Department of Pulmonary, Allergy and Critical Care Medicine/Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
J Breath Res. 2008 Sep;2(3):37002. doi: 10.1088/1752-7155/2/3/037002.
The measurement of nitric oxide (NO) in exhaled breath has given us the ability to learn about and monitor the inflammatory status of the airway through a non-invasive method that is easy to perform and repeat. This has been most useful in the diagnosis and management of asthma and has promised a seemingly unlimited potential for evaluating the airways and how clinical decisions are made (Grob N M and Dweik R A 2008 Chest133 837-9). The exhaled NO field was initially limited, however, due to the absence of standardized methodology. The ATS and ERS jointly released recommendations for standardized methods of measuring and reporting exhaled NO in 1999 that were revised in 2005 (1999 Am. J. Respir. Crit. Care. Med. 160 2104-17; 2005 Am. J. Respir. Crit. Care. Med. 171 912-30). In this paper, we summarize the literature that followed this standardization. We searched the literature for all papers that included the term 'exhaled nitric oxide' and selected those that followed ATS guidelines for online measurement for further review. We also reviewed cut-off values suggested by groups studying exhaled nitric oxide. We found a wide range of NO values reported for normal and asthma populations. The geometric mean for FE(NO) ranged from 10 ppb to 33 ppb in healthy adult control populations. For asthma, the FE(NO) geometric mean ranged from 6 ppb to 98 ppb. This considerable variation likely reflects the different clinical settings and purposes of measurement. Exhaled NO has been used for a multitude of reasons that range from screening, to diagnosis, to monitoring the effect of therapy. The field of exhaled NO has made undeniable progress since the standardization of the measurement methods. Our challenge now is to have guidelines to interpret exhaled NO levels in the appropriate context. As the utility of exhaled NO continues to evolve, it can serve as a good example of the crucial role of the standardization of collection and measurement methods to propel any new test in the right direction as it makes its way from a research tool to a clinically useful test.
呼出气一氧化氮（NO）的测量使我们能够通过一种易于进行和重复的非侵入性方法了解和监测气道的炎症状态。这在哮喘的诊断和管理中非常有用，并为评估气道和临床决策的制定提供了看似无限的潜力（Grob NM 和 Dweik RA 2008 Chest133 837-9）。然而，由于缺乏标准化方法，呼出气一氧化氮领域最初受到限制。美国胸科学会（ATS）和欧洲呼吸学会（ERS）于 1999 年联合发布了标准化测量和报告呼出气一氧化氮方法的建议，并于 2005 年进行了修订（1999 年美国呼吸与危重症医学杂志 160 2104-17；2005 年美国呼吸与危重症医学杂志 171 912-30）。在本文中，我们总结了遵循这一标准化建议的文献。我们搜索了所有包含“呼出气一氧化氮”一词的文献，并选择了遵循 ATS 在线测量指南的文献进行进一步审查。我们还审查了研究呼出气一氧化氮的小组提出的截止值。我们发现报告的正常人群和哮喘人群的一氧化氮值范围很广。健康成人对照组呼出气一氧化氮的几何平均值范围为 10ppb 至 33ppb。对于哮喘，呼出气一氧化氮的几何平均值范围为 6ppb 至 98ppb。这种相当大的差异可能反映了不同的临床环境和测量目的。呼出气一氧化氮被用于多种原因，从筛查到诊断再到监测治疗效果。自从测量方法标准化以来，呼出气一氧化氮领域取得了不可否认的进展。我们现在的挑战是要有指南来在适当的背景下解释呼出气一氧化氮水平。随着呼出气一氧化氮的应用不断发展，它可以作为一个很好的例子，说明收集和测量方法标准化对于推动任何新的测试朝着正确的方向发展的关键作用，因为它从研究工具转变为临床有用的测试。
