Developing Fractional Exhaled Nitric Oxide Predicted and Upper Limit of Normal Values for a Disadvantaged Population
Background: Fractional exhaled nitric oxide (FENO), used as a biomarker, is influenced by several factors including ethnicity. Normative data are essential for interpretation, and currently single cutoff values are used in children and adults. Research Question: Accounting for factors that influence...
Published in: | Chest |
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Main Authors: | , , , , , , , |
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American College of Chest Physicians
2023
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Online Access: | https://eprints.qut.edu.au/246699/ |
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Queensland University of Technology: QUT ePrints |
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ftqueensland |
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topic |
FENO nitric oxide NO ppb reference values ULN |
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FENO nitric oxide NO ppb reference values ULN Collaro, Andrew J. Chang, Anne B. Marchant, Julie M. Vicendese, Don Chatfield, Mark D. Cole, Johanna F. Blake, Tamara L. McElrea, Margaret S. Developing Fractional Exhaled Nitric Oxide Predicted and Upper Limit of Normal Values for a Disadvantaged Population |
topic_facet |
FENO nitric oxide NO ppb reference values ULN |
description |
Background: Fractional exhaled nitric oxide (FENO), used as a biomarker, is influenced by several factors including ethnicity. Normative data are essential for interpretation, and currently single cutoff values are used in children and adults. Research Question: Accounting for factors that influence FENO, (1) what are appropriate predicted and upper limit of normal (ULN) FENO values in an underserved population (First Nations Australians), (2) how do these values compare with age-based interpretive guidelines, and (3) what factors influence FENO and what is the size of the effect? Study Design and Methods: FENO data of First Nations Australians (age < 16 years, n = 862; age ≥ 16 years, n = 348) were obtained. Medical history using participant questionnaires and medical records were used to define healthy participants. Flexible regression using spline functions, as used by the Global Lung Function Initiative, were used to generate predicted and ULN values. Results: Look-up tables for predicted and ULN values using age (4-76 years) and height (100-200 cm) were generated and are supplied with a calculator for clinician use. In healthy First Nations children (age < 18 years), ULN values ranged between 25 and 60 parts per billion (ppb) when considering only biologically plausible age and height combinations. For healthy adults, ULN values ranged between 39 and 88 ppb. Neither the current FENO interpretation guidelines, nor the currently recommended cutoff of 50 ppb for First Nations children 16 years of age or younger were appropriate for use in this cohort. Our modelling revealed that predicted and ULN values of healthy participants varied nonlinearly with age and height. Interpretation: Because single pediatric, adult, or all-age FENO cutoff values used by current interpretive guidelines to define abnormality fail to account for factors that modify FENO values, we propose predicted and ULN values for First Nations Australians 4 to 76 years of age. Creating age- and height-adjusted predicted and ULN values ... |
format |
Article in Journal/Newspaper |
author |
Collaro, Andrew J. Chang, Anne B. Marchant, Julie M. Vicendese, Don Chatfield, Mark D. Cole, Johanna F. Blake, Tamara L. McElrea, Margaret S. |
author_facet |
Collaro, Andrew J. Chang, Anne B. Marchant, Julie M. Vicendese, Don Chatfield, Mark D. Cole, Johanna F. Blake, Tamara L. McElrea, Margaret S. |
author_sort |
Collaro, Andrew J. |
title |
Developing Fractional Exhaled Nitric Oxide Predicted and Upper Limit of Normal Values for a Disadvantaged Population |
title_short |
Developing Fractional Exhaled Nitric Oxide Predicted and Upper Limit of Normal Values for a Disadvantaged Population |
title_full |
Developing Fractional Exhaled Nitric Oxide Predicted and Upper Limit of Normal Values for a Disadvantaged Population |
title_fullStr |
Developing Fractional Exhaled Nitric Oxide Predicted and Upper Limit of Normal Values for a Disadvantaged Population |
title_full_unstemmed |
Developing Fractional Exhaled Nitric Oxide Predicted and Upper Limit of Normal Values for a Disadvantaged Population |
title_sort |
developing fractional exhaled nitric oxide predicted and upper limit of normal values for a disadvantaged population |
publisher |
American College of Chest Physicians |
publishDate |
2023 |
url |
https://eprints.qut.edu.au/246699/ |
genre |
First Nations |
genre_facet |
First Nations |
op_source |
Chest |
op_relation |
https://eprints.qut.edu.au/246699/1/CHEST-D-22-00329.pdf doi:10.1016/j.chest.2022.10.014 Collaro, Andrew J., Chang, Anne B., Marchant, Julie M., Vicendese, Don, Chatfield, Mark D., Cole, Johanna F., Blake, Tamara L., & McElrea, Margaret S. (2023) Developing Fractional Exhaled Nitric Oxide Predicted and Upper Limit of Normal Values for a Disadvantaged Population. Chest, 163(3), pp. 624-633. http://purl.org/au-research/grants/nhmrc/1170958 http://purl.org/au-research/grants/nhmrc/2003334 https://eprints.qut.edu.au/246699/ Australian Centre for Health Services Innovation; Faculty of Health; School of Public Health & Social Work |
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free_to_read http://creativecommons.org/licenses/by-nc-nd/4.0/ 2022 American College of Chest Physicians This work is covered by copyright. Unless the document is being made available under a Creative Commons Licence, you must assume that re-use is limited to personal use and that permission from the copyright owner must be obtained for all other uses. If the document is available under a Creative Commons License (or other specified license) then refer to the Licence for details of permitted re-use. It is a condition of access that users recognise and abide by the legal requirements associated with these rights. If you believe that this work infringes copyright please provide details by email to qut.copyright@qut.edu.au |
op_doi |
https://doi.org/10.1016/j.chest.2022.10.014 |
container_title |
Chest |
container_volume |
163 |
container_issue |
3 |
container_start_page |
624 |
op_container_end_page |
633 |
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1799479904016793600 |
spelling |
ftqueensland:oai:eprints.qut.edu.au:246699 2024-05-19T07:40:20+00:00 Developing Fractional Exhaled Nitric Oxide Predicted and Upper Limit of Normal Values for a Disadvantaged Population Collaro, Andrew J. Chang, Anne B. Marchant, Julie M. Vicendese, Don Chatfield, Mark D. Cole, Johanna F. Blake, Tamara L. McElrea, Margaret S. 2023-03 application/pdf https://eprints.qut.edu.au/246699/ unknown American College of Chest Physicians https://eprints.qut.edu.au/246699/1/CHEST-D-22-00329.pdf doi:10.1016/j.chest.2022.10.014 Collaro, Andrew J., Chang, Anne B., Marchant, Julie M., Vicendese, Don, Chatfield, Mark D., Cole, Johanna F., Blake, Tamara L., & McElrea, Margaret S. (2023) Developing Fractional Exhaled Nitric Oxide Predicted and Upper Limit of Normal Values for a Disadvantaged Population. Chest, 163(3), pp. 624-633. http://purl.org/au-research/grants/nhmrc/1170958 http://purl.org/au-research/grants/nhmrc/2003334 https://eprints.qut.edu.au/246699/ Australian Centre for Health Services Innovation; Faculty of Health; School of Public Health & Social Work free_to_read http://creativecommons.org/licenses/by-nc-nd/4.0/ 2022 American College of Chest Physicians This work is covered by copyright. Unless the document is being made available under a Creative Commons Licence, you must assume that re-use is limited to personal use and that permission from the copyright owner must be obtained for all other uses. If the document is available under a Creative Commons License (or other specified license) then refer to the Licence for details of permitted re-use. It is a condition of access that users recognise and abide by the legal requirements associated with these rights. If you believe that this work infringes copyright please provide details by email to qut.copyright@qut.edu.au Chest FENO nitric oxide NO ppb reference values ULN Contribution to Journal 2023 ftqueensland https://doi.org/10.1016/j.chest.2022.10.014 2024-05-01T00:02:12Z Background: Fractional exhaled nitric oxide (FENO), used as a biomarker, is influenced by several factors including ethnicity. Normative data are essential for interpretation, and currently single cutoff values are used in children and adults. Research Question: Accounting for factors that influence FENO, (1) what are appropriate predicted and upper limit of normal (ULN) FENO values in an underserved population (First Nations Australians), (2) how do these values compare with age-based interpretive guidelines, and (3) what factors influence FENO and what is the size of the effect? Study Design and Methods: FENO data of First Nations Australians (age < 16 years, n = 862; age ≥ 16 years, n = 348) were obtained. Medical history using participant questionnaires and medical records were used to define healthy participants. Flexible regression using spline functions, as used by the Global Lung Function Initiative, were used to generate predicted and ULN values. Results: Look-up tables for predicted and ULN values using age (4-76 years) and height (100-200 cm) were generated and are supplied with a calculator for clinician use. In healthy First Nations children (age < 18 years), ULN values ranged between 25 and 60 parts per billion (ppb) when considering only biologically plausible age and height combinations. For healthy adults, ULN values ranged between 39 and 88 ppb. Neither the current FENO interpretation guidelines, nor the currently recommended cutoff of 50 ppb for First Nations children 16 years of age or younger were appropriate for use in this cohort. Our modelling revealed that predicted and ULN values of healthy participants varied nonlinearly with age and height. Interpretation: Because single pediatric, adult, or all-age FENO cutoff values used by current interpretive guidelines to define abnormality fail to account for factors that modify FENO values, we propose predicted and ULN values for First Nations Australians 4 to 76 years of age. Creating age- and height-adjusted predicted and ULN values ... Article in Journal/Newspaper First Nations Queensland University of Technology: QUT ePrints Chest 163 3 624 633 |