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Comparative Study
. 2014 Feb 10:14:18.
doi: 10.1186/1471-2466-14-18.

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

Amanda Harris, Esther Bhullar, Kerry Gove, Rhiannon Joslin, Jennifer Pelling, Hazel J Evans, Woolf T Walker, Jane S Lucas  1
Affiliations
Comparative Study

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

Amanda Harris et al. BMC Pulm Med. .

Abstract

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.

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Figures

Figure 1
Figure 1
Box plots demonstrating nasal NO production (nL/min) measured by NIOX® Flex using a breath-hold manoeuver in healthy volunteers (n = 15), PCD (n = 11), CSLD (n = 6), CF (n = 6) and asthma (n = 9) (line: median, box: quartiles, whiskers: minimum and maximum.
Figure 2
Figure 2
Box plots demonstrating nasal NO production (nL/min) measured by NIOX MINO® during mouth breathing with nasal sampling at 2 ml/ sec in healthy volunteers (n = 13), PCD (n = 9), CSLD (n = 5), CF (n = 3) and asthma (n = 8).
Figure 3
Figure 3
Box plots demonstrating nasal NO production (nL/min) measured by NIOX MINO® during mouth breathing with nasal sampling at 5 ml/ sec in healthy volunteers (n = 15), PCD (n = 12), CSLD (n = 7), CF (n = 5) and asthma (n = 9).
Figure 4
Figure 4
Bland Altman plots comparing the NIOX® Flex with NIOX MINO® at 5 ml/sec. Each point represents the difference between the nNO readings (nL/min) obtained from a patient using the two analysers versus the mean of the two measurements. The reference lines represent the mean (and 1.96*SD) inter-analyser differences.
See this image and copyright information in PMC

References

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