Allergy Asthma Immunol Res.  2019 May;11(3):367-380. 10.4168/aair.2019.11.3.367.

Nasal Nitric Oxide Is Correlated With Nasal Patency and Nasal Symptoms

• Ren L
• Zhang W
• Zhang Y
• Zhang L

• KMID: 2442048
• DOI: http://doi.org/10.4168/aair.2019.11.3.367

Abstract

PURPOSE
Nitric oxide (NO) is an important endogenous mediator in both upper and lower respiratory systems. The purpose of the present study was to extract nasal NO (nNO) normal range of Chinese adults and the internal influencing factors. The differences in nNO levels between rhinitis and asymptomatic atopic subjects, and the diagnostic value of nNO in allergic rhinitis (AR) were further investigated.
METHODS
One thousand adults were recruited from the general public. Participants were divided into different subgroups according to the questionnaires and skin prick tests. In all of these subjects, nNO, fractional exhaled NO (FeNO) and nasal airflow resistance were measured. The normal ranges of nNO and FeNO, the differences between subgroups, and the correlations between NO (nNO and FeNO) and other internal factors were analyzed.
RESULTS
Both nNO and FeNO levels were significantly higher in AR patients than in healthy and asymptomatic atopic subjects. The nNO levels were significantly lower in asymptomatic atopic subjects than in normal adults. FeNO levels were significantly higher in non-AR patients than in the healthy and asymptomatic atopic adults. The cutoff value of nNO for the diagnosis of AR was 117.5 ppb (sensitivity, 50.9%; specificity, 63.9%). The nNO levels were correlated with FeNO levels, total nasal resistance measured at 75Pa, nasal volume within 0-7 cm from the anterior nares (V0-7cm) and nasal symptom visual analogue scale (VAS) scores, while the FeNO levels were correlated with age, height, weight, body surface area, nasal volume of V0-7cm and the nasal symptom VAS score.
CONCLUSIONS
The nNO level can be significantly different between healthy and AR patients and may be significantly correlated with nasal symptoms and nasal patency of rhinitis patients. However, the clinical value of nNO is still in the exploration stage.

Keyword

Nitric oxide; allergic rhinitis; rhinitis; Chinese; nasal obstruction; atopic

MeSH Terms

Adult
Asian Continental Ancestry Group
Body Weight
Diagnosis
Humans
Nasal Obstruction
Nitric Oxide*
Reference Values
Respiratory System
Rhinitis
Rhinitis, Allergic
Sensitivity and Specificity
Skin
Nitric Oxide

Figure

• 

  Fig. 1 The flow chart of the study.

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  Fig. 2 The comparisons of nNO values between different subgroups. The NO values are represented by box diagram. nNO, nasal nitric oxide; NO, nitric oxide; AR, allergic rhinitis; NAR, non-allergic rhinitis. *The significance of the difference between groups is indicated by the asterisk on the lines above the 2 sets of box plots. The more asterisks, the more significant is the difference.

• 

  Fig. 3 The comparisons of nasal FeNO values between different subgroups. The NO values are represented by box diagram. FeNO, fractional exhaled nitric oxide; NO, nitric oxide; AR, allergic rhinitis; NAR, non-allergic rhinitis. *The significance of the difference between groups is indicated by the asterisk on the lines above the 2 sets of box plots. The more asterisks, the more significant is the difference.

• 

  Fig. 4 The ROC curve and cutoff point of nNO and FeNO for predicting AR. The diagonal line is the reference line, which represents the AUC of 0.5. The ROC curve of nNO is shown in blue and the ROC curve of FeNO is shown in green. The cutoff values of nNO and FeNO from the Yoden index are marked on each curve with points of different shapes. The exact cutoff value is shown below the mark point on the nNO curve and above the mark point on the FeNO curve with their sensitivity and specificity behind. Sens, sensitivity; Spec, specificity; ROC, receiver-operator characteristic; nNO, nasal nitric oxide; FeNO, fractional exhaled nitric oxide; AR, allergic rhinitis; AUC, area under the curve.

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