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Correspondence |

Gender and Exhaled Nitric Oxide FREE TO VIEW

Mario Olivieri, MD; Massimo Corradi, MD; Mario Malerba, MD
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Affiliations: Department of Medicine and Public Health, University of Verona, Verona, Italy,  Department of Clinical Medicine, Nephrology, and Health Sciences, University of Parma, Parma, Italy,  Department of Internal Medicine, University of Brescia, Brescia, Italy

Correspondence to: Mario Malerba, MD, Department of Internal Medicine, University of Brescia, I Medicina, Spedali Civili di Brescia, Pzza Spedali Civili n 1, Brescia, Italy; e-mail: malerba@med.unibs.it



Chest. 2007;132(4):1410. doi:10.1378/chest.07-0741
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To the Editor:

We read with interest the article by Olin et al1 (November 2006) on the influence of height, age, and atopy on exhaled nitric oxide (Feno) in a large, adult, general population sample. In the results, the authors,1 state that gender was not associated with Feno. We think that this statement needs a comment. Evaluating data in the univariate analysis, Feno levels were higher in men than in women: median value (25th to 75th percentile), 15.8 parts per billion (ppb) [11.7 to 21.5] in women, vs 18.8 ppb (13.7 to 25.5) in men (p < 0.05). In a multiple linear regression model, the authors found no association with gender, whereas Feno was independently and positively associated with atopy, height, age, smoking, asthma symptoms in the last month, and reported use of inhaled steroids.,1

We have recently published an article2in which, when measuring Feno in 204 healthy, nonsmoking, nonatopic adults with normal spirometry values using the American Thoracic Society/European Respiratory Society3 recommendations, a significant difference (p < 0.01) in Feno values comparing men and women was documented. The possible explanations of the results found by Olin et al,1 could be the major effect of the other different independent variables on Feno compared with gender. It is well known that smoking and inhaled steroids dramatically reduce, whereas atopy and asthma symptoms significantly increase levels of Feno.,4We agree that the influence of atopy, smoke, asthma symptoms, and steroids on Feno values is more relevant than gender; however, we believe that Feno reference values based on gender should be considered in the management of asthma in order to obtain the best possible clinical control with the lowest inhaled steroids administration.5

The authors have no conflicts of interest to disclose.

Olin, AC, Rosengren, A, Thelle, D, et al (2006) Height, age, and atopy are associated with fraction of exhaled nitric oxide in a large adult general population sample.Chest130,1319-1325. [PubMed] [CrossRef]
 
Olivieri, M, Talamini, G, Corradi, M, et al Reference values for exhaled nitric oxide (REVENO) study.Respir Res2006;30,94-99
 
ATS/ERS recommendations for standardized procedures for online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide.Am J Respir Crit Care Med2005;171,912-930. [PubMed]
 
Ricciardolo, FL, Sterk, PJ, Gaston, B, et al Nitric oxide in health and disease of the respiratory system.Physiol Rev2004;84,731-765. [PubMed]
 
Smith, AD, Cowan, JO, Brassett, KP, et al Use of exhaled nitric oxide measurements to guide treatment in chronic asthma.N Engl J Med2005;352,2163-2173. [PubMed]
 

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References

Olin, AC, Rosengren, A, Thelle, D, et al (2006) Height, age, and atopy are associated with fraction of exhaled nitric oxide in a large adult general population sample.Chest130,1319-1325. [PubMed] [CrossRef]
 
Olivieri, M, Talamini, G, Corradi, M, et al Reference values for exhaled nitric oxide (REVENO) study.Respir Res2006;30,94-99
 
ATS/ERS recommendations for standardized procedures for online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide.Am J Respir Crit Care Med2005;171,912-930. [PubMed]
 
Ricciardolo, FL, Sterk, PJ, Gaston, B, et al Nitric oxide in health and disease of the respiratory system.Physiol Rev2004;84,731-765. [PubMed]
 
Smith, AD, Cowan, JO, Brassett, KP, et al Use of exhaled nitric oxide measurements to guide treatment in chronic asthma.N Engl J Med2005;352,2163-2173. [PubMed]
 
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