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“NIOX VERO® is the gold standard FeNO testing device”
– how did we figure that?

A picture of Karis Baker, Scientific Lead in Medical Affairs

"Research has shown that NIOX® electrochemical technology may be referred to as the new “gold standard” based on its reliability, reproducibility and portability, as well as its pre-calibration and service-free system.”

We’re proud to say that NIOX VERO® is the gold standard FeNO testing device.1 But how do we come to make that claim? We asked our Scientific Lead, Karis Baker, to explain.

What types of FeNO analyser are available and where are they used?

“The detection of nitric oxide (NO) in exhaled breath dates back to the early 1990s when researchers used chemiluminescence to identify it.2 Since then, chemiluminescence NO analysers have been described as the “gold standard” for FeNO (fractional exhaled nitric oxide) testing. However, they have largely been used in the research setting.3 More recently, studies have looked at the efficacy and reliability of electrochemical FeNO devices compared to chemiluminescence analysers in the clinic.4-7

Firstly, what are the differences between chemiluminescence and electrochemical NO detection?

“Although the chemiluminescence analysers used today perform excellently, they are expensive, and need frequent calibration and technical maintenance.5 Back in 2004, research led by Silkoff predicted that chemiluminescence analysers would eventually be replaced by simple, more robust and more economical approaches to NO measurement.8 Indeed, due to the technical complexity, size and cost of chemiluminescence analysers, electrochemical NO devices were developed.8 The advantages of these electrochemical newcomers include their smaller size and therefore portability, and their low cost.5,9

Are the results really comparable?

“Studies comparing FeNO values obtained with portable electrochemical sensors against those measured with chemiluminescence analysers have gone on to confirm that the difference in results is not clinically relevant.4 Several further studies comparing electrochemical analysers with chemiluminescence have also proven a good agreement.5

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1. NIOX®. Data on file; MKT-DOF-007. 2023. 2. Gustafsson LE et al. Endogenous nitric oxide is present in the exhaled air of rabbits, guinea pigs and humans. Biochemical and biophysical research communications. 1991;181(2):852-7. 3. Kapande KM et al. Comparative repeatability of two handheld fractional exhaled nitric oxide monitors. Pediatr Pulmonol. 2012;47(6):546-50. 4. Cristescu SM et al. Methods of NO detection in exhaled breath. Journal of breath research. 2013;7(1):017104. 5. Molino A et al. Comparison of three different exhaled nitric oxide analyzers in chronic respiratory disorders. Journal of breath research. 2019;13(2):021002. 6. Menzies D et al. Portable exhaled nitric oxide measurement: Comparison with the "gold standard" technique. Chest. 2007;131(2):410-4. 7. Korn S et al. Measurement of fractional exhaled nitric oxide:comparison of three different analysers. Respiration. 2020;99(1):1-8. 8. Silkoff PE et al. Clinical precision, accuracy, number and durations of exhalations for a novel electrochemical monitor for exhaled nitric oxide. J Breath Res. 2019;14(1):016011. 9. Maniscalco M et al. Fractional exhaled nitric oxide-measuring devices: technology update. Med Devices (Auckl). 2016;9:151-60. 10. Heffler E et al. Fractional Exhaled Nitric Oxide (FENO) in the management of asthma: a position paper of the Italian Respiratory Society (SIP/IRS) and Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC). Multidisciplinary respiratory medicine. 2020;15(1). 11. Alving K et al. Validation of a new portable exhaled nitric oxide analyzer, NIOX VERO®: randomized studies in asthma. Pulm Ther. 2017;3:207-218.