The advent of exhaled nitric oxide as a biomarker for eosinophilic inflammation in airways disease provides the clinician with a tool which is complementary to conventional physiological measurements such as spirometry. Measurements are technically easy and reproducible, but because nitric oxide is present in exhaled air in health, and is affected by numerous factors other than airway inflammation such as age, smoking and atopy, interpretation needs to be cautiously related to the clinical context, notably whether or not the patient has current respiratory symptoms. Low (less than 25 ppb) and high (greater than 50 ppb) levels are of value in assessing the possibility of the need for inhaled anti-inflammatory therapy in patients with non-specific symptoms. Low levels are helpful in the management of patients with complex asthma, in whom other factors such as anxiety, obesity and gastro-esophageal reflux may give rise to discordance between the severity of symptoms and the severity of airway inflammation. Studies have failed to show significant benefits when using exhaled nitric oxide to optimize inhaled steroid therapy, but further data regarding the potential benefits in oral steroid dependent asthma are awaited.
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Taylor, D.R. (2009). Exhaled NO in Asthma. In: Pawankar, R., Holgate, S.T., Rosenwasser, L.J. (eds) Allergy Frontiers: Diagnosis and Health Economics. Allergy Frontiers, vol 4. Springer, Tokyo. https://doi.org/10.1007/978-4-431-98349-1_8
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