Reference equations for exhaled nitric oxide—what is needed?

Abstract

Standardisation is the road to improvement! If we all measure exhaled nitric oxide (NO) the same way, we will be successful in having data to make reference questions. Many research groups have published their reference equation, but most differ considerably. About 25 years ago, using the flow of 50 ml s−1 was recommended and not using a nose clip. When collecting data worldwide, we still see publications that do not indicate what flow was used and that nose clip was utilised. Three things are needed: the analysing method, a flow recording and a filled-in nitric oxide questionnaire. The analysing method is because the techniques have different sensitivity, response times and calibration. The flow of 50 ml s−1 is on the steep part of the NO output curve; therefore, we need to record the flow to analyse repeated measurements or compare results. The NO questionnaire controls individual factors that may influence the NO measurements, i.e. food intake, smoking and upper airway infection. An important tool in following old and new disease treatments, at home or in health care, is exhaled biomarkers. If we follow the standardisation we have agreed upon, we will be able to have data to say what a high or a low exhaled NO value is.