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Fractional Exhaled Nitric Oxide: Indications and Interpretation

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Diagnostic Tests in Pediatric Pulmonology

Part of the book series: Respiratory Medicine ((RM))

Abstract

Exhaled nitric oxide (NO) is a marker for eosinophilic airway inflammation. The correlations between fraction of exhaled NO (FENO) and eosinophils in blood, sputum, bronchoalveolar lavage, and mucosal biopsies of the airway have been well studied. A quantitative, noninvasive, and simple methodology has been developed to determine how best to assess FENO as a measure of airway inflammation. FENO measurement has been standardized by the American Thoracic Society/European Respiratory Society (Am J Respir Crit Care Med 171(8):912–930, 2005). The gold standard for measuring FENO is the single-breath online method, which can be performed in young children from the age of 4–5 years. A chemiluminescence-based analyzer or a portable analyzer using an electrochemical sensor can be used to measure FENO. Many studies have shown that FENO has potential diagnostic and therapeutic roles in various respiratory diseases, particularly asthma. In asthma, FENO is useful to diagnose and monitor eosinophilic airway inflammation, and predict steroid responsiveness. It also can be helpful in supporting the diagnosis of asthma and in guiding adjustment of anti-inflammatory medication. ATS Clinical Practice Guidelines have been published for interpretation and clinical applicability of FENO (Dweik et al., 184(5):602–615, 2011). FENO can provide additional information on underlying airway inflammation, and is complementary to respiratory symptoms, lung function tests, and bronchial provocation tests for asthma and other respiratory diseases in the clinical setting.

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  1. Section of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital Drive, ROC 4270, Indianapolis, IN, 46202, USA

    Young-Jee Kim M.D. & Stephanie D. Davis M.D.

  2. Pediatrics, Asthma Center, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 2021, Cincinnati, OH, 45229, USA

    Carolyn M. Kercsmar M.S., M.D.

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  1. Section of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA

    Stephanie D. Davis

  2. Respiratory and Allergic Disease Division, Dept. Paediatrics & Adolescent Medicine, Medical University of Graz, Graz, Austria

    Ernst Eber

  3. Division of Pulmonary & Sleep Medicine, Children’s National Medical Center/George Washington University, School of Medicine and Health Sciences, Washington, District of Columbia, USA

    Anastassios C. Koumbourlis

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Kim, YJ., Kercsmar, C.M., Davis, S.D. (2015). Fractional Exhaled Nitric Oxide: Indications and Interpretation. In: Davis, S., Eber, E., Koumbourlis, A. (eds) Diagnostic Tests in Pediatric Pulmonology. Respiratory Medicine. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-1801-0_14

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