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. 2020 Aug 27;21(17):6187.
doi: 10.3390/ijms21176187.

Extended Exhaled Nitric Oxide Analysis in Interstitial Lung Diseases: A Systematic Review

Paolo Cameli  1 , Elena Bargagli  1 , Laura Bergantini  1 , Miriana d'Alessandro  1 , Maria Pieroni  1 , Giovanni A Fontana  2 , Piersante Sestini  1 , Rosa Metella Refini  1
Affiliations

Extended Exhaled Nitric Oxide Analysis in Interstitial Lung Diseases: A Systematic Review

Paolo Cameli et al. Int J Mol Sci. .

Abstract

Fractional exhaled nitric oxide (FeNO) is a well-known and widely accepted biomarker of airways inflammation that can be useful in the therapeutic management, and adherence to inhalation therapy control, in asthmatic patients. However, the multiple-flows assessment of FeNO can provide a reliable measurement of bronchial and alveolar production of NO, supporting its potential value as biomarker also in peripheral lung diseases, such as interstitial lung diseases (ILD). In this review, we first discuss the role of NO in the pathobiology of lung fibrosis and the technique currently approved for the measurement of maximum bronchial flux of NO (J'awNO) and alveolar concentration of NO (CaNO). We systematically report the published evidence regarding extended FeNO analysis in the management of patients with different ILDs, focusing on its potential role in differential diagnosis, prognostic evaluation and severity assessment of disease. The few available data concerning extended FeNO analysis, and the most common comorbidities of ILD, are explored too. In conclusion, multiple-flows FeNO analysis, and CaNO in particular, appears to be a promising tool to be implemented in the diagnostic and prognostic pathways of patients affected with ILDs.

Keywords: biomarker; exhaled breath; idiopathic pulmonary fibrosis; interstitial lung disease; nitric oxide; oxidative stress; review.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of critical review and selection for inclusion of papers in the systematic review.
See this image and copyright information in PMC

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