Can Fractional Exhaled Nitric Oxide with Blood Eosinophil Count Have a Place in the Diagnostic Algorithm for Asthma?
| Autor: | Ferda Öner Erkekol, Kurtuluş Aksu, Ilkay Koca Kalkan, Gözde Köycü Buhari, Hale Ateş, Buket Başa Akdoğan, Özlem Özdedeoğlu |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
Spirometry medicine.medical_specialty Receiver operating characteristic medicine.diagnostic_test business.industry Immunology Retrospective cohort study respiratory system medicine.disease respiratory tract diseases Internal medicine Exhaled nitric oxide medicine Immunology and Allergy Methacholine Respiratory system business Body mass index Asthma medicine.drug |
| Zdroj: | Asthma Allergy Immunology. 19:100-109 |
| ISSN: | 1308-9234 |
| DOI: | 10.21911/aai.643 |
| Popis: | Objective: Guidelines suggest using bronchial provocation testing (BPT), which is hard to attain, in patients with asthma-like symptoms presenting with nondiagnostic spirometric tests. To eliminate the risk of over/underdiagnosing asthma, we aimed to evaluate the predictive value of not only fractional exhaled nitric oxide (FeNO) but also other easily accessible clinical indices for ruling in/out asthma. Materials and Methods: This retrospective study included adults presenting to our clinic with respiratory symptoms suggestive of asthma but with normal spirometric values and negative reversibility test, who underwent FeNO and methacholine BPT (MchBPT). Medical records were used to obtain descriptive characteristics, clinical history, allergy screening, eosinophils in peripheral blood, and spirometry. Results: Among 51 patients, 19 were diagnosed with asthma. Body mass index and blood eosinophils were significantly higher in patients with positive MchBPT (p=0.042 and p=0.037, respectively). No significant difference was found in other indices, including FeNO (p=0.293). Receiver operating characteristic curve analysis revealed the best diagnostic cutoff level for FeNO as 14 ppb and blood eosinophil as 150/μl for the prediction of positive MchBPT (with 63.16%-62.5% and 80%-61% sensitivity-specificity, respectively). These two indices were the only independent predictors of positive BHR, and the model of FeNO>14ppb combined with eos>150/μl showed 100% specificity with a 100% negative predictive value. Conclusion: Our results suggest using the combination of FeNO with blood eosinophil count as a rule-out test, adding a new step in the algorithmic diagnosis of asthma. This might avoid an unnecessary BPT procedure, reduce the risk of over/under-diagnosis of asthma, and hasten the correct diagnosis. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|