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Original Research |

Does ethnicity influence fractional exhaled nitric oxide in healthy individuals? A systematic review

Tamara L. Blake, MClSc; Anne B. Chang, PhD; Mark D. Chatfield, MSc; Helen L. Petsky, PhD; Leanne T. Rodwell, PhD; Michael G. Brown, MAppSc; Deb C. Hill, BSc Nurs; Margaret S. McElrea, PhD
Author and Funding Information

Conflict of Interest:

All authors declare no competing interests.

Funding

Queensland Health, Aboriginal and Torres Strait Islander Health Branch. TB supported by postgraduate scholarship from National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Lung Health for Indigenous Children (1040830). AC supported by NHMRC Practitioner Fellowship (1058213).

1Queensland University of Technology, Centre for Children’s Health Research, South Brisbane, Australia

2Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Chermside, Australia

3Department of Respiratory and Sleep Medicine, Lady Cilento Children’s Hospital, South Brisbane, Australia

4Child Health Division, Menzies School of Health Research, Darwin, Australia

5Department of Thoracic Medicine, Royal Brisbane and Women’s Hospital, Herston, Australia

Corresponding Author: Tamara Blake Level 7, Centre for Children’s Health Research 46 Graham St, South Brisbane, Queensland, Australia 4101.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.02.007
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Abstract

Background  Fractional exhaled nitric oxide (FeNO) is used clinically as a biomarker of eosinophilic airway inflammation. Awareness of the factors influencing FeNO values is important for valid clinical interpretation.

Methods  We undertook a systematic review of PubMed, Cochrane Library, Scopus and Web of Science databases, as well as reference lists of included articles to evaluate whether ethnicity influences FeNO values, and to determine if this influence affects clinical interpretation according to current guidelines. We included all studies that performed online FeNO measurements on at least 25 healthy, non-Caucasian individuals, and examined the effect of ethnicity on FeNO.

Results  From 62 potential studies, 12 studies were included. One study recruited only children (<12 years), six studies recruited children and/or adolescents, four studies recruited adults only, and a single study involved children, adolescents, and adults. In total, 16 different ethnic populations representing 11 ethnicities were studied. Ethnicity was considered a significant influencing factor in ten of the included studies. We found the geometric mean FeNO to be above the normal healthy range in two studies. We also identified five studies in which at least 5% of participants had FeNO results above the age-specific inflammatory ranges.

Conclusion  Ethnicity influences FeNO values and for some ethnic groups this influence likely affects clinical interpretation according to current guidelines. There is a need to establish healthy FeNO reference ranges for specific ethnic groups in order to improve clinical application.


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