Does Ethnicity Influence Fractional Exhaled Nitric Oxide in Healthy Individuals?

A Systematic Review

Tamara L. Blake, Anne B. Chang, Mark D. Chatfield, Helen L. Petsky, Leanne T. Rodwell, Michael G. Brown, Deb C. Hill, Margaret S. McElrea

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    Abstract

    Background: Fractional exhaled nitric oxide (FENO) is used clinically as a biomarker of eosinophilic airway inflammation. Awareness of the factors influencing FENO values is important for valid clinical interpretation. 

    Methods: We undertook a systematic review of PubMed, Cochrane Library, Scopus, and Web of Science databases and reference lists of included articles to evaluate whether ethnicity influences FENO values, and to determine if this influence affects clinical interpretation according to current guidelines. We included all studies that performed online FENO measurements on at least 25 healthy, non-Caucasian individuals, and examined the effect of ethnicity on FENO. 

    Results: From 62 potential studies, 12 studies were included. One study recruited only children (< 12 years of age), six studies recruited children and/or adolescents, four studies recruited adults only, and a single study involved children, adolescents, and adults. In total, 16 different ethnic populations representing 11 ethnicities were studied. Ethnicity was considered a significant influencing factor in 10 of the included studies. We found the geometric mean FENO to be above the normal healthy range in two studies. We also identified five studies in which at least 5% of participants had FENO results above the age-specific inflammatory ranges. 

    Conclusions: Ethnicity influences FENO values, and for some ethnic groups this influence likely affects clinical interpretation according to current guidelines. There is a need to establish healthy FENO reference ranges for specific ethnic groups to improve clinical application.

    Original languageEnglish
    Pages (from-to)40-50
    Number of pages11
    JournalChest
    Volume152
    Issue number1
    DOIs
    Publication statusPublished - 1 Jul 2017

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    Nitric Oxide
    Ethnic Groups
    Reference Values
    Guidelines
    Only Child
    PubMed
    Libraries
    Biomarkers
    Databases
    Inflammation
    Population

    Cite this

    Blake, T. L., Chang, A. B., Chatfield, M. D., Petsky, H. L., Rodwell, L. T., Brown, M. G., ... McElrea, M. S. (2017). Does Ethnicity Influence Fractional Exhaled Nitric Oxide in Healthy Individuals? A Systematic Review. Chest, 152(1), 40-50. https://doi.org/10.1016/j.chest.2017.02.007
    Blake, Tamara L. ; Chang, Anne B. ; Chatfield, Mark D. ; Petsky, Helen L. ; Rodwell, Leanne T. ; Brown, Michael G. ; Hill, Deb C. ; McElrea, Margaret S. / Does Ethnicity Influence Fractional Exhaled Nitric Oxide in Healthy Individuals? A Systematic Review. In: Chest. 2017 ; Vol. 152, No. 1. pp. 40-50.
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    abstract = "Background: Fractional exhaled nitric oxide (FENO) is used clinically as a biomarker of eosinophilic airway inflammation. Awareness of the factors influencing FENO values is important for valid clinical interpretation. Methods: We undertook a systematic review of PubMed, Cochrane Library, Scopus, and Web of Science databases and reference lists of included articles to evaluate whether ethnicity influences FENO values, and to determine if this influence affects clinical interpretation according to current guidelines. We included all studies that performed online FENO measurements on at least 25 healthy, non-Caucasian individuals, and examined the effect of ethnicity on FENO. Results: From 62 potential studies, 12 studies were included. One study recruited only children (< 12 years of age), six studies recruited children and/or adolescents, four studies recruited adults only, and a single study involved children, adolescents, and adults. In total, 16 different ethnic populations representing 11 ethnicities were studied. Ethnicity was considered a significant influencing factor in 10 of the included studies. We found the geometric mean FENO to be above the normal healthy range in two studies. We also identified five studies in which at least 5{\%} of participants had FENO results above the age-specific inflammatory ranges. Conclusions: Ethnicity influences FENO values, and for some ethnic groups this influence likely affects clinical interpretation according to current guidelines. There is a need to establish healthy FENO reference ranges for specific ethnic groups to improve clinical application.",
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    author = "Blake, {Tamara L.} and Chang, {Anne B.} and Chatfield, {Mark D.} and Petsky, {Helen L.} and Rodwell, {Leanne T.} and Brown, {Michael G.} and Hill, {Deb C.} and McElrea, {Margaret S.}",
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    Blake, TL, Chang, AB, Chatfield, MD, Petsky, HL, Rodwell, LT, Brown, MG, Hill, DC & McElrea, MS 2017, 'Does Ethnicity Influence Fractional Exhaled Nitric Oxide in Healthy Individuals? A Systematic Review', Chest, vol. 152, no. 1, pp. 40-50. https://doi.org/10.1016/j.chest.2017.02.007

    Does Ethnicity Influence Fractional Exhaled Nitric Oxide in Healthy Individuals? A Systematic Review. / Blake, Tamara L.; Chang, Anne B.; Chatfield, Mark D.; Petsky, Helen L.; Rodwell, Leanne T.; Brown, Michael G.; Hill, Deb C.; McElrea, Margaret S.

    In: Chest, Vol. 152, No. 1, 01.07.2017, p. 40-50.

    Research output: Contribution to journalArticleResearchpeer-review

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    AU - Blake, Tamara L.

    AU - Chang, Anne B.

    AU - Chatfield, Mark D.

    AU - Petsky, Helen L.

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    AU - Brown, Michael G.

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    AU - McElrea, Margaret S.

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    N2 - Background: Fractional exhaled nitric oxide (FENO) is used clinically as a biomarker of eosinophilic airway inflammation. Awareness of the factors influencing FENO values is important for valid clinical interpretation. Methods: We undertook a systematic review of PubMed, Cochrane Library, Scopus, and Web of Science databases and reference lists of included articles to evaluate whether ethnicity influences FENO values, and to determine if this influence affects clinical interpretation according to current guidelines. We included all studies that performed online FENO measurements on at least 25 healthy, non-Caucasian individuals, and examined the effect of ethnicity on FENO. Results: From 62 potential studies, 12 studies were included. One study recruited only children (< 12 years of age), six studies recruited children and/or adolescents, four studies recruited adults only, and a single study involved children, adolescents, and adults. In total, 16 different ethnic populations representing 11 ethnicities were studied. Ethnicity was considered a significant influencing factor in 10 of the included studies. We found the geometric mean FENO to be above the normal healthy range in two studies. We also identified five studies in which at least 5% of participants had FENO results above the age-specific inflammatory ranges. Conclusions: Ethnicity influences FENO values, and for some ethnic groups this influence likely affects clinical interpretation according to current guidelines. There is a need to establish healthy FENO reference ranges for specific ethnic groups to improve clinical application.

    AB - Background: Fractional exhaled nitric oxide (FENO) is used clinically as a biomarker of eosinophilic airway inflammation. Awareness of the factors influencing FENO values is important for valid clinical interpretation. Methods: We undertook a systematic review of PubMed, Cochrane Library, Scopus, and Web of Science databases and reference lists of included articles to evaluate whether ethnicity influences FENO values, and to determine if this influence affects clinical interpretation according to current guidelines. We included all studies that performed online FENO measurements on at least 25 healthy, non-Caucasian individuals, and examined the effect of ethnicity on FENO. Results: From 62 potential studies, 12 studies were included. One study recruited only children (< 12 years of age), six studies recruited children and/or adolescents, four studies recruited adults only, and a single study involved children, adolescents, and adults. In total, 16 different ethnic populations representing 11 ethnicities were studied. Ethnicity was considered a significant influencing factor in 10 of the included studies. We found the geometric mean FENO to be above the normal healthy range in two studies. We also identified five studies in which at least 5% of participants had FENO results above the age-specific inflammatory ranges. Conclusions: Ethnicity influences FENO values, and for some ethnic groups this influence likely affects clinical interpretation according to current guidelines. There is a need to establish healthy FENO reference ranges for specific ethnic groups to improve clinical application.

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    KW - pulmonary function test

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