Usefulness of Exhaled Nitric Oxide for Diagnosing Asthma

被引:46
|
作者
Pedrosa, Maria [1 ]
Cancelliere, Nataly [1 ]
Barranco, Pilar [1 ]
Lopez-Carrasco, Valentin [1 ]
Quirce, Santiago [1 ]
机构
[1] Univ Hosp La Paz, Dept Allergy, Madrid 28046, Spain
关键词
airway inflammation; asthma; diagnosis; methacholine; nitric oxide; MILD; METHACHOLINE; INFLAMMATION;
D O I
10.3109/02770903.2010.491147
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
Rationale. A standard asthma diagnosis is made based on clinical history, reversibility of airway obstruction, and bronchial hyperresponsiveness. Fractional exhaled nitric oxide (FeNO) is a noninvasive airway inflammatory marker that has been suggested as a diagnostic tool for asthma. The aim of this study was to establish a FeNO cut-off value for asthma diagnosis. Methods. One hundred and fourteen consecutive adult patients (mean age 34 +/- 13 years) reporting symptoms consistent with asthma, with normal spirometric parameters and a negative bronchodilator test, were included in the study. All underwent a methacholine challenge test following the five-breath dosimeter protocol. FeNO was measured with a portable device (NioxMino, Aerocrine AB, Sweden) just before the methacholine challenge. The sensitivity, specificity, and diagnostic performance of FeNO measurement were calculated. Results. Thirty-five out of the 114 patients (30.7%) were diagnosed with asthma. A positive methacholine challenge was associated with higher FeNO levels and with lower forced expiratory volume in one second (FEV1) at baseline. No correlation was found between methacholine provocative concentration causing a decrease of 20% in FEV1 (PC20) and FeNO levels. A receiver-operating characteristic curve was constructed for FeNO levels (area under the curve [AUC]: 0.762; 95% confidence interval [CI]: 0.667-0.857; p < .001). The FeNO cut-off point with maximal specificity and sensitivity for asthma diagnosis was 40 ppb. Conclusions. Patients with confirmed asthma showed higher FeNO levels. A cut-off value of 40 ppb was calculated as the most efficient for asthma diagnosis in our population. The use of FeNO measurement may be a helpful tool to rule out a diagnosis of asthma, especially in patients in whom a methacholine challenge is not feasible or available.
引用
收藏
页码:817 / 821
页数:5
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