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Nasal nitric oxide screening for primary ciliary dyskinesia: systematic review and meta-analysis

Nasal nitric oxide screening for primary ciliary dyskinesia: systematic review and meta-analysis
Nasal nitric oxide screening for primary ciliary dyskinesia: systematic review and meta-analysis
Nasal nitric oxide (nNO) concentrations are low in patients with primary ciliary dyskinesia (PCD) providing a noninvasive screening test. We conducted a systematic review of the literature to examine the utility of nNO in screening for PCD, in particular 1) different respiratory manoeuvres during sampling (velum closure, tidal breathing, etc.), 2) accuracy in screening young/uncooperative children, 3) stationary versus portable analysers, and 4) nNO in "atypical" PCD. 96 papers were assessed according to modified PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria and 22 were included in this review. Meta-analysis of 11 studies comparing nNO during a velum closure breath hold gave a mean±sd nNO of 19.4±18.6 nL·min(-1) in PCD (n = 478) and 265.0±118.9 nL·min(-1) in healthy controls (n = 338). Weighted mean difference for PCD versus healthy controls was 231.1 nL·min(-1) (95% CI 193.3-268.9; n = 338) and 114.1 nL·min(-1) (95% CI 101.5-126.8; n = 415) for PCD versus cystic fibrosis. Five studies of nNO measurement during tidal breathing demonstrated that this is an acceptable manoeuvre in young children where velum closure is not possible, but the discriminatory value was reduced. Four small studies of portable NO analysers suggest these are reliable tools for screening for PCD. However, nNO must be interpreted alongside clinical suspicion. Future studies should focus on standardising sampling techniques and reporting.
0903-1936
Collins, Samuel A.
3c35238c-dbbd-4021-b7fa-c5b89e471981
Gove, Kerry
8f043bbb-080d-49b3-9ee5-046f3a636ee0
Walker, Woolf
0758e514-9212-4388-8879-e5a2dca3dbaa
Lucas, Jane S.A.
5cb3546c-87b2-4e59-af48-402076e25313
Collins, Samuel A.
3c35238c-dbbd-4021-b7fa-c5b89e471981
Gove, Kerry
8f043bbb-080d-49b3-9ee5-046f3a636ee0
Walker, Woolf
0758e514-9212-4388-8879-e5a2dca3dbaa
Lucas, Jane S.A.
5cb3546c-87b2-4e59-af48-402076e25313

Collins, Samuel A., Gove, Kerry, Walker, Woolf and Lucas, Jane S.A. (2014) Nasal nitric oxide screening for primary ciliary dyskinesia: systematic review and meta-analysis. European Respiratory Journal. (doi:10.1183/09031936.00088614). (PMID:25323224)

Record type: Article

Abstract

Nasal nitric oxide (nNO) concentrations are low in patients with primary ciliary dyskinesia (PCD) providing a noninvasive screening test. We conducted a systematic review of the literature to examine the utility of nNO in screening for PCD, in particular 1) different respiratory manoeuvres during sampling (velum closure, tidal breathing, etc.), 2) accuracy in screening young/uncooperative children, 3) stationary versus portable analysers, and 4) nNO in "atypical" PCD. 96 papers were assessed according to modified PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria and 22 were included in this review. Meta-analysis of 11 studies comparing nNO during a velum closure breath hold gave a mean±sd nNO of 19.4±18.6 nL·min(-1) in PCD (n = 478) and 265.0±118.9 nL·min(-1) in healthy controls (n = 338). Weighted mean difference for PCD versus healthy controls was 231.1 nL·min(-1) (95% CI 193.3-268.9; n = 338) and 114.1 nL·min(-1) (95% CI 101.5-126.8; n = 415) for PCD versus cystic fibrosis. Five studies of nNO measurement during tidal breathing demonstrated that this is an acceptable manoeuvre in young children where velum closure is not possible, but the discriminatory value was reduced. Four small studies of portable NO analysers suggest these are reliable tools for screening for PCD. However, nNO must be interpreted alongside clinical suspicion. Future studies should focus on standardising sampling techniques and reporting.

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e-pub ahead of print date: 16 October 2014
Organisations: Clinical & Experimental Sciences

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Local EPrints ID: 371817
URI: https://eprints.soton.ac.uk/id/eprint/371817
ISSN: 0903-1936
PURE UUID: d488501a-131d-44ff-9378-c56827a920b6

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Date deposited: 18 Nov 2014 13:35
Last modified: 17 Jul 2017 21:46

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