Measurement of nasal nitric oxide: evaluation of six different sampling methods

Specific guidelines are developed for the measurement of bronchial FENO, however, nasal nitric oxide (nNO) measurement is not standardised yet, resulting in divergent nNO values. This study compares six different sampling methods for nNO as described in the literature, to analyse their outcome and short term and long term reproducibility. nNO concentrations were measured in 38 healthy subjects. Each subject performed nNO measurements during tidal breathing (nNO-TB), single breath quiet exhalations (nNO-QE), QE with oral exhalation against a resistance (nNO-QE + R), breath holding (nNO-BH) and during single-breath humming exhalations at 128 and 440 Hz (nNO-HE128 and nNO-HE440, respectively). To assess short term and long term reproducibility all manoeuvres were repeated after one and 24 h. Lowest values were found during quiet exhalation (mean nNO-QE was 364 p.p.b., SEM 27). Methods in which there is turbulence of nasal flow (as in TB, HE128 and HE440) result in higher nNO levels. Highest values were found in methods with decreased nasal flow [when there is no nasal flow as in BH or when the velum is closed as in QE + R: mean nNO 763 p.p.b. (SEM 61)]. NNO during humming at 440 Hz was significantly higher than at 128 Hz (P < 0.01). The within-subject coefficient of variation of repeated measurements was lowest during humming and breath holding, 3.4 and 3.8%, respectively. Concerning short term and long term reproducibility, best agreement is reached with humming and second best with breath holding. Different methods result in different levels and reproducibility of nNO. In regard to this, methods of humming and breath holding are recommended for standardised measurement of nasal NO. Eur J Clin Invest 2009; 39 (1): 72-77.