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Clin Exp Allergy. 2019 Apr 1. doi: 10.1111/cea.13394. [Epub ahead of print]

Determinants of fractional exhaled nitric oxide in healthy men and women from the European Community Respiratory Health Survey III.

Author information

1
Department of Medical Sciences, Respiratory Medicine, Allergy and Sleep, Uppsala University, Uppsala, Sweden.
2
Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden.
3
Department of Medicine, Health and Social Studies, Dalarna University, Falun, Sweden.
4
Unit of Occupational Medicine, University of Verona, Verona, Italy.
5
Department of Sleep, Landspítali University Hospital, Reykjavík, Iceland.
6
Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
7
Section of Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
8
Department of Clinical Science, University of Bergen, Bergen, Norway.
9
Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
10
Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway.
11
Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
12
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
13
Alergia e Imunologia, Complexo Hospital de Clinicas, Universidade Federal do Paraná, Curitiba, Brazil.
14
Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
15
Department of Pediatrics, CHU Grenoble Alpes, Grenoble, France.
16
Institute for Advanced Biosciences, Inserm, Grenoble, France.
17
Université Grenoble Alpes, Grenoble, France.
18
Division of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
19
Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.
20
Département de Pneumologie et Addictologie, Centre Hospitalier Universitaire de Montpellier, Hôpital Arnaud-de-Villeneuve, univ Montpellier, Montpellier, France.
21
Institut Pierre-Louis D'épidémiologie et de Santé Publique, Équipe EPAR, Sorbonne Université, INSERM, Paris, France.
22
Epidemiology and Social Medicine, University of Antwerp StatUA Statistics Center, University of Antwerp, Antwerp, Belgium.
23
Hospital of the Ludwig-Maximilian University Munich, LMU Munich, Munich, Germany.
24
Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany.
25
Lung Clinic, Tartu University Hospital, Tartu, Estonia.
26
Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
27
ISGlobal, Barcelona, Spain.
28
Universitat Pompeu Fabra (UPF), Barcelona, Spain.
29
CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
30
Department of Public Health, Aarhus University, Aarhus, Denmark.
31
Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich, Ludwig Maximilians University Munich, Munich, Germany.
32
Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.
33
Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
34
Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
35
INSERM, UMR1152, Paris, France.
36
DHU FIRE, Université Paris-Diderot, Paris, France.
37
National Heart and Lung Institute, Imperial College, London, UK.

Abstract

INTRODUCTION:

The fractional exhaled nitric oxide (FE NO) is a marker for type 2 inflammation used in diagnostics and management of asthma. In order to use FE NO as a reliable biomarker, it is important to investigate factors that influence FE NO in healthy individuals. Men have higher levels of FE NO than women, but it is unclear whether determinants of FE NO differ by sex.

OBJECTIVE:

To identify determinants of FE NO in men and women without lung diseases.

METHOD:

Fractional exhaled nitric oxide was validly measured in 3881 healthy subjects that had answered the main questionnaire of the European Community Respiratory Health Survey III without airways or lung disease.

RESULTS:

Exhaled NO levels were 21.3% higher in men compared with women P < 0.001. Being in the upper age quartile (60.3-67.6 years), men had 19.2 ppb (95% CI: 18.3, 20.2) higher FE NO than subjects in the lowest age quartile (39.7-48.3 years) P = 0.02. Women in the two highest age quartiles (54.6-60.2 and 60.3-67.6 years) had 15.4 ppb (14.7, 16.2), P = 0.03 and 16.4 ppb (15.6, 17.1), P = <0.001 higher FE NO, compared with the lowest age quartile. Height was related to 8% higher FE NO level in men (P < 0.001) and 5% higher FE NO levels in women (P = 0.008). Men who smoked had 37% lower FE NO levels and women had 30% lower levels compared with never-smokers (P < 0.001 for both). Men and women sensitized to both grass and perennial allergens had higher FE NO levels compared with non-sensitized subjects 26% and 29%, P < 0.001 for both.

CONCLUSION AND CLINICAL RELEVANCE:

Fractional exhaled nitric oxide levels were higher in men than women. Similar effects of current smoking, height, and IgE sensitization were found in both sexes. FE NO started increasing at lower age in women than in men, suggesting that interpretation of FE NO levels in adults aged over 50 years should take into account age and sex.

KEYWORDS:

IgE sensitization; fractional exhaled nitric oxide; healthy population; smoking

PMID:
30934155
DOI:
10.1111/cea.13394

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