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Related Experiment Video

Updated: Mar 6, 2026

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Exhaled Nitric Oxide in Systemic Sclerosis Lung Disease.

Natalie K Kozij1, John T Granton1, Philip E Silkoff2

  • 1University Health Network Pulmonary Hypertension Programme, Toronto General Hospital, Department of Medicine, University of Toronto, Toronto, ON, Canada.

Canadian Respiratory Journal
|March 16, 2017
PubMed
Summary

Exhaled nitric oxide (eNO) can help differentiate lung diseases in systemic sclerosis (SSc). Measurements showed distinct eNO patterns in SSc-associated pulmonary arterial hypertension and interstitial lung disease, supporting its use as a biomarker.

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Area of Science:

  • Pulmonary Medicine
  • Biomarker Discovery
  • Respiratory Physiology

Background:

  • Exhaled nitric oxide (eNO) is a potential biomarker for differentiating systemic sclerosis (SSc) associated pulmonary arterial hypertension (PAH) and interstitial lung disease (ILD).
  • Previous studies have not fully evaluated the discriminative validity, feasibility, and optimal measurement methods for eNO in SSc lung diseases.

Purpose of the Study:

  • To evaluate the discriminative validity and feasibility of exhaled nitric oxide (eNO) measurements.
  • To compare eNO levels across different lung diseases, SSc subsets, and healthy controls.
  • To determine the optimal modeling approach for partitioning eNO in SSc.

Main Methods:

  • Consecutive patients from the UHN Pulmonary Hypertension Programme were recruited.
  • Exhaled nitric oxide (eNO) was measured using chemiluminescent detection at 50 mL/s intervals.
  • A two-compartment model of axial diffusion (CMAD) and the trumpet model of axial diffusion (TMAD) were used to partition alveolar and conducting airway NO.

Main Results:

  • Sixty subjects were evaluated, and the CMAD model was identified as preferred for SSc.
  • Control subjects had lower alveolar NO than PAH subjects (p=0.008).
  • SSc-ILD showed significantly lower conducting airway NO than controls (p=0.04), while SSc-PAH had increased alveolar NO (p=0.01).
  • SSc-PAH conducting airway NO inversely correlated with DLCO (r=-0.88).

Conclusions:

  • Feasibility of eNO measurement in SSc lung disease is demonstrated.
  • The CMAD model is preferred for eNO analysis in SSc patients.
  • eNO shows discriminative validity for SSc-associated lung diseases, supporting its role as a biomarker.