Spirometry (Vmax Encore 22, Viasys Healthcare, Palm Springs, CA), single-breath diffusion capacity for the lungs measured using carbon monoxide (Dl CO) and pulmonary diffusing capacity for carbon monoxide per unit of alveolar volume (Dl CO/VA) were performed according to international recommendations as previously reported4 (link),7 (link),23 (link),24 (link). Finnish reference values for spirometry were used. The fraction of exhaled nitric oxide (FENO) was measured with a portable rapid-response chemiluminescent analyzer according to ATS standards (flow rate 50 mL/s; NIOX System, Aerocrine, Sweden). For inflammatory parameters, venous blood was collected, and white blood cells, including eosinophils, were counted. Total IgE levels were measured by using ImmunoCAP (Thermo Scientific, Uppsala, Sweden). Laboratory assays were performed in an accredited laboratory (SFS-EN ISO/IEC 17025:2005 and ISO 15189:2007) of Seinäjoki Central Hospital. Atopy was defined as at least one positive response (≥3 mm) in the skin prick test towards common aeroallergens.
Niox system
Manufactured by NIOX Group
Sourced in Sweden
The NIOX System is a laboratory device that measures the concentration of nitric oxide (NO) in exhaled breath. It provides accurate and reliable measurements of NO levels, which can be used as a biomarker for various medical conditions.
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Lab products found in correlation
16 protocols using niox system
1
Comprehensive Lung Function Assessments
2
Asthma Burden Characterization Protocol
3
Pulmonary Function and Methacholine Challenge
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Assessment of pulmonary function and the methacholine bronchial challenge test were conducted by the trained operators with a spirometer (MasterScreen PFT; Jaeger™; CareFusion), in accordance with the American Thoracic Society/European Respiratory Society guidelines.23 (link) Bronchial hyperresponsiveness was defined as FEV1 decreasing to ≥20% of its baseline level when ≤2.504 mg of a cumulative dose of methacholine (PD20) was administered. FeNO was measured with a portable rapid response chemiluminescent analyzer at an expiratory flow rate of 50 mL/sec (NIOX System; Aerocrine, Stockholm, Sweden).24 (link)
4
Measuring Airway Inflammatory Biomarkers
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Feno was measured using a portable nitric oxide analyzer (NIOX System; Aerocrine, Stockholm, Sweden). The levels of peripheral blood eosinophil, serum s-IgE (ImmunoCAP, Thermo Fisher/Phadia, Uppsala, Sweden), and total IgE (t-IgE) were determined.
5
Pulmonary Function and FeNO Measurement
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Pulmonary function was conducted by trained operators with a spirometer (MasterScreen PFT; Jaeger™, CareFusion, Hoechberg, Germany), in accordance with the American Thoracic Society/European Respiratory Society guidelines.21 (link) Parameters, including percent of predicted forced vital capacity (FVC%) predicted and forced expiratory volume in 1 second of predicted, and midflows (average forced expiratory flow during the mid (25%-75%) portion of FVC maneuver, were recorded. FeNO were measured with a portable rapid response chemiluminescent analyzer at an expiratory flow rate of 50 mL/s (NIOX System, Aerocrine, Sweden).22 (link)
6
Fractional Exhaled Nitric Oxide Measurement
7
Childhood Asthma Lung Function and Nitric Oxide
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Spirometry was performed using the Jaeger MasterScope system (Jaeger-Toennies GmbH, Hoechberg, Germany) according to protocols described by the Childhood Asthma Research and Education (CARE) Network [27 (link),30 (link)]. The family was instructed to give the child their prescribed asthma medications but to hold albuterol and caffeinated food products for 6 hours prior to the annual visit. If the child was ill or taking albuterol for symptoms, the visit was rescheduled. Fractional exhaled nitric oxide (FeNO) was measured as reported previously[31 (link)] using the NIOX system (Aerocrine, Stockholm, Sweden) according to American Thoracic Society online measurement standards adapted for children [32 (link)]. The expiratory flow rate was 0.05 L/s. Exhalation times were at least 6 seconds with a 2-second analysis period. Children were required to have 3 measurements within 10% or 2 measurements within 5% for acceptability. Measurements were made before the performance of spirometry [31 (link)].
8
Measuring Airway Inflammation in Asthma
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Fraction of exhaled nitric oxide (FeNO) is a non-invasive biomarker of airway inflammation in asthma which parallels, but has distinctions from EOS; both indicate airway inflammation and predict risks for exacerbations and airflow obstruction (Dweik et al., 2010 (link)). FeNO was measured at each visit in breath condensate, according to American Thoracic Society guidelines (NIOX System; Aerocrine, Solna, Sweden; Silkoff et al., 2004 (link)). Sputum and blood samples were collected to quantify eosinophilic inflammation. For sputum induction, participants were pre-treated with a beta-agonist to prevent bronchospasm, then inhaled a nebulized 3% buffered saline solution mist and produced sputum at 4-min intervals. Sputum was diluted 1:1 with a 1:10 concentration of dithiothreitol (DTT–SPUTOLYSIN ® Reagent, Calbiochem). Samples were shaken in a 37° water bath and centrifuged, then cytospins were prepared and stained with Giemsa to determine cell distributions. Venous blood samples were collected into EDTA-coated tubes. Slides were prepared for determination of cell differentials (lymphocytes, monocytes/macrophages, neutrophils, eosinophils, and basophils). Our analyses focused on sputum EOS percent and blood EOS total counts.
9
Fractional Exhaled Nitric Oxide Measurement
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FENO was measured with the NIOX system (Aerocrine, Stockholm, Sweden) with a single breath on-line method at constant flow of 50 ml/sec according to American Thoracic Society guidelines (American Thoracic Society and European Respiratory Society, 2005 (link); Dweik et al., 2011 (link)). Exhalations were repeated after 1 min relaxation period until the performance of three FENO values varies less than 10% (American Thoracic Society and European Respiratory Society, 2005 (link)). FENO measurements were obtained before spirometry.
10
Asthma Phenotype and Anti-IL-5 Treatments
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Clinical characteristics: Demographic characteristics, asthma duration, 6-item Asthma Control Questionnaire score. 13 Surrogate inflammatory markers/anti-inflammatory treatments:
Peripheral blood eosinophils, fractional exhaled nitric oxide (FENO, NIOX System, Aerocrine, Sweden), 14 maintenance dose of OCS, OCS bursts or episodes of doubling the OCS maintenance dose for 3 days or more in the last 3 months, IgE. Lung function: FEV 1 measured according to standardized methods. 15 Comorbidities: Chronic rhinosinusitis and presence of nasal polyps (NPs) or chronic otitis were diagnosed by an ear-nose-throat specialist; allergic rhinoconjunctivitis was diagnosed by elevated specific IgE testing combined with a history of allergic symptoms; and atopic dermatitis was diagnosed on the basis of patient's history and physical examination. Adrenal insufficiency was confirmed by low morning cortisol levels (<150 nmol/L) or inability to lower OCS dose because of severe adrenal insufficiency symptoms such as severe fatigue and nausea. Changes in antieIL-5 treatments: Frequency of switches between antieIL-5 treatments, reasons for switches (eg, persistent asthma or sinonasal symptoms including exacerbations, persistent airflow limitation, inability to taper or stop OCS, adverse effects), or discontinuation of antieIL-5 treatments.
Peripheral blood eosinophils, fractional exhaled nitric oxide (FENO, NIOX System, Aerocrine, Sweden), 14 maintenance dose of OCS, OCS bursts or episodes of doubling the OCS maintenance dose for 3 days or more in the last 3 months, IgE. Lung function: FEV 1 measured according to standardized methods. 15 Comorbidities: Chronic rhinosinusitis and presence of nasal polyps (NPs) or chronic otitis were diagnosed by an ear-nose-throat specialist; allergic rhinoconjunctivitis was diagnosed by elevated specific IgE testing combined with a history of allergic symptoms; and atopic dermatitis was diagnosed on the basis of patient's history and physical examination. Adrenal insufficiency was confirmed by low morning cortisol levels (<150 nmol/L) or inability to lower OCS dose because of severe adrenal insufficiency symptoms such as severe fatigue and nausea. Changes in antieIL-5 treatments: Frequency of switches between antieIL-5 treatments, reasons for switches (eg, persistent asthma or sinonasal symptoms including exacerbations, persistent airflow limitation, inability to taper or stop OCS, adverse effects), or discontinuation of antieIL-5 treatments.
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