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March 2020

Nasal nitric oxide in children with asthma and allergic rhinitis

The study compares nasal nitric oxide levels in upper airways in children with respiratory diseases.


  • Nasal nitric oxide (nNO) level was significantly higher in children with allergic rhinitis (AR) and those with both AR and asthma (AR-asthma) than asthmatic and healthy children.
  • Based on receiver operating characteristic (ROC) curve analysis, the nNO level cut-offs for diagnosis of AR and AR-asthma were 1545 and 1459 ppb, respectively.

Why this matters

  • Currently, different methods or analysers are used to measure nNO, and the assessment of nNO still needs improvements in standardisation to become a more reliable tool.
  • However, it seems nNO measurements provide additional information about ongoing inflammation in the respiratory tract, without painful, expensive and long-lasting laboratory tests.

Study design

  • Levels of nNO measured using an electrochemical analyser in 179 patients (aged 7-15 years) with asthma (n=49), AR (n=47), AR-asthma (n=58) and healthy controls (n=25).
  • Associations between nNO levels and patient clinical parameters were evaluated.
  • Funding: None disclosed.

Key results

  • nNO level was significantly increased in children with AR and AR-asthma (2322.3±447.24 and 2397.3±423.25 ppb, respectively; p<0.001 for both) vs asthmatic and healthy children (1017.4±396.85 and 836.2±333.47 ppb, respectively).
  • No statistically significant difference was noted between nNO levels of patients living in urban and rural areas.
  • Only in the case of patients with AR, nNO was significantly higher in male patients than female patients (2437.38±419.79 ppb vs 2207.22±451.13 ppb; p=0.029).
  • ROC curve analysis showed that a cut-off value of 1545 and 1459 ppb nNO to predict AR and AR-asthma, respectively, obtained 100% sensitivity and 100% specificity.
  • A positive significant correlation between nNO and patient age (R=0.46; p=0.021) and height (R=0.495; p=0.012) was observed only in the control group.
  • No association was observed between nNO level and clinical parameters, including the percentage of eosinophils and total immunoglobulin E.


  • Small sample size.
  • Lack of association between nNO measurement and exposure to allergen.


  1. Galiniak S, Biesiadecki M, Aebisher D, Rachel M. Nasal nitric oxide in upper airways in children with asthma and allergic rhinitis. Adv Med Sci. 2020 Jan 09 [Epub ahead of print];65(1):127-133. doi: 10.1016/j.advms.2019.11.005. PMID: 31927424