The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

COMPARISON OF THE APIERON SINGLE BREATH EXHALED NITRIC OXIDE (ENO) DEVICE WITH THE MULTIPLE BREATH SIEVERS ENO ANALYZER IN PATIENTS REFERRED FOR ENO TESTING

Carl D. Mottram, Deqa A. Abdi, Amina M. Ahmed, Idil I. Gureeye, Jong W. Lim, Lori J. Hanson, Paul D. Scanlon; Pulmonary and Critical Care, Mayo Clinic, Rochester, MN

Background: Exhaled nitric oxide (ENO) is a biomarker of airway inflammation and is a relatively new clinical testing modality. ENO is measured by having the subject inhale maximally and then exhale their breath through a patient-interfaced mouthpiece to the ENO analyzer at a target flow rate. The Apieron Insight is a new device which is easier to use from both a practical and technical aspect when compared to our current Sievers testing unit. However, it differs from the Sievers unit in both analyzer technology and testing methodology. The American Thoracic Society (ATS) and European Respiratory Society (ERS) have set forth testing guidelines but these guidelines were based on available testing methods at the time. The ATS-ERS recommendations include performing 2 acceptable and repeatable maneuvers and reporting the mean of these data, whereas the Aperion device only requires a single maneuver after performing numerous practice maneuvers to fine tune the testing technique. There is a significant reduction in the cost per test if this new device proves to be accurate. Hypothesis: The data measured by the Apieron Insight device is comparable to the Sievers Nitric Oxide Analyzer (NOA 280i). A single acceptable measurement following practice maneuvers is comparable to multiple acceptable measurements that are repeatable according to current ATS-ERS recommendations. Methods: 50 subjects (> 16 yrs) for whom exhaled nitric oxide is ordered as a clinical test will be used in the comparison. Both the Sievers and Apieron units will be calibrated according to manufactures recommendations prior to testing and compliance with pretest instructions with be evaluated by the testing technologist. The subjects with be randomize to either testing with the Apieron or Sievers unit first. Data will be analyzed using a linear regression, student paired t-test, and Bland Altman plot. Results/Conclusion: The data collected by the Apieron Insight device were comparable to the Sievers Nitric Oxide Analyzer (R2 = 0.94, p=0.11), which is considered the “laboratory quality” measurement of exhaled nitric oxide in our lab. Even though the instruments correlated and no statistical difference between the two devices, there was a bias with the Sievers unit reading higher than the Apieron (11 ppb). The bias should be considered when comparing longitudinal results from the two different instruments Sponsored Research - None

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