Skip to main content
SpringerLink
Log in

Nasal NO measurement by direct sampling from the nose during breathhold: aspiration flow, nasal resistance and reproducibility

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology and Head & Neck Aims and scope Submit manuscript

Abstract

The objective of this study was assessment of the effect of aspiration flow, the nasal cycle, and time on nasal nitric oxide (nNO) concentrations in air sampled from one nostril during breathhold. nNO was measured in 45 healthy subjects (19 males, aged 18–45 years) from one nostril during breathholding. We compared nNO values and time to plateau in both nostrils with 3 aspiration flows (280, 700, 1,200 ml/min) and assessed the short-term and long-term reproducibility. Mean nNO values at flows of 280, 700 and 1,200 ml/min differed significantly (P < 0.01): 854, 474, 380 ppb, respectively. The (median) plateau was reached after 6, 4 and 3 s for the different flows. The within-subject coefficient of variability was always < 5%. We found no difference in nNO between left-, right-, largest or smallest nostril (P > 0.10). nNO values after 6, 24 h and 7 days were not significantly different from baseline (P > 0.10) and showed fair reproducibility. The highest aspiration flow was experienced as unpleasant. nNO can be measured in either nostril and shows no diurnal variation. The measurement is quick, reproducible, feasible and best accepted with an aspiration flow of 700 ml/min during breathhold for 10 s.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. (2005) ATS/ERS Recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005. Am J Respir Crit Care Med 171:912–930

  2. (1999) Recommendations for standardized procedures for the on-line and off-line measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide in adults and children-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med 160:2104–2117

  3. Andersson JA, Cervin A, Lindberg S, Uddman R, Cardell LO (2002) The paranasal sinuses as reservoirs for nitric oxide. Acta Otolaryngol 122:861–865

    Article  PubMed  CAS  Google Scholar 

  4. Arnal JF, Didier A, Rami J, M’Rini C, Charlet JP, Serrano E, Besombes JP (1997) Nasal nitric oxide is increased in allergic rhinitis. Clin Exp Allergy 27:358–362

    Article  PubMed  CAS  Google Scholar 

  5. Baraldi E, de Jongste JC (2002) Measurement of exhaled nitric oxide in children, 2001. Eur Respir J 20:223–237

    Article  PubMed  CAS  Google Scholar 

  6. Bartley J, Fergusson W, Moody A, Wells AU, Kolbe J (1999) Normal adult values, diurnal variation, and repeatability of nasal nitric oxide measurement. Am J Rhinol 13:401–405

    Article  PubMed  CAS  Google Scholar 

  7. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1:307–310

    PubMed  CAS  Google Scholar 

  8. Bush A, Cole P, Hariri M, Mackay I, Phillips G, O’Callaghan C, Wilson R, Warner JO (1998) Primary ciliary dyskinesia: diagnosis and standards of care. Eur Respir J 12:982–988

    Article  PubMed  CAS  Google Scholar 

  9. Chatkin JM, Qian W, McClean PA, Zamel N, Haight J, Silkoff P (1999) Nitric oxide accumulation in the nonventilated nasal cavity. Arch Otolaryngol Head Neck Surg 125:682–685

    PubMed  CAS  Google Scholar 

  10. Colantonio D, Brouillette L, Parikh A, Scadding GK (2002) Paradoxical low nasal nitric oxide in nasal polyposis. Clin Exp Allergy 32:698–701

    Article  PubMed  CAS  Google Scholar 

  11. Corbelli R, Bringolf-Isler B, Amacher A, Sasse B, Spycher M, Hammer J (2004) Nasal nitric oxide measurements to screen children for primary ciliary dyskinesia. Chest 126:1054–1059

    Article  PubMed  CAS  Google Scholar 

  12. Daya H, Qian W, McClean P, Haight J, Zamel N, Papsin BC, Forte V (2002) Nasal nitric oxide in children: a novel measurement technique and normal values. Laryngoscope 112:1831–1835

    Article  PubMed  CAS  Google Scholar 

  13. Djupesland PG, Chatkin JM, Qian W, Cole P, Zamel N, McClean P, Furlott H, Haight JS (1999) Aerodynamic influences on nasal nitric oxide output measurements. Acta Otolaryngol 119:479–485

    Article  PubMed  CAS  Google Scholar 

  14. Dubois AB, Douglas JS, Stitt JT, Mohsenin V (1998) Production and absorption of nitric oxide gas in the nose. J Appl Physiol 84:1217–1224

    PubMed  CAS  Google Scholar 

  15. Ferguson EA, Eccles R (1997) Changes in nasal nitric oxide concentration associated with symptoms of common cold and treatment with a topical nasal decongestant. Acta Otolaryngol 117:614–617

    Article  PubMed  CAS  Google Scholar 

  16. Gungor A, Vural C (2002) A method for off-line nasal nitric oxide measurement. Ear Nose Throat J 81:449–453

    PubMed  Google Scholar 

  17. Horvath I, Loukides S, Wodehouse T, Csiszer E, Cole PJ, Kharitonov SA, Barnes PJ (2003) Comparison of exhaled and nasal nitric oxide and exhaled carbon monoxide levels in bronchiectatic patients with and without primary ciliary dyskinesia. Thorax 58:68–72

    Article  PubMed  CAS  Google Scholar 

  18. Imada M, Iwamoto J, Nonaka S, Kobayashi Y, Unno T (1996) Measurement of nitric oxide in human nasal airway. Eur Respir J 9:556–559

    Article  PubMed  CAS  Google Scholar 

  19. Imada M, Nonaka S, Kobayashi Y, Iwamoto J (2002) Functional roles of nasal nitric oxide in nasal patency and mucociliary function. Acta Otolaryngol 122:513–519

    Article  PubMed  CAS  Google Scholar 

  20. Jorissen M, Lefevere L, Willems T (2001) Nasal nitric oxide. Allergy 56:1026–1033

    Article  PubMed  CAS  Google Scholar 

  21. Karadag B, James AJ, Gultekin E, Wilson NM, Bush A (1999) Nasal and lower airway level of nitric oxide in children with primary ciliary dyskinesia. Eur Respir J 13:1402–1405

    Article  PubMed  CAS  Google Scholar 

  22. Kharitonov S, Alving K, Barnes PJ (1997) Exhaled and nasal nitric oxide measurements: recommendations. The European Respiratory Society Task Force. Eur Respir J 10:1683–1693

    Article  PubMed  CAS  Google Scholar 

  23. Kharitonov SA, Rajakulasingam K, O’Connor B, Durham SR, Barnes PJ (1997) Nasal nitric oxide is increased in patients with asthma and allergic rhinitis and may be modulated by nasal glucocorticoids. J Allergy Clin Immunol 99:58–64

    PubMed  CAS  Google Scholar 

  24. Kirihene RK, Rees G, Wormald PJ (2002) The influence of the size of the maxillary sinus ostium on the nasal and sinus nitric oxide levels. Am J Rhinol 16:261–264

    PubMed  Google Scholar 

  25. Lindberg S, Cervin A, Runer T (1997) Nitric oxide (NO) production in the upper airways is decreased in chronic sinusitis. Acta Otolaryngol 117:113–117

    Article  PubMed  CAS  Google Scholar 

  26. Lundberg JO (1996) Airborne nitric oxide: inflammatory marker and aerocrine messenger in man. Acta Physiol Scand Suppl 633:1–27

    PubMed  CAS  Google Scholar 

  27. Lundberg JO, Weitzberg E (1999) Nasal nitric oxide in man. Thorax 54:947–952

    Article  PubMed  CAS  Google Scholar 

  28. Lundberg JO, Rinder J, Weitzberg E, Lundberg JM, Alving K (1994) Nasally exhaled nitric oxide in humans originates mainly in the paranasal sinuses. Acta Physiol Scand 152:431–432

    Article  PubMed  CAS  Google Scholar 

  29. Lundberg JO, Rinder J, Weitzberg F, Alving K, Lundberg JM (1997) Heavy physical exercise decreases nitric oxide levels in the nasal airways in humans. Acta Physiol Scand 159:51–57

    Article  PubMed  CAS  Google Scholar 

  30. Maniscalco M, Sofia M, Faraone S, Carratu L (2000) The effect of platelet-activating factor (PAF) on nasal airway resistance in healthy subjects is not mediated by nitric oxide. Allergy 55:757–761

    Article  PubMed  CAS  Google Scholar 

  31. Narang I, Ersu R, Wilson NM, Bush A (2002) Nitric oxide in chronic airway inflammation in children: diagnostic use and pathophysiological significance. Thorax 57:586–589

    Article  PubMed  CAS  Google Scholar 

  32. Palm JP, Alving K, Lundberg JO (2003) Characterization of airway nitric oxide in allergic rhinitis: the effect of intranasal administration of L-NAME. Allergy 58:885–892

    Article  PubMed  CAS  Google Scholar 

  33. Qian W, Djupesland PG, Chatkin JM, McClean P, Furlott H, Chapnik JS, Zamel N, Haight JS (1999) Aspiration flow optimized for nasal nitric oxide measurement. Rhinology 37:61–65

    PubMed  CAS  Google Scholar 

  34. Qian W, Sabo R, Ohm M, Haight JS, Fenton RS (2001) Nasal nitric oxide and the nasal cycle. Laryngoscope 111:1603–1607

    Article  PubMed  CAS  Google Scholar 

  35. Ricciardolo FL (2003) Multiple roles of nitric oxide in the airways. Thorax 58:175–182

    Article  PubMed  CAS  Google Scholar 

  36. Silkoff PE, Chatkin J, Qian W, Chakravorty S, Gutierrez C, Furlott H, McClean P, Rai S, Zamel N, Haight J (1999) Nasal nitric oxide: a comparison of measurement techniques. Am J Rhinol 13:169–178

    Article  PubMed  CAS  Google Scholar 

  37. Struben VMD, Wieringa MH, Mantingh CJ, Bommeljé C, Don M, Feenstra L, de Jongste JC (2005) Nasal NO: normal values in children age 6 through 17. Eur Respir J (in press)

  38. Thomas SR, Kharitonov SA, Scott SF, Hodson ME, Barnes PJ (2000) Nasal and exhaled nitric oxide is reduced in adult patients with cystic fibrosis and does not correlate with cystic fibrosis genotype. Chest 117:1085–1089

    Article  PubMed  CAS  Google Scholar 

  39. Vural C, Gungor A (2002) Variations of nasal nitric oxide in a subject with allergic rhinitis: a longitudinal study. Am J Otolaryngol 23:191–195

    Article  PubMed  CAS  Google Scholar 

  40. Vural C, Gungor A (2003) The effect of topical fluticasone on nasal nitric oxide levels in a patient with allergic rhinitis. Ear Nose Throat J 82:592–597

    PubMed  Google Scholar 

  41. Wilson AM, Dempsey OJ, Sims EJ, Lipworth BJ (2001) A comparison of topical budesonide and oral montelukast in seasonal allergic rhinitis and asthma. Clin Exp Allergy 31:616–624

    Article  PubMed  CAS  Google Scholar 

  42. Wodehouse T, Kharitonov SA, Mackay IS, Barnes PJ, Wilson R, Cole PJ (2003) Nasal nitric oxide measurements for the screening of primary ciliary dyskinesia. Eur Respir J 21:43–47

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Oto-Rhino-Laryngology, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands

    V. M. D. Struben, M. H. Wieringa, C. J. Mantingh & L. Feenstra

  2. Department of Paediatrics, Division of Paediatric Respiratory Medicine, Erasmus Medical Centre, University Medical Centre Rotterdam, Location Sophia, Dr. Molewaterplein 60, 3015 GD, Rotterdam, The Netherlands

    J. C. de Jongste

Authors
  1. V. M. D. Struben
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. H. Wieringa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. J. Mantingh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. C. de Jongste
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. L. Feenstra
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. C. de Jongste.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Struben, V.M.D., Wieringa, M.H., Mantingh, C.J. et al. Nasal NO measurement by direct sampling from the nose during breathhold: aspiration flow, nasal resistance and reproducibility. Eur Arch Otorhinolaryngol 263, 723–728 (2006). https://doi.org/10.1007/s00405-006-0059-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-006-0059-1

Keywords

Search

Navigation