Exhaled Nitric Oxide in Infants-What Is a Nice Test Like FE_NO Doing in a Place Like This?

ABSTRACT

In adults and older children the measurement of fractional exhaled nitric oxide (FE_NO) has been shown to be useful as a tool to diagnose and monitor eosinophilic airway inflammation. However, the recommended method to measure FE_NO in school-age children is not suited for use in preschool children and infants. This article reviews the data on FE_NO measurements in infants. In the first year of life, measurement of FE_NO can be done during tidal breathing or during a single forced passive expiration. Several technical factors, including contamination with nasal and ambient NO, and the influence of expiratory flow influence FE_NO levels in infants. Because asthma is uncommon in infants and wheezing is often related to viral infections, considerable differences in clinical utility of FE_NO between older children and infants could be expected. From the available data FE_NO could potentially be useful to identify early-onset asthma, to diagnose primary ciliary dyskinesia (PCD), and to monitor the effect of various treatments. In conclusion, there is still much uncertainty about the potential clinical utility of FE_NO in infants. There is a need for clinical studies showing the merits and limitations of different methodologies, to standardize FE_NO measurements in infants, and to obtain normal reference values for this age group.

KEYWORDS

Eosinophilic airway inflammation - early childhood wheezing - asthma - inflammometry - lung function

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