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. 2021 Jul;13(7):4418-4426.
doi: 10.21037/jtd-21-25.

A comparative study of the RuiBreath and NIOX VERO analyzers for detecting fractional exhaled nitric oxide

Yalan Liu  1 , Xiaohong Chang  1 , Lirong Liang  2 , Zhaoshen Hou  1 , Yong Lu  1
Affiliations

A comparative study of the RuiBreath and NIOX VERO analyzers for detecting fractional exhaled nitric oxide

Yalan Liu et al. J Thorac Dis. 2021 Jul.

Abstract

Background: Fractional exhaled nitric oxide (FeNO) measurement is a reliable, noninvasive marker of airway inflammation. Portable FeNO analyzers facilitate the assessment of airway inflammation in primary care. Differences between analyzers from different manufacturers are not comparable. Here, we aimed to compare the FeNO values obtained by a new portable device (RuiBreath, Guangzhou Ruipu Medical Technology Co., Ltd, Guangzhou, China) to those obtained by the widely used NIOX VERO portable analyzer (Aerocrine AB, Solna, Sweden) in patients with asthma.

Methods: This prospective validation study enrolled patients (≥14 years old) with asthma over a 2-month period (July and August 2019) at the Beijing Chao-Yang Hospital. At least one valid FeNO measurement was obtained using each analyzer for all the participants.

Results: There were 197 participants in this study. The FeNONIOX and FeNORuiBreath values significantly differed (P=0.016). After log-transformation, a difference was found only when the FeNONIOX was <25 ppb (P<0.001). The FeNONIOX and FeNORuiBreath values had a significant correlation (r=0.938, P<0.001), which was confirmed by the Altman-Bland plot. Using a receiver-operating characteristic curve analysis, when using 49 ppb as the cut-off point for the two devices in identifying patients with symptomatic asthma symptoms, the sensitivity and specificity were 0.42 and 0.88, respectively, by NIOX, and 0.40 and 0.89, respectively, by RuiBreath.

Conclusions: This is the first report of FeNO values obtained by the new portable RuiBreath FeNO analyzer. The FeNORuiBreath values are reliable and directly comparable with the FeNONIOX values.

Keywords: Exhaled nitric oxide; NIOX VERO; RuiBreath; airway inflammation; asthma.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/jtd-21-25). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram of the patient selection process.
Figure 2
Figure 2
Scatter plot of the fraction of exhaled nitric oxide (FeNO) values obtained using the NIOX VERO and RuiBreath analyzers. Points represent the FeNONIOX values, and triangles represent the FeNORuibreath values. The solid lines and dotted lines represent the interquartile ranges and the medians, respectively.
Figure 3
Figure 3
Point diagram of the pairwise distribution of the fraction of exhaled nitric oxide (FeNO) values measured by Ruibreath and NIOX VERO. The points represent the FeNONIOX values, and the triangles represent the FeNORuibreath values. The diagram was generated according to the increasing FeNONIOX values.
Figure 4
Figure 4
The fraction of exhaled nitric oxide (FeNO) value showed a significant correlation between the two analyzers. (A) Linear regression with 95% confidence interval. (B) Altman-Bland plot (right panel) of the RuiBreath vs. NIOX VERO values in 197 asthmatic patients.
Figure 5
Figure 5
Receiver-operating characteristic (ROC) curve analysis was performed to differentiate between patients with asymptomatic and symptomatic asthma. The analysis included different cut-off points of the fraction of exhaled nitric oxide (FeNO) measurements obtained by NIOX (blue line) and RuiBreath (green line) in differentiating symptomatic asthma patients. The area under the curve (AUC) values of NIOX and RuiBreath measurements were 0.661 (P<0.001) and 0.680 (P<0.001), respectively.
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