Fractional exhaled nitric oxide distribution and its relevant factors in the general adult population and its healthy subpopulation

Mitsuhiro Yamada; Masato Takase; Kumi Nakaya; Tomohiro Nakamura; Mana Kogure; Naoki Nakaya; Naoya Fujino; Tsutomu Tamada; Chikashi Iwasaki; Manami Suzuki; Shuichiro Matsumoto; Nobuo Fuse; Akira Uruno; Kazuki Kumada; Soichi Ogishima; Shinichi Kuriyama; Masakazu Ichinose; Hisatoshi Sugiura; Atsushi Hozawa

doi:10.1016/j.jacig.2024.100253

Fractional exhaled nitric oxide distribution and its relevant factors in the general adult population and its healthy subpopulation

J Allergy Clin Immunol Glob. 2024 Apr 8;3(3):100253. doi: 10.1016/j.jacig.2024.100253. eCollection 2024 Aug.

Authors

Mitsuhiro Yamada¹, Masato Takase², Kumi Nakaya², Tomohiro Nakamura³, Mana Kogure², Naoki Nakaya², Naoya Fujino¹, Tsutomu Tamada¹, Chikashi Iwasaki¹, Manami Suzuki¹, Shuichiro Matsumoto¹, Nobuo Fuse⁴, Akira Uruno⁴, Kazuki Kumada⁵, Soichi Ogishima⁶, Shinichi Kuriyama², Masakazu Ichinose⁷, Hisatoshi Sugiura¹, Atsushi Hozawa²

Affiliations

¹ Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
² Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
³ Kyoto Women's University, Kyoto, Japan.
⁴ Department of Integrative Genomics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
⁵ Department of Biobank, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
⁶ Department of Health Record Informatics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan.
⁷ Osaki Citizen Hospital Academic Center, Osaki, Japan.

Abstract

Background: Measurement of fractional exhaled nitric oxide (Feno) has been used in the diagnosis and management of asthma. Understanding the distribution of Feno in a larger resident population and its "healthy" subpopulation would contribute to the interpretation of Feno in clinical practice.

Objective: This study aimed to investigate the distribution and its associated factors in the adult population and its healthy subpopulations.

Methods: We conducted a cross-sectional study of 8,638 men and 17,288 women aged 20 years or older living in Miyagi prefecture, Japan. We investigated the distribution of Feno and its associated factors in all subjects, a subpopulation with no history of upper and lower airway diseases (healthy subpopulation 1), and a subpopulation with no history of upper and lower airway diseases, normal lung function, and no positivity for other biomarkers of type 2 inflammation (healthy subpopulation 2).

Results: The distribution of Feno in healthy subpopulations, especially in healthy subpopulation 2 (median [interquartile range], 17 [12-23] with 95th percentile of 36 ppb) was lower than in all subjects (19 [13-26] ppb with 95th percentile of 47 ppb). In healthy subpopulation 1, 10.3% had elevated Feno (≥35 ppb), and elevated Feno was positively associated with factors including obstructive ventilatory defect, blood eosinophilia, house dust mite-specific IgE positivity, and history of hypertension. Male sex was associated with elevated Feno in all subjects and healthy subpopulations.

Conclusion: The distribution of Feno in the healthy subpopulation supports the validity of the criteria (≥35 ppb) currently used in Japan for the diagnosis of asthma.

Keywords: COPD; Fractional exhaled nitric oxide; asthma; biomarkers; health survey of residents.