Validation of a portable nitric oxide analyzer for screening in primary ciliary dyskinesias

BMC Pulmonary Medicine

Jane S Lucas²  Woolf T Walker²  Hazel J Evans³  Jennifer Pelling¹  Rhiannon Joslin¹  Kerry Gove³  Esther Bhullar¹  Amanda Harris³ 

[1]Primary Ciliary Dyskinesia Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK

[2]Clinical and Experimental Sciences Academic Unit (Mail Point 803), University of Southampton Faculty of Medicine, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK

[3]NIHR Southampton Respiratory Biomedical Research Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK

关键词: Nitric oxide analyser;    Primary ciliary dyskinesia;    Nasal nitric oxide;   

Others  :  865432
DOI  :  10.1186/1471-2466-14-18

 received in 2013-01-09, accepted in 2014-02-04,  发布年份 2014

【 摘 要 】

Background

Nasal nitric oxide (nNO) levels are very low in primary ciliary dyskinesia (PCD) and it is used as a screening test.

Methods

We assessed the reliability and usability of a hand-held analyser in comparison to a stationary nitric oxide (NO) analyser in 50 participants (15 healthy, 13 PCD, 22 other respiratory diseases; age 6–79 years). Nasal NO was measured using a stationary NO analyser during a breath-holding maneuver, and using a hand-held analyser during tidal breathing, sampling at 2 ml/sec or 5 ml/sec. The three methods were compared for their specificity and sensitivity as a screen for PCD, their success rate in different age groups, within subject repeatability and acceptability. Correlation between methods was assessed.

Results

Valid nNO measurements were obtained in 94% of participants using the stationary analyser, 96% using the hand-held analyser at 5 ml/sec and 76% at 2 ml/sec. The hand-held device at 5 ml/sec had excellent sensitivity and specificity as a screening test for PCD during tidal breathing (cut-off of 30 nL/min,100% sensitivity, >95% specificity). The cut-off using the stationary analyser during breath-hold was 38 nL/min (100% sensitivity, 95% specificity). The stationary and hand-held analyser (5 ml/sec) showed reasonable within-subject repeatability(% coefficient of variation = 15).

Conclusion

The hand-held NO analyser provides a promising screening tool for PCD.

【 授权许可】

   
2014 Harris et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Lucas JS, Walker WT, Kuehni CE, Lazor R: Primary ciliary dyskinesia. In Orphan Lung Diseases. Edited by Courdier J-F. UK: European Respiratory Monograph; European Respiratory Society Publications; 2011:201-217.
• [2]Barbato A, Frischer T, Kuehni CE, Snijders D, Azevedo I, Baktai G, Bartoloni L, Eber E, Escribano A, Haarman E, Hesselmar B, Hogg C, Jorissen M, Lucas J, Nielsen KG, O'Callaghan C, Omran H, Pohunek P, Strippoli MP, Bush A: Primary ciliary dyskinesia: a consensus statement on diagnostic and treatment approaches in children. Eur Respir J 2009, 34:1264-1276.
• [3]Bush A, Chodhari R, Collins N, Copeland F, Hall P, Harcourt J, Hariri M, Hogg C, Lucas J, Mitchison HM, O'Callaghan C, Phillips G: Primary ciliary dyskinesia: current state of the art. Arch Dis Child 2007, 92:1136-1140.
• [4]O'Callaghan C, Chilvers M, Hogg C, Bush A, Lucas J: Diagnosing primary ciliary dyskinesia. Thorax 2007, 62:656-657.
• [5]Kuehni CE, Frischer T, Strippoli MP, Maurer E, Bush A, Nielsen KG, Escribano A, Lucas JS, Yiallouros P, Omran H, Eber E, O'Callaghan C, Snijders D, Barbato A: Factors influencing age at diagnosis of primary ciliary dyskinesia in European children. Eur Respir J 2010, 36:1248-1258.
• [6]Karadag B, James AJ, Gultekin E, Wilson NM, Bush A: Nasal and lower airway level of nitric oxide in children with primary ciliary dyskinesia. Eur Respir J 1999, 13:1402-1405.
• [7]Wodehouse T, Kharitonov SA, Mackay IS, Barnes PJ, Wilson R, Cole PJ: Nasal nitric oxide measurements for the screening of primary ciliary dyskinesia. Eur Respir J 2003, 21:43-47.
• [8]Walker WT, Jackson CL, Lackie PM, Hogg C, Lucas JS: Nitric oxide in primary ciliary dyskinesia. Eur Respir J 2012, 40:1024-1032.
• [9]Leigh MW, Hazucha MJ, Chawla KK, Baker BR, Shapiro AJ, Brown DE, Lavange LM, Horton BJ, Qaqish B, Carson JL, Davis SD, Dell SD, Ferkol TW, Atkinson JJ, Olivier KN, Sagel SD, Rosenfeld M, Milla C, Lee HS, Krischer J, Zariwala MA, Knowles MR: Standardizing nasal nitric oxide measurement as a test for primary ciliary dyskinesia. Ann Am Thorac Soc 2013, 10(6):574-581.
• [10]Lucas JS, Walker WT: Nitric oxide is an important test in the diagnostic pathway for primary ciliary. Ann Am Thorac Soc 2013. in press
• [11]Boot JD, de Ridder L, de Kam ML, Calderon C, Mascelli MA, Diamant Z: Comparison of exhaled nitric oxide measurements between NIOX MINO electrochemical and Ecomedics chemiluminescence analyzer. Respir Med 2008, 102:1667-1667.
• [12]Kim SH, Moon JY, Kwak HJ, Kim SI, Park DW, Kim JW, Kim TH, Sohn JW, Shin DH, Park SS, Yoon HJ: Comparison of two exhaled nitric oxide analyzers: the NIOX MINO hand-held electrochemical analyzer and the NOA280i stationary chemiluminescence analyzer. Respirology 2012, 17:830-834.
• [13]Schiller B, Hammer J, Barben J, Trachsel D: Comparability of a hand-held nitric oxide analyser with online and offline chemiluminescence-based nitric oxide measurement. Pediatr Allergy Immunol 2009, 20:679-685.
• [14]Selby A, Clayton B, Grundy J, Pike K, Drew K, Raza A, Kurukulaaratchy R, Arshad SH, Roberts G: Are exhaled nitric oxide measurements using the portable NIOX MINO repeatable? Respir Res 2010, 11:43. BioMed Central Full Text
• [15]Maniscalco M, de Laurentiis G, Weitzberg E, Lundberg JO, Sofia M: Validation study of nasal nitric oxide measurements using a hand-held electrochemical analyser. Eur J Clin Invest 2008, 38:197-200.
• [16]Weschta M, Deutschle T, Riechelmann H: Nasal fractional exhaled nitric oxide analysis with a novel hand-held device. Rhinology 2008, 46:23-27.
• [17]Montella S, Alving K, Maniscalco M, Sofia M, De SS, Raia V, Santamaria F: Measurement of nasal nitric oxide by hand-held and stationary devices. Eur J Clin Invest 2011, 41:1063-1070.
• [18]Marthin JK, Nielsen KG: Hand-held tidal breathing nasal nitric oxide measurement–a promising targeted case-finding tool for the diagnosis of primary ciliary dyskinesia. PLoS One 2013, 8:e57262.
• [19]Bush A, Cole P, Hariri M, Mackay I, Phillips G, O'Callaghan C, Wilson R, Warner JO: Primary ciliary dyskinesia: diagnosis and standards of care. Eur Respir J 1998, 12:982-988.
• [20]American Thoracic Society; European Respiratory Society: ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide,2005. Am J Respir Crit Care Med 2005, 171(8):912-30.
• [21]Mateos-Corral D, Coombs R, Grasemann H, Ratjen F, Dell SD: Diagnostic value of nasal nitric oxide measured with non-velum closure techniques for children with primary ciliary dyskinesia. J Pediatr 2011, 159:420-424.
• [22]Marthin JK, Nielsen KG: Choice of nasal nitric oxide technique as first-line test for primary ciliary dyskinesia. Eur Respir J 2011, 37:559-565.
• [23]Pifferi M, Bush A, Caramella D, Di CM, Zangani M, Chinellato I, Macchia P, Boner AL: Agenesis of paranasal sinuses and nasal nitric oxide in primary ciliary dyskinesia. Eur Respir J 2011, 37:566-571.