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Niox flex

Manufactured by NIOX Group
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The NIOX Flex is a compact and portable device designed for the measurement of nitric oxide (NO) concentration in exhaled breath. It provides accurate and reliable results to support respiratory assessment and management.

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Lab products found in correlation

Aerosol provocation system, by Cardinal Health (2 mentions) Cell dyn 4000, by Abbott (1 mentions)

13 protocols using niox flex

1

Pioglitazone in Asthma Treatment

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Eligible participants were randomized to 12 weeks pioglitazone (30 mg once a day for 4 weeks, then 45 mg once a day for 8 weeks) or matched placebo using an internet-based randomization schedule stratified by inhaled corticosteroid use. The allocation sequence was generated using random permuted blocks of two, four, and six and maintained on a secure server by the Nottingham Clinical Trials Unit (CTU).
The baseline clinical measurements were: the fractional exhaled nitric oxide (FeNO) in parts per billion (ppb) at 50 mL/second (NIOX® Flex, Aerocrine, Solna, Sweden), pre-bronchodilator FEV1, airway hyperresponsiveness to methacholine (PD20, Ganshorn ProvoJet, Ganshorn Medizin Electronic GmbH, Niederlauer, Germany) based on the protocol of Yan, Asthma Control Questionnaire (ACQ), Asthma Quality of Life Questionnaire (AQLQ), and induced sputum [23 (link)–25 (link)]. Study visits were at same time of day +/- 1.5 hours at 4, 8, 12, and 16 weeks within three days of the protocol date and the baseline clinical measurements were repeated after 12 weeks of treatment.
Anderson J.R., Mortimer K., Pang L., Smith K.M., Bailey H., Hodgson D.B., Shaw D.E., Knox A.J, & Harrison T.W. (2016). Evaluation of the PPAR-γ Agonist Pioglitazone in Mild Asthma: A Double-Blind Randomized Controlled Trial. PLoS ONE, 11(8), e0160257.
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2

Assessment of Airway and Systemic Inflammation

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The fraction of exhaled nitric oxide (FeNO; airway inflammation marker) was measured with a chemiluminescence analyzer (NIOX Flex, Aerocrine AB, Solna, Sweden). Eosinophil blood count (B-Eos; systemic inflammation marker) was measured with a routine method (Cell-Dyn Sapphire, Abbott, Illinois, USA). Forced expiratory volume during one second (FEV1) was recorded with a MasterScope spirometer (Erich Jaeger, Wurzburg, Germany) and was used as a measure of pulmonary function. The methacholine provocative dose causing a fall of FEV1 by 20% (PD20) was determined with the Aerosol Provocation System (Viasys Healthcare GmbH, Germany). Measurements were done in accordance with standardized routines and guidelines [25 (link)–27 (link)] and have been described in detail elsewhere [16 (link), 17 (link), 28 (link)]. Blood samples used for ECP analysis (Eosinophil Cationic Protein, systemic inflammation marker) were collected in SST tubes and left for 60 min at room temperature. Thereafter, they were centrifuged at 3000 rpm for 15 min and stored in Sarstedt sample tubes at − 20 °C. The samples were analysed with the ImmunoCAP ECP assay. An S-ECP level ≥ 20 µg/L was defined as elevated.
Johnson J., Malinovschi A., Lidholm J., Petersson C.J., Nordvall L., Janson C., Alving K, & Borres M.P. (2020). Sensitization to storage proteins in peanut and hazelnut is associated with higher levels of inflammatory markers in asthma. Clinical and Molecular Allergy : CMA, 18, 11.
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3

Exhaled Nitric Oxide Measurement

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Five-flow exhaled nitric oxide (NiOX flex, Aerocrine, Solna, Sweden) was used to determine FeNO50, bronchial intercept, and alveolar gradient. Induced sputum was performed by nebulizing hypertonic saline solution and a differential cell count was obtained, both as described in the Supplementary material.
John M.E., Cockcroft J.R., McKeever T.M., Coward W.R., Shale D.J., Johnson S.R., Thornton J.G., Harrison T.W., Knox A.J, & Bolton C.E. (2015). Cardiovascular and inflammatory effects of simvastatin therapy in patients with COPD: a randomized controlled trial. International Journal of Chronic Obstructive Pulmonary Disease, 10, 211-221.
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4

Nasal Nitric Oxide Measurement and Cell Sampling

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Patients were required to have been free of infection for ≥4 weeks. At UHS, demographic and clinical history was recorded using a standard form. At UHS nNO was measured [20 (link)] using a chemiluminescence analyser (NIOX Flex; Aerocrine, Solna, Sweden) aspirating nasal air from the nostril at 0.3 L·min−1 during a breath-hold manoeuvre. Based on experience, since 2007 we have considered an arbitrary cut-off of ≤30 nL·min−1. Following nNO measurement, a nasal brush biopsy provided epithelial cells for HSVMA, TEM and ALI culture.
Satellite centres completed patient proformas and brush biopsies were couriered to UHS. Cells for HSVMA and ALI culture were transported in buffered medium within 3 h, while fixed samples for TEM were accepted with longer transportation times.
Jackson C.L., Behan L., Collins S.A., Goggin P.M., Adam E.C., Coles J.L., Evans H.J., Harris A., Lackie P., Packham S., Page A., Thompson J., Walker W.T., Kuehni C, & Lucas J.S. (2015). Accuracy of diagnostic testing in primary ciliary dyskinesia. The European Respiratory Journal, 47(3), 837-848.
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5

Standardized Lung Function Measurements

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Spirometry was measured using standard spirometric techniques (Viasys Healthcare, Jaeger, Hoechberg, Germany) at least 6 h after the patient’s most recent treatment with albuterol, according to the guidelines of the American Thoracic Society (ATS)30 (link). The fraction of exhaled nitric oxide was measured (Niox Flex; Aerocrine, Solna, Sweden) at 50 mL/s (FeNO50) in concordance with standardized guidelines31 (link). Lung volumes and the lung diffusion capacity of carbon monoxide (DLCO) were determined according to ATS guidelines (Zan 500 body plethysmography, nSpire Health Limited, Hertford, UK)32 (link).
Wu D., Lai T., Yuan Y., Chen M., Xia J., Li W., Pan G., Yuan B., Lv Q., Li Y., Li D, & Wu B. (2017). Elevated expression of placental growth factor is associated with airway-wall vascular remodelling and thickening in smokers with asthma. Scientific Reports, 7, 43017.
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6

Airway Measurement in Respiratory Research

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The fraction of exhaled nitric oxide (FeNO) was measured with a chemiluminescence analyzer (NIOX Flex, Aerocrine AB, Solna, Sweden). Eosinophil blood count (B-Eos) was measured with a routine method (Cell-Dyn Sapphire, Abbott, Illinois, USA). Forced expiratory volume in one second (FEV1) was recorded with a MasterScope spirometer (Erich Jaeger, Wurzburg, Germany), and was used as a measure of pulmonary function. The methacholine provocative dose causing a fall of FEV1 by 20% (PD20) was determined with the Aerosol Provocation System (Viasys Healthcare GmbH, Germany). Measurements were done in accordance with standardized routines and guidelines [21 (link)–23 (link)], and have been described in detail elsewhere [18 (link), 20 (link)].
Johnson J., Borres M.P., Nordvall L., Lidholm J., Janson C., Alving K, & Malinovschi A. (2015). Perceived Food Hypersensitivity Relates to Poor Asthma Control and Quality of Life in Young Non-Atopic Asthmatics. PLoS ONE, 10(4), e0124675.
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7

Measurement of Exhaled Nitric Oxide

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Measurement of exhaled NO levels was performed using the NIOX Flex (Aerocrine AB, Solna, Sweden). Exhaled NO levels were measured at multiple flows (10 ml/s, 30 ml/s, 50 ml/s, 100 ml/s, 200 mL/s). Exhaled bronchial NO at 50 mL/s (FeNO) was taken as the mean value of two blows. Alveolar NO concentration (Calv) was corrected for axial back diffusion as described by Kerckx et al.23 (link) Two adequate blows at three different flow rates were considered the minimum required to calculate a value for alveolar NO.
Hodgson D., Anderson J., Reynolds C., Meakin G., Bailey H., Pavord I., Shaw D, & Harrison T. (2015). A randomised controlled trial of small particle inhaled steroids in refractory eosinophilic asthma (SPIRA). Thorax, 70(6), 559-565.
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8

Measuring Fractional Exhaled Nitric Oxide

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FeNO was measured by a chemiluminescence analyzer (NIOx-Flex, Aerocrine AB, Solna, Sweden), at an expiratory flow rate of 50 mL/s by applying resistance of 50 cm H2O/mL/s.13 ,14 (link) Each subject performed 2 exhalations using a vital capacity maneuver and the mean of these values was taken.
Gastaldi A.C., Paredi P., Talwar A., Meah S., Barnes P.J, & Usmani O.S. (2015). Oscillating Positive Expiratory Pressure on Respiratory Resistance in Chronic Obstructive Pulmonary Disease With a Small Amount of Secretion: A Randomized Clinical Trial. Medicine, 94(42), e1845.
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9

Exhaled Nitric Oxide Measurement

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FeNO measurements were performed at baseline using a NIOX Flex (Aerocrine, AB, Stockholm, Sweden). Patients were comfortably seated; inhaled NO depleted ambient air and exhaled at a flow rate of 50 mL/s. The manoeuvre was performed 3–4 times.
Tufvesson E., Stenberg H., Ankerst J, & Bjermer L. (2020). Type 2 Inflammatory Biomarker Response After Exercise Challenge Testing. Journal of Asthma and Allergy, 13, 269-274.
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10

Exhaled Nitric Oxide and Blood Cell Counts

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Exhaled nitric oxide at an exhalation flow of 50 mL/s (FENO50) was measured with NIOX VERO (Circassia AB, Solna, Sweden), NIOX Flex (Aerocrine AB, Solna, Sweden) or Eco Medics CLD 88 (Eco Medics, Duernten, Switzerland). The measurements were performed in accordance with current recommendations.12 (link)
Blood neutrophil count (B-Neu) and blood eosinophil count (B-Eos) were analysed (Cell-Dyn 4000; Abbott Laboratories, Abbott Park, IL, USA and Sysmex XN-10; Sysmex America, Inc., Lincolnshire, IL, USA).
Högman M., Sulku J., Ställberg B., Janson C., Bröms K., Hedenström H., Lisspers K, & Malinovschi A. (2018). 2017 Global Initiative for Chronic Obstructive Lung Disease reclassifies half of COPD subjects to lower risk group. International Journal of Chronic Obstructive Pulmonary Disease, 13, 165-173.
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