Methodological issues related to exhaled nitric oxide measurement in children aged four to six years

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This study was designed to test five methodological issues related to measurement of fractional exhaled nitric oxide (FENO) in children aged 4-6 years using commercially available apparatus. Participants attended two randomly selected schools. A respiratory questionnaire was completed. Measurements of FENO were made on successive days, using a NIOX (R) analyzer employing standard or modified methodologies. Ninety-one children participated in the study (mean age, 5.3 years; 46 boys). Using a standard methodology (n = 61), FENO was successfully measured in 28 (46%) children, 1/12 aged 4 years, 12/25 aged 5 years, and 15/24 aged 6 years (trend test P = 0.01). On the first assessment, FENO could be determined in more boys than girls (64% vs. 30%, respectively, P = 0.008), but this gender difference was not apparent on the second assessment. Exhaled NO was reproducible over a 24-hr period; the mean difference between repeated measurements of natural log (In) FENO was 0.016 parts per billion (ppb) (95% confidence limits, -0.479, 0.511), n = 20. Data from 35 assessments showed that values of FENO did not alter over nine individual, successive measurements. Use of a modified methodology in 30 children increased success in obtaining FENO, but these values were unreliable. In conclusion, measurements of FENO can be obtained in the majority of 5- and 6-year-old but not 4-year-old children. Exhaled NO measurements were reproducible over a 24-hr interval, and did not change over up to nine expiratory maneuvers in these young children.

Original languageEnglish
Pages (from-to)97-104
Number of pages7
JournalPediatric Pulmonology
Issue number2
Publication statusPublished - Aug 2005


  • nitric oxide
  • child
  • NIOX
  • methodology
  • asthma
  • NO


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