title: Exhaled nitric oxide: independent effects of atopy, smoking, respiratory tract infection, gender and height.
abstract: Measurement of exhaled nitric oxide is widely used in respiratory research and clinical practice, especially in patients with asthma. However, interpretation is often difficult, due to common interfering factors, and little is known about interactions between factors. We assessed the influences and interactions of factors such as smoking, respiratory tract infections and respiratory allergy concerning exhaled nitric oxide values, with the aim to derive a scheme for adjustment. We studied 897 subjects (514 females, 383 males; mean age+/-standard deviation 34.5+/-13.0 years) with and without respiratory allergy (allergic rhinitis and/or asthma), smoking and respiratory tract infection. Logarithmic nitric oxide levels were described by an additive model comprising respiratory allergy, smoking, respiratory tract infection, gender and height (p0.001 each), without significant interaction terms. Geometric mean was 17.5ppb in a healthy female non smoker of height 170cm, whereby respiratory allergy corresponded to a change by factor 1.50, smoking 0.63, infection 1.24, male gender 1.17, and each 10cm increase (decrease) in height to 1.11 (0.90). Factors were virtually identical when excluding asthma and using the category allergic rhinitis instead of respiratory allergy (n=863). Within each category formed by combinations of these different predictors, the range of residual variation was approximately constant. We conclude that the factors influencing exhaled nitric oxide, which we analyzed, act independently of each other. Thus, circumstances such as smoking and respiratory tract infection do not appear to affect the usefulness of exhaled nitric oxide, provided that appropriate factors for adjustment are applied.
authors.affiliation: Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University, Ziemssenstr. 1, 80336 München, Germany. holger.dressel@med.uni-muenchen.de
authors.forename: Holger
authors.initials: H
authors.lastname: Dressel
authors.forename: Dorothea
authors.initials: D
authors.lastname: de la Motte
authors.forename: Jörg
authors.initials: J
authors.lastname: Reichert
authors.forename: Uta
authors.initials: U
authors.lastname: Ochmann
authors.forename: Raluca
authors.initials: R
authors.lastname: Petru
authors.forename: Peter
authors.initials: P
authors.lastname: Angerer
authors.forename: Olaf
authors.initials: O
authors.lastname: Holz
authors.forename: Dennis
authors.initials: D
authors.lastname: Nowak
authors.forename: Rudolf A
authors.initials: RA
authors.lastname: Jörres
mesh_terms: D000328:Adult; D001249:Asthma / Q000378:metabolism; D001827:Body Height / Q000502:physiology*; D001944:Breath Tests / Q000379:methods; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009569:Nitric Oxide / Q000378:metabolism*; D011237:Predictive Value of Tests; D012130:Respiratory Hypersensitivity / Q000378:metabolism*; D012141:Respiratory Tract Infections / Q000378:metabolism*; D012737:Sex Factors; D012907:Smoking / Q000378:metabolism*
chemical_list: D009569:Nitric Oxide