Can Fractional Exhaled Nitric Oxide with Blood Eosinophil Count Have a Place in the Diagnostic Algorithm for Asthma?

IF 0.3 Q4 ALLERGY
İ. Kalkan, G. Buhari, H. Ateş, Buket Başa Akdoğan, Özlem Özdedeoğlu, K. Aksu, F. Erkekol
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引用次数: 0

Abstract

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.
呼气一氧化氮分数与血嗜酸性粒细胞计数能否在哮喘诊断算法中占有一席之地?
目的:指南建议使用支气管激发试验(BPT),这是很难实现的,在哮喘样症状的患者表现为非诊断性肺活量测定试验。为了消除哮喘过度/漏诊的风险,我们旨在评估分数呼气一氧化氮(FeNO)以及其他易于获得的用于排除哮喘的临床指标的预测价值。材料和方法:本回顾性研究纳入到我们诊所就诊的有哮喘呼吸道症状但肺活量正常且可逆性试验阴性的成年人,他们接受了FeNO和甲基胆碱BPT (methacholine BPT)治疗。使用医疗记录获得描述性特征、临床病史、过敏筛查、外周血嗜酸性粒细胞和肺活量测定。结果:51例患者中有19例确诊为哮喘。MchBPT阳性患者体质量指数和血嗜酸性粒细胞明显增高(p=0.042和p=0.037)。两组间FeNO等其他指标差异无统计学意义(p=0.293)。受试者工作特征曲线分析显示,预测MchBPT阳性的最佳诊断临界值为FeNO 14 ppb和血嗜酸性粒细胞150/μl(敏感性-特异性分别为63.16% ~ 62.5%和80% ~ 61%)。这两项指标是BHR阳性的唯一独立预测指标,FeNO>14ppb联合eos>150/μl模型特异性为100%,阴性预测值为100%。结论:我们的研究结果建议将FeNO联合血嗜酸性粒细胞计数作为一种排除试验,为哮喘的算法诊断增加了新的一步。这可能会避免不必要的BPT程序,减少哮喘的过度/不足诊断的风险,并加快正确的诊断。
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来源期刊
CiteScore
0.80
自引率
0.00%
发文量
10
期刊介绍: Asthma Allergy Immunology has been published three times a year in April, August and December as the official and periodical journal of the Turkish National Society of Allergy and Clinical Immunology since 2003. All articles published in the journal have been available online since 2003. A peer reviewed system is used in evaluation of the manuscripts submitted to Asthma Allergy Immunology. The official language of the journal is English. The aim of the journal is to present advances in the field of allergic diseases and clinical immunology to the readers. In accordance with this goal, manuscripts in the format of original research, review, case report, articles about clinical and practical applications and editorials, short report and letters to the editor about allergic diseases and clinical immunology are published in the journal. The target reader population of the Asthma Allergy Immunology includes specialists and residents of allergy and clinical immunology, pulmonology, internal medicine, pediatrics, dermatology and otolaryngology as well as physicians working in other fields of medicine interested in allergy and immunological diseases.
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