Guideline and StatementAn official JRS statement: The principles of fractional exhaled nitric oxide (FeNO) measurement and interpretation of the results in clinical practice
Section snippets
Mechanism of exhaled NO production
NO is produced by NO synthase (NOS) and l-arginine is its substrate. NOS is classified as constitutive and inducible. Constitutive NOS (cNOS) includes neuronal NOS (nNOS) and endothelial NOS (eNOS), which are mainly expressed in nerve cells and vascular endothelial cells, respectively. Inducible NOS (iNOS) is upregulated by various stimuli, such as inflammatory cytokines. iNOS is expressed mainly in epithelial cells in addition to several inflammatory cells, including macrophages and
Principles of measurement
Methods of analyzing FeNO concentrations include the chemiluminescence method, which uses stationary measuring equipment, and the electrochemical method (also termed the ion electrode method or electrode method; however, this statement will use the term “ion electrode method”), which uses portable measuring equipment. There are three stationary measuring devices that can be used in Japan. The NOA280i® (by Sievers, USA) and CLD88sp® (by ECO MEDICS, Switzerland) are commercially available;
Influence of various factors on exhaled NO values
FeNO measurement is influenced by various individual factors, such as food, medicines, smoking, rhinosinusitis, and atopy in addition to the measurement conditions. Previous studies have found sufficient evidence to show that current smoking and use of steroids can reduce FeNO values, while atopy and rhinosinusitis can elevate FeNO values. On the other hand, none of the other factors have been established to be critical confounding factors for the interpretation of the measurement results.
Exhaled NO in various respiratory diseases
FeNO is a useful biomarker of airway inflammation in asthma. In 1993, Alving et al. found two-to three-fold elevations in FeNO in patients with asthma in comparison with healthy individuals [50] and, in the following year, Kharitonov et al. showed that there was no difference in FeNO values for asthmatic patients treated with ICS compared to healthy individuals [3]. The role of FeNO in asthma management has been steadily revealed. In 2013, FeNO measurements became applicable for medical
Conflict of interest
Kazuto Matsunaga received consulting fees and lecture fees from Astra-Zeneca, Nippon Boehringer Ingelheim, Novartis Pharma, Kyorin Pharma, Meiji-Seika Pharma, Sanofi, GlaxoSmithKline, and Kyorin Pharma, and research grant from Nippon Boehringer Ingelheim and Novartis Pharma. Junpei Saito received consulting fees and lecture fees from AstraZeneca and GlaxoSmithKline, and research grant from AstraZeneca, Novartis Pharma, and Shionogi & Co.,Ltd. Koichi Fukunaga received consulting fees and
Acknowledgements
This official statement was approved by The Japanese Respiratory Society October 2019, and was prepared by an ad hoc committee of the JRS Assembly on Pulmonary Physiology.
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Cited by (0)
This is a translated summary of a full handbook published as a book in Japanese (ISBN: 978-4-7792-2018-0) by The Japanese Respiratory Society, [The JRS official handbook for the measurement of fractional exhaled nitric oxide (FeNO)].