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force from the ATS with many of the researchers from the ERSTF meeting combined to
produce ..Recommendations of Standardised Procedures for the Online and Off-line
Measurement of Exhaled Lower Respiratory Nitric oxide and Nasal Nitric oxide in Adults
and childre n - lggg,,, which was adopted in July of that year as an official statement of the
ATS (American Thoracic Society and Association. 1999). Following this, there have been
two further documents written regarding standardisation of No measurement (Baraldi' de
Jongste et a:.2002; American Thoracic Society and European Respiratory Society 2005)' The
established ERSTF went on to publish "Measurement of Exhaled Nitric oxide in Children'
ZO0I- (Baraldi, de Jongste et al.2OO2). Finally a joint statement was prepared by the ATS and
ERS, which was adopted by both societies in 2O04 and subsequently published in 2005' This
was the ..ATS/ERS Recommendations for Standardized Procedures for the Online and Off-
line Measurement of Exhaled Lower Respiratory Nitric oxide and Nasal Nitric oxide 2w5"
(American Thoracic Society and European Respiratory Society 2005)'
In this section I will review the current 'standardisation' documents and discuss some of the
studies that led to these recommendations and the developments from 1997 to 2005' I will
critique my research to identify if the procedures I developed were correct and if they
contributed to the variability seen between research groups in light of subsequent findings'
The papers published from the research described in the previous chapters have been cited in
these documents.
There are a number of separate acceptable procedures to measure NO in adults and children -
each now having a standard method of measurement. These are:
1. Single breath online measurement (see Table 9'1)'
2. online measurement of exhaled No during spontaneous or tidal breathing (see Table 9'2)'
3. Offline measurement via a reservoir collection system (for delayed analysis)'
4. Nasal NO measurements (see Table 9.3).
Following this, I will review the more recent research on measuring exhaled NO in infants
using single breath or tidal breathing techniques'
9.3.1 Single breath online rneasurement
The current technique recommended for single breath online measurement for adults and
children (> 6 years of age) who are able to achieve a single exhalation is presented in Table
9.1.
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