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Updated: Jun 30, 2026
Employing the Forced Oscillation Technique for the Assessment of Respiratory Mechanics in Adults
Published on: February 9, 2022
Association of Fractional Exhaled Nitric Oxide With Pulmonary Health and All-Cause Mortality in a Population Without
Shan Xiao1, Xiang Wen2, Wangli Qiu3
1Department of Pulmonary and Critical Care Medicine, Shenzhen Longgang District Central Hospital, Shenzhen, China.
Objectives:
The association between fractional exhaled nitric oxide (FeNO) and airway inflammation is evident. However, the precise relationship of FeNO with pulmonary health and all-cause mortality among participants without airflow limitation remains undisclosed. We investigated the association of FeNO with respiratory symptoms, lung function, and all-cause mortality in this population.
Methods:
Participants included in the 2007–2012 National Health and Nutrition Examination Survey cycles with complete questionnaire information, quality-controlled prebronchodilator spirometry data, acceptable FeNO data, and full follow-up records until December 31, 2019, were included. The skewed distribution of FeNO was addressed by applying natural logarithmic transformation. Multivariable linear regression, logistic regression, and Cox proportional-hazards regression analyses were used to investigate the relationship of FeNO with spirometry, respiratory symptoms, and all-cause mortality. Subgroup analyses were performed based on sex, age, body mass index, smoking status, and blood eosinophil count to validate the robustness of the results.
Results:
The data of 5842 eligible participants were analyzed. After adjusting for confounding factors, for each 1-unit increment in natural logarithm (ln) (FeNO), the risk of chronic cough and wheezing decreased by 28% and 22%, respectively. Additionally, forced vital capacity increased by 27.9mL, and forced expiratory volume in 1 second increased by 27.8mL. During the average follow-up of 10 years, 255 participants experienced mortality. There was a nonlinear relationship between FeNO and all-cause mortality. Specifically, when ln (FeNO) was <2.6 (FeNO<13.5ppb), the hazard ratio was 0.45 (95% confidence interval 0.29–0.70; p<0.001). The subgroup analyses demonstrated consistent results.
Conclusions:
Elevated FeNO was closely associated with fewer respiratory symptoms and improved lung function in a population without airflow limitation. A nonlinear relationship existed between FeNO and all-cause mortality, with mortality initially decreasing as FeNO increased, followed by stabilization.
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