CHEST Guidelines-How-to-Assess-Alveolar-Nitric-Oxide

How-to-Assess-Alveolar-Nitric-Oxide_chest

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The correspondence comments on an article by Paredi et al. published in CHEST, proposing a new method to assess sources of exhaled nitric oxide (NO) for evaluating lung inflammation. The authors of the correspondence, including Lehtimäki and others, discuss the merits and limitations of this method, which uses the area under the curve (AUC) approach for evaluating exhaled NO profiles at various flow rates. They argue that while alveolar NO concentration is a promising indicator of peripheral lung inflammation, the AUC approach has its weaknesses. <br /><br />The authors express concerns regarding the validity of the AUC method, emphasizing that conventional methods to calculate NO dynamics, though complex, are more reliable. These traditional methods, including linear regression analysis of exhaled NO fractions at different flow rates, are needed to accurately estimate alveolar NO concentration (Cano). The correspondence points out that factors such as nasal or ambient NO contamination can affect the AUC calculations, thus impacting the reliability of Cano measurements derived solely from a single flow rate.<br /><br />The correspondence advocates for standardization of methodologies to best assess NO flux and concentration for research consistency. The European Respiratory Society is preparing guidelines to address these methodological issues and will offer easy-to-use calculation tools available for the purpose. Ultimately, the authors suggest that comprehensive measurements and models are essential to provide accurate assessments and support continued research into pulmonary NO dynamics. <br /><br />The authors also disclose no conflicts of interest, ensuring that their analysis and opinions are unbiased. Their aim is to refine the scientific methods used to study NO parameters in the respiratory system to enhance understanding of diseases like asthma and scleroderma.

Keywords

exhaled nitric oxide

lung inflammation

area under the curve

alveolar NO concentration

NO dynamics

methodology standardization

European Respiratory Society

pulmonary NO dynamics

asthma

scleroderma