Standardizing Nasal Nitric Oxide Measurement As a Test for Primary Ciliary Dyskinesia

Overview

Journal Ann Am Thorac Soc

Specialty Pulmonary Medicine

Date 2013 Sep 13

PMID 24024753

Citations 124

Authors

Margaret W Leigh

Milan J Hazucha

Kunal K Chawla

Brock R Baker

Adam J Shapiro

David E Brown

Lisa M LaVange

Bethany J Horton

Bahjat Qaqish

Johnny L Carson

Stephanie D Davis

Sharon D Dell

Thomas W Ferkol

Jeffrey J Atkinson

Kenneth N Olivier

Scott D Sagel

Margaret Rosenfeld

Carlos Milla

Hye-Seung Lee

Jeffrey Krischer

Maimoona A Zariwala

Michael R Knowles

Affiliations

Soon will be listed here.

Abstract

Rationale: Several studies suggest that nasal nitric oxide (nNO) measurement could be a test for primary ciliary dyskinesia (PCD), but the procedure and interpretation have not been standardized.

Objectives: To use a standard protocol for measuring nNO to establish a disease-specific cutoff value at one site, and then validate at six other sites.

Methods: At the lead site, nNO was prospectively measured in individuals later confirmed to have PCD by ciliary ultrastructural defects (n = 143) or DNAH11 mutations (n = 6); and in 78 healthy and 146 disease control subjects, including individuals with asthma (n = 37), cystic fibrosis (n = 77), and chronic obstructive pulmonary disease (n = 32). A disease-specific cutoff value was determined, using generalized estimating equations (GEEs). Six other sites prospectively measured nNO in 155 consecutive individuals enrolled for evaluation for possible PCD.

Measurements And Main Results: At the lead site, nNO values in PCD (mean ± standard deviation, 20.7 ± 24.1 nl/min; range, 1.5-207.3 nl/min) only rarely overlapped with the nNO values of healthy control subjects (304.6 ± 118.8; 125.5-867.0 nl/min), asthma (267.8 ± 103.2; 125.0-589.7 nl/min), or chronic obstructive pulmonary disease (223.7 ± 87.1; 109.7-449.1 nl/min); however, there was overlap with cystic fibrosis (134.0 ± 73.5; 15.6-386.1 nl/min). The disease-specific nNO cutoff value was defined at 77 nl/minute (sensitivity, 0.98; specificity, >0.999). At six other sites, this cutoff identified 70 of the 71 (98.6%) participants with confirmed PCD.

Conclusions: Using a standardized protocol in multicenter studies, nNO measurement accurately identifies individuals with PCD, and supports its usefulness as a test to support the clinical diagnosis of PCD.

Citing Articles

Progression of Otologic and Nasal Symptoms in Primary Ciliary Dyskinesia Throughout Childhood.

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Delayed Diagnosis of Primary Ciliary Dyskinesia in Low-Middle-Income Countries: The Clinical Value of Nasal Nitric Oxide.

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PMID: 39433723 DOI: 10.1007/s40620-024-02116-1.

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