The values of fractional exhaled nitric oxide in the treatment of chronic cough_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZHANG Yongming ,  LIN Jiangtao

Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, P. R. China;

Corresponding?author：

LIN Jiangtao, Email: jiangtao_l@263.net

Keywords：

Chronic cough; Fractional exhaled nitric oxide; Cough variant asthma; Eosinophilic bronchitis; Treatment

DOI：

10.7507/1671-6205.201805035

Video：

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ObjectiveTo evaluates the values of fractional exhaled nitric oxide (FENO) in the treatment of chronic cough prospectively.MethodsSubjects with chronic cough were recruited from the outpatient clinic of China-Japan Friendship Hospital. All the patients accepted FENO tests, sputum cell counts, pulmonary function tests, bronchial provocation tests, serum IgE, cough symptom scores and Leicester Cough Questionnaire before and after treatment of 4 weeks.ResultsThere were 29 patients with cough variant asthma (CVA), 19 patients with eosinophilic bronchitis (EB) and 39 patients with other causes. The baseline FENO level of the subjects whose coughs were relieved after inhaled corticosteroids (ICS) therapy of 4 weeks was (63±42) ppb, significantly higher than those with bad-response [(28±13) ppb, P<0.01]. The proportion of FENO decrease after ICS therapy was not only significantly related to the proportion of eosinophilic decrease (r=0.54, P<0.01), but also significantly related to the proportion of decrease of cough symptom scores (r=0.48, P<0.01). To distinguish the good responders from bad responders, the optimal baseline FENO cutoff value was 36 ppb, with sensitivity of 82%, specificity of 93%, positive predictive value of 94%, negative predictive value of 87%, accuracy of 83%.ConclusionsThere is a good relationship between the FENO decreasing levels after ICS therapy and the reliefs of cough symptoms in the CVA and EB patients. Chronic cough patients with FENO value more than 36 ppb are indicated to respond to ICS therapy.

Citation： ZHANG Yongming, LIN Jiangtao. The values of fractional exhaled nitric oxide in the treatment of chronic cough. Chinese Journal of Respiratory and Critical Care Medicine, 2018, 17(3): 267-270. doi: 10.7507/1671-6205.201805035 Copy

1.	中華醫學會呼吸病學分會哮喘學組. 咳嗽的診斷與治療指南（2015）. 中華結核和呼吸雜志, 2016, 39(5): 323-354.
2.	Kaiser G, Lim MD, Carl M, et al. The Use of Fraction of Exhaled Nitric Oxide in Pulmonary Practice. Chest, 2008, 133: 1232-1242.
3.	GINA Executive and Science Committee. Global Strategy for Asthma Management and Prevention 2017. Available at: http://www.gina.com.
4.	中華醫學會呼吸病學分會哮喘學組. 支氣管哮喘防治指南（2016年版）. 中華結核和呼吸雜志, 2016, 39(9): 675-697.
5.	Reddel HK, Taylor DR, Bateman ED, et al. An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med, 2009, 180: 59-99.
6.	Dweik RA, Boggs PB, Erzurum SC, et al. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels(FENO) for clinical application. Am J Respir Crit Care Med, 2011, 184(5): 602-615.
7.	National Institute for Health and Care Excellence. Asthma: diagnosis and monitoring of asthma in adults, children and young people. Available at: http://www.nice.org.uk/guidance/2017.
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9.	American Thoracic Society, European Respiratory Society. ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005. Am J Respir Crit Care Med, 2005, 171: 912–930.
10.	中華醫學會呼吸病學分會哮喘學組. 咳嗽的診斷與治療指南（2009版）. 中華結核和呼吸雜志, 2009, 32: 407-413.
11.	Birring SS, Prudon B, Carr AJ, et al. Development of a symptom specific health status measure for patients with chronic cough: Leicester Cough Questionnaire (LCQ). Thorax, 2003, 58: 339-343.
12.	張永明, 林江濤, 蘇楠, 等. 呼出氣一氧化氮檢測在慢性咳嗽病因診斷中的價值. 中華醫學雜志, 2011, 91(18): 1254-1258.
13.	張永明, 林江濤. 呼出氣一氧化氮測定在慢性咳嗽診治中的應用價值初探. 中華結核和呼吸雜志, 2011, 34(7): 504-507.
14.	Song WJ, Kim HJ, Shim JS, et al. Diagnostic accuracy of fractional exhaled nitric oxide measurement in predicting cough-variant asthma and eosinophilic bronchitis in adults with chronic cough: a systematic review and meta-analysis. J Allergy Clin Immunol, 2017, 140: 701-709.
15.	張永明, 林江濤. 健康成年人呼出氣一氧化氮水平及其影響因素. 中華醫學雜志, 2012, 92(28): 1971-1973.
16.	任旭斌, 劉春濤, 黃玉芳, 等. 呼出氣一氧化氮檢測對支氣管哮喘的診斷價值. 中國呼吸與危重監護雜志, 2009, 8(4): 322-326.
17.	杜文, 王丹, 張蘭蘭, 等. 支氣管哮喘患者單次給藥后呼出氣一氧化氮的動態變化及其意義. 中華結核和呼吸雜志, 2015, 38(8): 623-624.
18.	Lim S, Jatakanon A, John M, et al. Effect of inhaled budesonide on lung function and airway inflammation. Assessment by various inflammatory markers in mild asthma. Am J Respir Crit Care Med, 1999, 159(1): 22-30.
19.	Bates AC, Silkoff PE. Exhaled nitric oxide in asthma: from bench to beside. J Allergy Clin Immunol, 2003, 111: 256-262.
20.	Sandrini A, Taylor DR, Thomas PS, et al. Fractional exhaled nitric oxide in asthma: an update. Respirology, 2010, 15(1): 57–70.
21.	Jones SL, Hwebison P, Cowan JO, et al. Exhaled NO and assessment of anti- inflammatory effects of inhaled steroid: dose-response relationship. Eur Respir J, 2002, 20: 601-608.
22.	Keen C, Olin AC, Edentoft A, et al. Airway patients with cystic fibrosis is associated function, pseudomonas infection, and polyunsaturated fatty acids. Chest, 2007, 131: 1857-1864.
23.	Chaudhuri R, McMahon AD, Thomson LJ, et al. Effect of inhaled corticosteroids on symptom severity and sputum mediator levels in chronic persistent cough. J Allergy Clin Immunol, 2004, 113: 1063-1070.
24.	Hahn PY, Morgenthaler TY, Lim KG, et al. Use of exhaled nitric oxide in predicting response to ICS for cough. Mayo Clin Proc, 2007, 82: 1350-1355.

1. 中華醫學會呼吸病學分會哮喘學組. 咳嗽的診斷與治療指南（2015）. 中華結核和呼吸雜志, 2016, 39(5): 323-354.
2. Kaiser G, Lim MD, Carl M, et al. The Use of Fraction of Exhaled Nitric Oxide in Pulmonary Practice. Chest, 2008, 133: 1232-1242.
3. GINA Executive and Science Committee. Global Strategy for Asthma Management and Prevention 2017. Available at: http://www.gina.com.
4. 中華醫學會呼吸病學分會哮喘學組. 支氣管哮喘防治指南（2016年版）. 中華結核和呼吸雜志, 2016, 39(9): 675-697.
5. Reddel HK, Taylor DR, Bateman ED, et al. An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med, 2009, 180: 59-99.
6. Dweik RA, Boggs PB, Erzurum SC, et al. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels(FENO) for clinical application. Am J Respir Crit Care Med, 2011, 184(5): 602-615.
7. National Institute for Health and Care Excellence. Asthma: diagnosis and monitoring of asthma in adults, children and young people. Available at: http://www.nice.org.uk/guidance/2017.
8. 無創氣道炎癥評估支氣管哮喘的臨床應用中國專家共識. 中華結核和呼吸雜志, 2015, 38(5): 329-341.
9. American Thoracic Society, European Respiratory Society. ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005. Am J Respir Crit Care Med, 2005, 171: 912–930.
10. 中華醫學會呼吸病學分會哮喘學組. 咳嗽的診斷與治療指南（2009版）. 中華結核和呼吸雜志, 2009, 32: 407-413.
11. Birring SS, Prudon B, Carr AJ, et al. Development of a symptom specific health status measure for patients with chronic cough: Leicester Cough Questionnaire (LCQ). Thorax, 2003, 58: 339-343.
12. 張永明, 林江濤, 蘇楠, 等. 呼出氣一氧化氮檢測在慢性咳嗽病因診斷中的價值. 中華醫學雜志, 2011, 91(18): 1254-1258.
13. 張永明, 林江濤. 呼出氣一氧化氮測定在慢性咳嗽診治中的應用價值初探. 中華結核和呼吸雜志, 2011, 34(7): 504-507.
14. Song WJ, Kim HJ, Shim JS, et al. Diagnostic accuracy of fractional exhaled nitric oxide measurement in predicting cough-variant asthma and eosinophilic bronchitis in adults with chronic cough: a systematic review and meta-analysis. J Allergy Clin Immunol, 2017, 140: 701-709.
15. 張永明, 林江濤. 健康成年人呼出氣一氧化氮水平及其影響因素. 中華醫學雜志, 2012, 92(28): 1971-1973.
16. 任旭斌, 劉春濤, 黃玉芳, 等. 呼出氣一氧化氮檢測對支氣管哮喘的診斷價值. 中國呼吸與危重監護雜志, 2009, 8(4): 322-326.
17. 杜文, 王丹, 張蘭蘭, 等. 支氣管哮喘患者單次給藥后呼出氣一氧化氮的動態變化及其意義. 中華結核和呼吸雜志, 2015, 38(8): 623-624.
18. Lim S, Jatakanon A, John M, et al. Effect of inhaled budesonide on lung function and airway inflammation. Assessment by various inflammatory markers in mild asthma. Am J Respir Crit Care Med, 1999, 159(1): 22-30.
19. Bates AC, Silkoff PE. Exhaled nitric oxide in asthma: from bench to beside. J Allergy Clin Immunol, 2003, 111: 256-262.
20. Sandrini A, Taylor DR, Thomas PS, et al. Fractional exhaled nitric oxide in asthma: an update. Respirology, 2010, 15(1): 57–70.
21. Jones SL, Hwebison P, Cowan JO, et al. Exhaled NO and assessment of anti- inflammatory effects of inhaled steroid: dose-response relationship. Eur Respir J, 2002, 20: 601-608.
22. Keen C, Olin AC, Edentoft A, et al. Airway patients with cystic fibrosis is associated function, pseudomonas infection, and polyunsaturated fatty acids. Chest, 2007, 131: 1857-1864.
23. Chaudhuri R, McMahon AD, Thomson LJ, et al. Effect of inhaled corticosteroids on symptom severity and sputum mediator levels in chronic persistent cough. J Allergy Clin Immunol, 2004, 113: 1063-1070.
24. Hahn PY, Morgenthaler TY, Lim KG, et al. Use of exhaled nitric oxide in predicting response to ICS for cough. Mayo Clin Proc, 2007, 82: 1350-1355.

Chinese Journal of Respiratory and Critical Care Medicine

The values of fractional exhaled nitric oxide in the treatment of chronic cough

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