Diagnostic value of exhaled nitric oxide in adult asthma: a systemic review and meta-analysis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LI Yi'na ,  LIU Chuntao

Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

LIU Chuntao, Email: taosen666@vip.163.com

Keywords：

Fractional exhaled nitric oxide; Asthma; Diagnosis; Meta-analysis

DOI：

10.7507/1671-6205.202105010

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To explore the diagnostic value of fractional exhaled nitric oxide (FeNO) in adult asthma.Methods PubMed, Embase, Cochrane Library, Wanfang, CNKI and VIP databases were searched for relevant literatures from the time of database establishment to February 2021. Data analysis were made by Revman and Stata.Results A total of 44 articles with 47 records and 9654 subjects were included. The diagnosis sensitivity, specificity, positive and negative predictive value of FeNO were 0.71 (95%CI 0.65 - 0.76), 0.80 (95%CI 0.75 - 0.84), 3.47 (95%CI 2.86 - 4.21), and 0.37 (95%CI 0.31 - 0.43), respectively. The diagnostic odds ratio was 9.49 (95%CI 7.13 - 12.61), and the area under the receiver operating characteristic curve was 0.82 (95%CI 0.79 - 0.85).Conclusions FeNO has certain diagnostic value in diagnosis of asthma. Types of asthma, region and cut-off value all have impact on the diagnostic efficiency of FeNO.

Citation： LI Yi'na, LIU Chuntao. Diagnostic value of exhaled nitric oxide in adult asthma: a systemic review and meta-analysis. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(6): 416-423. doi: 10.7507/1671-6205.202105010 Copy

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2.	Huang K, Yang T, Xu J, et al. Prevalence, risk factors, and management of asthma in China: a national cross-sectional study. Lancet, 2019, 394(10196): 407-418.
3.	Brigham EP, West NE. Diagnosis of asthma: diagnostic testing. Int Forum Allergy Rhinol, 2015, 5 Suppl 1: S27-S30.
4.	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(1): 59-99.
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7.	National institute for health and care excellence: clinical guidelines[M]. Asthma: Diagnosis, monitoring and chronic asthma management. London; National Institute for Health and Care Excellence (UK) Copyright ? NICE 2020.2020.
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9.	Lluncor M, Barranco P, Amaya ED, et al. Relationship between upper airway diseases, exhaled nitric oxide, and bronchial hyperresponsiveness to methacholine. J Asthma, 2019, 56(1): 53-60.
10.	Liu J, Xu R, Zhan C, et al. Clinical utility of ultrahigh fractional exhaled nitric oxide in predicting bronchial hyperresponsiveness in patients with suspected asthma. Postgrad Med J, 2019, 95(1128): 541-546.
11.	Chen FJ, Huang XY, Lin GP, et al. Validity of fractional exhaled nitric oxide and small airway function indices in diagnosis of cough-variant asthma. J Asthma, 2018, 55(7): 750-755.
12.	Porpodis K, Domvri K, Kontakiotis T, et al. Comparison of diagnostic validity of mannitol and methacholine challenges and relationship to clinical status and airway inflammation in steroid-na?ve asthmatic patients. J Asthma, 2017, 54(5): 520-529.
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1. Masoli M, Fabian D, Holt S, et al. The global burden of asthma: executive summary of the GINA dissemination committee report. Allergy, 2004, 59(5): 469-478.
2. Huang K, Yang T, Xu J, et al. Prevalence, risk factors, and management of asthma in China: a national cross-sectional study. Lancet, 2019, 394(10196): 407-418.
3. Brigham EP, West NE. Diagnosis of asthma: diagnostic testing. Int Forum Allergy Rhinol, 2015, 5 Suppl 1: S27-S30.
4. 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(1): 59-99.
5. Crapo RO, Casaburi R, Coates AL, et al. Guidelines for methacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS board of directors, July 1999. Am J Respir Crit Care Med, 2000, 161(1): 309-329.
6. Holz O, Buhl R, Hausen T, et al. Measuring airway inflammation in clinical practise - application and interpretation. Pneumologie, 2007, 61(3): 194-201.
7. National institute for health and care excellence: clinical guidelines[M]. Asthma: Diagnosis, monitoring and chronic asthma management. London; National Institute for Health and Care Excellence (UK) Copyright ? NICE 2020.2020.
8. Karrasch S, Linde K, Rücker G, et al. Accuracy of FENO for diagnosing asthma: a systematic review. Thorax, 2017, 72(2): 109-116.
9. Lluncor M, Barranco P, Amaya ED, et al. Relationship between upper airway diseases, exhaled nitric oxide, and bronchial hyperresponsiveness to methacholine. J Asthma, 2019, 56(1): 53-60.
10. Liu J, Xu R, Zhan C, et al. Clinical utility of ultrahigh fractional exhaled nitric oxide in predicting bronchial hyperresponsiveness in patients with suspected asthma. Postgrad Med J, 2019, 95(1128): 541-546.
11. Chen FJ, Huang XY, Lin GP, et al. Validity of fractional exhaled nitric oxide and small airway function indices in diagnosis of cough-variant asthma. J Asthma, 2018, 55(7): 750-755.
12. Porpodis K, Domvri K, Kontakiotis T, et al. Comparison of diagnostic validity of mannitol and methacholine challenges and relationship to clinical status and airway inflammation in steroid-na?ve asthmatic patients. J Asthma, 2017, 54(5): 520-529.
13. Nickels AS, Lim KG. Evaluation of exhaled nitric oxide's ability to predict methacholine challenge in adults with nonobstructive spirometry. Ann Allergy Asthma Immunol, 2016, 117(4): 365-369.
14. Wang Y, Li L, Han R, et al. Diagnostic value and influencing factors of fractional exhaled nitric oxide in suspected asthma patients. Int J Clin Exp Pathol, 2015, 8(5): 5570-5576.
15. He L, Wei M, Luo J, et al. Re-evaluation of the diagnostic value of fractional exhaled nitric oxide & its impact in patients with asthma. Indian J Med Res, 2018, 148(4): 441-448.
16. Beretta C, Rifflart C, Evrard G, et al. Assessment of eosinophilic airway inflammation as a contribution to the diagnosis of occupational asthma. Allergy, 2018, 73(1): 206-213.
17. 方思, 陳樹煜, 何熹, 等. 呼出氣一氧化氮與脈沖振蕩技術對亞急性咳嗽患者篩查咳嗽變異性哮喘的價值. 中華醫學雜志, 2017, 97(30): 2338-2343.
18. Arora R, Thornblade CE, Dauby PA, et al. Exhaled nitric oxide levels in military recruits with new onset asthma. Allergy Asthma Proc, 2006, 27(6): 493-498.
19. ElHalawani SM, Ly NT, Mahon RT, et al. Exhaled nitric oxide as a predictor of exercise-induced bronchoconstriction. Chest, 2003, 124(2): 639-643.
20. Florentin A, Acouetey DS, Remen T, et al. Exhaled nitric oxide and screening for occupational asthma in two at-risk sectors: bakery and hairdressing. Int J Tuberc Lung Dis, 2014, 18(6): 744-750.
21. Fortuna AM, Feixas T, González M, et al. Diagnostic utility of inflammatory biomarkers in asthma: exhaled nitric oxide and induced sputum eosinophil count. Respir Med, 2007, 101(11): 2416-2421.
22. Fukuhara A, Saito J, Sato S, et al. Validation study of asthma screening criteria based on subjective symptoms and fractional exhaled nitric oxide. Ann Allergy Asthma Immunol, 2011, 107(6): 480-486.
23. Heffler E, Guida G, Marsico P, et al. Exhaled nitric oxide as a diagnostic test for asthma in rhinitic patients with asthmatic symptoms. Respir Med, 2006, 100(11): 1981-1987.
24. Katsoulis K, Ganavias L, Michailopoulos P, et al. Exhaled nitric oxide as screening tool in subjects with suspected asthma without reversibility. Int Arch Allergy Immunol, 2013, 162(1): 58-64.
25. Kostikas K, Papaioannou AI, Tanou K, et al. Portable exhaled nitric oxide as a screening tool for asthma in young adults during pollen season. Chest, 2008, 133(4): 906-913.
26. Kowal K, Bodzenta-Lukaszyk A, Zukowski S. Exhaled nitric oxide in evaluation of young adults with chronic cough. J Asthma, 2009, 46(7): 692-698.
27. Malinovschi A, Backer V, Harving H, et al. The value of exhaled nitric oxide to identify asthma in smoking patients with asthma-like symptoms. Respir Med, 2012, 106(6): 794-801.
28. Pedrosa M, Cancelliere N, Barranco P, et al. Usefulness of exhaled nitric oxide for diagnosing asthma. J Asthma, 2010, 47(7): 817-821.
29. Sato S, Saito J, Sato Y, et al. Clinical usefulness of fractional exhaled nitric oxide for diagnosing prolonged cough. Respir Med, 2008, 102(10): 1452-1459.
30. Schleich FN, Asandei R, Manise M, et al. Is FE_NO50 useful diagnostic tool in suspected asthma?. Int J Clin Pract, 2012, 66(2): 158-165.
31. Schneider A, Schwarzbach J, Faderl B, et al. FENO measurement and sputum analysis for diagnosing asthma in clinical practice. Respir Med, 2013, 107(2): 209-216.
32. Smith AD, Cowan JO, Brassett KP, et al. Exhaled nitric oxide: a predictor of steroid response. Am J Respir Crit Care Med, 2005, 172(4): 453-459.
33. Tilemann L, Gindner L, Meyer F, et al. Differences in local and systemic inflammatory markers in patients with obstructive airways disease. Prim Care Respir J, 2011, 20(4): 407-414.
34. Voutilainen M, Malmberg LP, Vasankari T, et al. Exhaled nitric oxide indicates poorly athlete's asthma. Clin Respir J, 2013, 7(4): 347-353.
35. 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.
36. 敖敏, 郭述良, 稅莉莉, 等. 呼出氣一氧化氮在咳嗽變異性哮喘診斷中的價值. 重慶醫科大學學報, 2019, 44(3): 322-326.
37. 陳鳳佳, 嚴英碩, 周燕斌. 呼出氣一氧化氮監測對支氣管哮喘的診斷及治療評估價值研究. 中國全科醫學, 2014, 17(29): 3430-3434.
38. 陳潔, 李秀. 呼出氣一氧化氮診斷支氣管哮喘的臨床價值. 臨床肺科雜志, 2015, 20(9): 1706-1708.
39. 鄧海燕, 彭麗慈, 王海潮. 呼出氣一氧化氮檢測在咳嗽變異性哮喘中的診斷意義. 中外醫療, 2017, 36(2): 1-4+9.
40. 杜麗艷, 龐桂芬, 于國云, 等. 呼出氣一氧化氮與肺功能聯合檢測對于慢性咳嗽病因的診斷價值. 臨床肺科雜志, 2018, 23(6): 1081-1084.
41. 黃金華, 許浦生, 黎教武, 等. 支氣管激發試驗、FENO 及誘導痰 ECP 在哮喘中的相關性及 FENO、誘導痰 ECP 診斷價值. 臨床肺科雜志, 2016, 21(7): 1177-1181.
42. 江銀玲, 楊萬春, 沈欣. 呼出氣一氧化氮與支氣管哮喘患者外周血嗜酸性粒細胞相關性及聯合檢測價值. 分子診斷與治療雜志, 2020, 12(8): 1115-1118+1132.
43. 姜箜鳴, 陳國忠. 呼出氣一氧化氮檢測在慢性咳嗽病因診斷中的臨床意義. 武漢大學學報(醫學版), 2018, 39(5): 793-796.
44. 劉莉, 張紅梅, 王偉霞, 等. 呼出氣一氧化氮在老年咳嗽變異性哮喘鑒別診斷中的應用. 檢驗醫學與臨床, 2018, 15(15): 2325-2328.
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成人重癥腺病毒肺炎的臨床特點與診療分析

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Diagnostic value of exhaled nitric oxide in adult asthma: a systemic review and meta-analysis

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