Nasal nitric oxide measurement in children for the diagnosis of primary ciliary dyskinesia: European Respiratory Society technical standard.

Beydon, Nicole; Kouis, Panayotis; Marthin, June K; Latzin, Philipp; Colas, Murielle; Davis, Stephanie D; Haarman, Eric; Harris, Amanda Lea; Hogg, Claire; Kilbride, Emma; Kuehni, Claudia E; Marangu, Diana; Nielsen, Kim G; Pendergrast, Catherine; Robinson, Phil; Rumman, Nisreen; Rutter, Matthew; Walker, Woolf T; Ferkol, Thomas and Lucas, Jane S (2023). Nasal nitric oxide measurement in children for the diagnosis of primary ciliary dyskinesia: European Respiratory Society technical standard. European respiratory journal, 61(4), p. 2202031. European Respiratory Society 10.1183/13993003.02031-2022

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Nasal nitric oxide (nNO) is extremely low in most people with primary ciliary dyskinesia (PCD) and its measurement is an important contributor to making the diagnosis. Existing guidelines and technical standards focus on nNO measurements in older, cooperative children using chemiluminescent analysers. However, measurements of nNO in pre-school children (2-5 years) may facilitate early diagnosis, and electrochemical rather than chemiluminescence analysers are widely used. Pre-schoolers often need different methods to be employed when measuring nNO. Hence a European Respiratory Society Task Force has developed this technical standard as the first step towards standardising sampling, analysis, and reporting of nNO measured as part of the diagnostic testing for PCD in all age groups including preschool-age children. Furthermore, we considered both chemiluminescence and electrochemical analysers that are in use worldwide. There was paucity of quality evidence for electrochemical analysers and sampling methods used in young children, and this manuscript proposes future research priorities to allow updates of this technical standard.

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