What is nNO?
Nitric oxide (NO) naturally occurs in the airways.1 There are high nasal concentrations of nitric oxide present in the human airway, with higher amounts of exhaled NO originating in the nasal airways than the lower airways and oral cavity.2,3
nNO serves physiological functions in the nose, including mediating mucociliary activity and mucus secretion.4,5 In healthy individuals, nNO concentrations accumulate rapidly in the nonventilated nasal cavity.3 However, nNO is substantially diminished in some conditions, such as Primary Ciliary Dyskinesia (PCD), making nNO a useful biomarker for supporting diagnosis.6
Primary cilia dyskinesia (PCD)
Primary cilia dyskinesia (PCD) is a hereditary and clinically heterogeneous disease associated with abnormal ciliary structure, occurring in around 1 in every 7,500 individuals.7 PCD mainly affects the sinuses, ears, and lungs, with sufferers frequently developing respiratory tract infections which can cause longer term life-threatening breathingissues such as bronchiectasis and even pneumonia.8
Cilia, the tiny hairlike structures that line the airways, usually move mucus towards the mouth, removing particles, fluid and bacteria from the airways.8 However, in patients with PCD this process is affected and caused by a disfunction of the cilia, preventing the mucus being moved out of the airways.8
Many people with PCD produce significantly lower nNO than healthy patients, however, a simple nNO test can be used to help diagnose PCD.7,9
Did you know the NIOX VERO® can also be used for nNO testing?
The NIOX VERO® has specific attachments for testing nNO and is suitable for patients over the age of 5.11 The device simply samples the air in the nasal cavity via one of two testing methods: tidal breathing and breathing against resistance.11 This allows the device to gently sample nNO production in the non-ventilated nasal cavity, making it simple for most patients.9,11
Simply link your device to NIOX® Panel Apps to track nNO levels in real-time.
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* NIOX®. Data on File; MKT-DOF-007. 2024.
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References:
1. Leone A et al. Nitric oxide is present in exhaled breath in humans: direct GC-MS confirmation. Biochemical and biophysical research communications. 1994;201(2):883-7.
2. Alving K et al. Increased amount of nitric oxide in exhaled air of asthmatics. European Respiratory Journal. 1993;6(9):1368-70.
3. Chatkin J et al. Nitric oxide accumulation in the nonventilated nasal cavity. Archives of Otolaryngology–Head & Neck Surgery. 1999;125(6):682-5.
4. Jain B et al. Modulation of airway epithelial cell ciliary beat frequency by nitric oxide. Biochemical and biophysical research communications. 1993;191(1):83-8.
5. Zapol W et al. Nitric oxide and the lung. American journal of respiratory and critical care medicine. 1994;149(5):1375-80.
6. Boon M et al. Diagnostic accuracy of nitric oxide measurements to detect primary ciliary dyskinesia. European journal of clinical investigation. 2014;44(5):477-85.
7. Beydon N et al. Nasal nitric oxide measurement in children for the diagnosis of primary ciliary dyskinesia: European Respiratory Society technical standard. European Respiratory Journal. 2023;61(4).
8. National Heart, Lung, and Blood Institute (NHLBI). What is Primary Ciliary Dyskinesia? Available at: https://www.nhlbi.nih.gov/health/primary-ciliary-dyskinesia. Accessed: October 2024.
10. Zhang X et al. The value of nasal nitric oxide measurement in the diagnosis of primary ciliary dyskinesia. Pediatric Investigation. 2019;3(04):209-13.
9. Lucas J et al. New portable nasal nitric oxide (nNO) analyser differentiates primary ciliary dyskinesia (PCD) from healthy individuals. Eur Respir J. 2017.
11. NIOX®. NIOX VERO® Nasal Measurement Mode User Manual. May 2023.