Standardizing Nasal Nitric Oxide Measurement as a Test for Primary Ciliary Dyskinesia

Ann Am Thorac Soc. 2013 Dec;10(6):574-81. doi: 10.1513/AnnalsATS.201305-110OC.

Abstract

Rationale: Several studies suggest that nasal nitric oxide (nNO) measurement could be a test for primary ciliary dyskinesia (PCD), but the procedure and interpretation have not been standardized.

Objectives: To use a standard protocol for measuring nNO to establish a disease-specific cutoff value at one site, and then validate at six other sites.

Methods: At the lead site, nNO was prospectively measured in individuals later confirmed to have PCD by ciliary ultrastructural defects (n = 143) or DNAH11 mutations (n = 6); and in 78 healthy and 146 disease control subjects, including individuals with asthma (n = 37), cystic fibrosis (n = 77), and chronic obstructive pulmonary disease (n = 32). A disease-specific cutoff value was determined, using generalized estimating equations (GEEs). Six other sites prospectively measured nNO in 155 consecutive individuals enrolled for evaluation for possible PCD.

Measurements and main results: At the lead site, nNO values in PCD (mean ± standard deviation, 20.7 ± 24.1 nl/min; range, 1.5-207.3 nl/min) only rarely overlapped with the nNO values of healthy control subjects (304.6 ± 118.8; 125.5-867.0 nl/min), asthma (267.8 ± 103.2; 125.0-589.7 nl/min), or chronic obstructive pulmonary disease (223.7 ± 87.1; 109.7-449.1 nl/min); however, there was overlap with cystic fibrosis (134.0 ± 73.5; 15.6-386.1 nl/min). The disease-specific nNO cutoff value was defined at 77 nl/minute (sensitivity, 0.98; specificity, >0.999). At six other sites, this cutoff identified 70 of the 71 (98.6%) participants with confirmed PCD.

Conclusions: Using a standardized protocol in multicenter studies, nNO measurement accurately identifies individuals with PCD, and supports its usefulness as a test to support the clinical diagnosis of PCD.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Asthma / diagnosis
  • Axonemal Dyneins / genetics
  • Breath Tests / methods
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Cilia / ultrastructure
  • Cystic Fibrosis / diagnosis
  • Female
  • Humans
  • Kartagener Syndrome / diagnosis*
  • Kartagener Syndrome / genetics
  • Kartagener Syndrome / pathology
  • Male
  • Microscopy, Electron, Transmission
  • Middle Aged
  • Nasal Mucosa / cytology
  • Nasal Mucosa / ultrastructure
  • Nitric Oxide / analysis*
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Reference Values
  • Sensitivity and Specificity
  • Young Adult

Substances

  • Nitric Oxide
  • Axonemal Dyneins
  • DNAH11 protein, human