Measurements of exhaled nitric oxide with the single-breath technique and positive expiratory pressure in infants

Am J Respir Crit Care Med. 1999 Jan;159(1):74-8. doi: 10.1164/ajrccm.159.1.9805021.


The aim of this study was to adapt the single-breath technique with positive expiratory pressure to measure exhaled nitric oxide (eNO) in infants. We hypothesized that exhaled eNO was greater in wheezy than in healthy infants. We studied 30 infants (16 wheezy and 14 healthy). The forced expiratory volume in 0.5 s (FEV0.5) was determined with the raised volume rapid thoracic compression technique, and eNO was measured during constant expiratory flow with a rapid-response chemiluminescence analyzer. After passive inflation to a preset pressure of 20 cm H2O, thoracic compression with an inflatable jacket caused forced expiration to occur through a face-mask with an expiratory flow resistor attached. During the forced expiration, the jacket pressure was increased to maintain a constant driving mouth pressure and hence a constant expiratory flow (50 ml/s). The mean level of eNO in the wheezy infants (31.8 ppb) was significantly higher than the level in healthy infants (18.8 ppb) (p = 0.03). A family history of atopy in parents was associated with increased eNO levels (p < 0.001) independent of age, sex, weight, length, wheezing, and FEV0.5. We conclude that the single-breath technique with positive expiratory pressure is a feasible method for measuring eNO in infants. Levels of eNO were significantly higher in wheezy infants and in those with a family history of atopy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Feasibility Studies
  • Forced Expiratory Volume / physiology
  • Humans
  • Hypersensitivity / genetics
  • Infant
  • Medical Records
  • Methods
  • Nitric Oxide*
  • Parents
  • Positive-Pressure Respiration*
  • Pulmonary Ventilation / physiology
  • Reference Values
  • Respiration*
  • Respiratory Sounds / physiopathology*


  • Nitric Oxide