) and logarithmic transformations in several studies.
- Limited reporting on objective measures for smoking status across studies.
Conclusions:
- Existing FeNO reference value equations vary in included factors and statistical methodologies.
- Development of standardized methods for evaluating normal FeNO data is recommended.
- Future reference equations should be based on a predetermined physiological model for improved clinical utility.
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