Diagnostic utility of inflammatory biomarkers in asthma: Exhaled nitric oxide and induced sputum eosinophil count

Fortuna, Ana María; Feixas, Teresa; González, Mercedes; Casán, Pere

doi:10.1016/j.rmed.2007.05.019

Cited by 45 publications

(40 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A further three studies 80,81,92 were identified from the update search. Four of these studies 70,77,87,95 included data for FeNO testing in conjunction with another test.…”

Section: Diagnostic Reviewmentioning

confidence: 99%

“…l Nine studies 54,[69][70][71][72][82][83][84]86,87,90 recruited patients with symptoms of asthma who were broadly equivalent to patients entering the UK pathway at position A (see Figure 8). Of these, six 69,71,72,[82][83][84]86,87 were considered to be of most relevance to the decision problem, although the studies had not necessarily been conducted in the UK.…”

Section: Studies Meeting the Inclusion Criteriamentioning

confidence: 99%

See 1 more Smart Citation

Measurement of exhaled nitric oxide concentration in asthma: a systematic review and economic evaluation of NIOX MINO, NIOX VERO and NObreath

Harnan

Tappenden

Essat

et al. 2015

Health Technol Assess

View full text Add to dashboard Cite

BackgroundHigh fractions of exhaled nitric oxide (FeNO) in the breath of patients with symptoms of asthma are correlated with high levels of eosinophils and indicate that a patient is likely to respond to inhaled corticosteroids. This may have a role in the diagnosis and management of asthma.ObjectiveTo assess the diagnostic accuracy, clinical effectiveness and cost-effectiveness of the hand-held electrochemical devices NIOX MINO®(Aerocrine, Solna, Sweden), NIOX VERO®(Aerocrine) and NObreath®(Bedfont Scientific, Maidstone, UK) for the diagnosis and management of asthma.Data sourcesSystematic searches were carried out between March 2013 and April 2013 from database inception. Databases searched included MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, Science Citation Index Expanded and Conference Proceedings Citation Index – Science. Trial registers such as ClinicalTrials.gov and themetaRegister of Controlled Trials were also searched in March 2013. All searches were updated in September 2013.Review methodsA rapid review was conducted to assess the equivalence of hand-held and chemiluminescent FeNO monitors. Systematic reviews of diagnostic accuracy and management efficacy were conducted. A systematic review of economic analyses was also conducted and two de novo health economic models were developed. All three reviews were undertaken according to robust high-quality methodology.ResultsThe rapid review (27 studies) found varying levels of agreement between monitors (Bland–Altman 95% limits of agreement up to ±10 parts per billion), with better agreement at lower FeNO values. Correlation was good (generallyr > 0.9). The diagnostic accuracy review identified 22 studies in adults (all ages) and four in children. No studies used NObreath or NIOX VERO and seven used NIOX MINO. Estimates of diagnostic accuracy varied widely. FeNO used in combination with another test altered diagnostic accuracy only slightly. High levels of heterogeneity precluded meta-analysis. Limited observations included that FeNO may be more reliable and useful as a rule-in than as a rule-out test; lower cut-off values in children and in smokers may be appropriate; and FeNO may be less reliable in the elderly. The management review identified five randomised controlled trials in adults, one in pregnant asthmatics and seven in children. Despite clinical heterogeneity, exacerbation rates were lower in all studies but not generally statistically significantly so. Effects on inhaled corticosteroid (ICS) use were inconsistent, possibly because of differences in management protocols, differential effectiveness in adults and children and differences in population severity. One UK diagnostic model and one management model were identified. Aerocrine also submitted diagnostic and management models. All had significant limitations including short time horizons and the selective use of efficacy evidence. The de novo diagnostic model suggested that the expected difference in quality-adjusted life-year (QALY) gains between diagnostic options is likely to be very small. Airway hyper-responsiveness by methacholine challenge test is expected to produce the greatest QALY gain but with an expected incremental cost-effectiveness ratio (ICER) compared with FeNO (NObreath) in combination with bronchodilator reversibility of £1.125M per QALY gained. All remaining options are expected to be dominated. The de novo management model indicates that the ICER of guidelines plus FeNO monitoring using NObreath compared with guidelines alone in children is expected to be approximately £45,200 per QALY gained. Within the adult subgroup, FeNO monitoring using NObreath compared with guidelines alone is expected to have an ICER of approximately £2100 per QALY gained. The results are particularly sensitive to assumptions regarding changes in ICS use over time, the number of nurse visits for FeNO monitoring and duration of effect.ConclusionsLimitations of the evidence base impose considerable uncertainty on all analyses. Equivalence of devices was assumed but not assured. Evidence for diagnosis is difficult to interpret in the context of inserting FeNO monitoring into a diagnostic pathway. Evidence for management is also inconclusive, but largely consistent with FeNO monitoring resulting in fewer exacerbations, with a small or zero reduction in ICS use in adults and a possible increased ICS use in children or patients with more severe asthma. It is unclear which specific management protocol is likely to be most effective. The economic analysis indicates that FeNO monitoring could have value in diagnostic and management settings. The diagnostic model indicates that FeNO monitoring plus bronchodilator reversibility dominates many other diagnostic tests. FeNO-guided management has the potential to be cost-effective, although this is largely dependent on the duration of effect. The conclusions drawn from both models require strong technical value judgements with respect to several aspects of the decision problem in which little or no empirical evidence exists. There are many potential directions for further work, including investigations into which management protocol is best and long-term follow-up in both diagnosis and management studies.Study registrationThis study is registered as PROSPERO CRD42013004149.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract

“…A further three studies 80,81,92 were identified from the update search. Four of these studies 70,77,87,95 included data for FeNO testing in conjunction with another test.…”

Section: Diagnostic Reviewmentioning

confidence: 99%

Section: Studies Meeting the Inclusion Criteriamentioning

confidence: 99%

Measurement of exhaled nitric oxide concentration in asthma: a systematic review and economic evaluation of NIOX MINO, NIOX VERO and NObreath

Harnan

Tappenden

Essat

et al. 2015

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…It has been found to be elevated in patients with atopic asthma (i.e., asthma associated with either positive skin test or specific IgE to aeroallergens) and was shown to correlate modestly with eosinophilia in sputum and endobronchial biopsy in steroid-naïve patients. [7][8][9][10][11] It has also been found to be elevated in both children and adults with atopy without a diagnosis of asthma, (eg atopic rhinitis). 12,13 FeNO levels in atopic patients appear to correlate with number of positive skin prick tests and tests of bronchial hyperresponsiveness.…”

Section: Introduction Backgroundmentioning

confidence: 99%

The Clinical Utility of Fractional Exhaled Nitric Oxide (FeNO) in Asthma Management

Wang¹,

Pianosi²,

Keogh³

et al. 2017

View full text Add to dashboard Cite

“…Fractionally Exhaled Nitric Oxide (FeNO), on the other hand, is a less invasive assay that measures the exhaled nitric oxide, thereby indirectly assessing the level of inflammation in the airways. Nevertheless, the level of diagnosis based upon FeNO decreases in patients with smoking habits or other OAD (46,47).…”

Section: Serum Biomarkers For Asthmamentioning

confidence: 99%

Serum biomarkers in elderly asthma

2013

View full text Add to dashboard Cite

Covilhã, Junho de 2013Serum Biomarkers in Elderly Asthma ii Serum Biomarkers in Elderly Asthma iii "Victoria discentium, gloria docentium" Serum Biomarkers in Elderly Asthma iv Acknowledgements À minha orientadora, a Professora Doutora Olga Lourenço, um profundo agradecimento por toda a orientação, dedicação, e paciência que para comigo demonstrou, nos bons e nos maus momentos. Um grande obrigado por todos os segredos de citometria que comigo partilhou, permitindo-me ver e compreender aquilo que realmente podemos encontrar na folha de aquisição, para além de pontos e eixos em fundo branco.Ao Professor Doutor Luís Taborda Barata, por toda a ajuda que forneceu para a submissão do nosso artigo, e por ter estimulado o meu interesse nesta área da Alergologia.À Professora Doutora Mafalda Fonseca pela fundamental transmissão de conhecimentos de imunologia e pelas pequenas mas valiosas sugestões sobre citometria de fluxo.À minha família, em especial aos meus pais, por toda a preocupação e ajuda que disponibilizaram. Sem eles nunca teria conseguido chegar onde cheguei.Ao David e ao Paulo, por terem partilhado comigo, durante cinco anos, os bons momentos da vida e do espírito académico, contribuindo de igual parte para a coleção de boas memórias que adornam o topo dos armários da nossa cozinha. À Laura, pelo seu sempre presente espírito crítico, por rever este manuscrito e dar a sua opinião imparcial, como se da sua própria dissertação se tratasse, e pela ajuda que me deu nos momentos mais difíceis do último ano.A todos os amigos e colegas com os quais partilhei a magia da Covilhã no decorrer desta importante fase da minha vida. Foram uma verdadeira família.Ao Gonçalo Nogueira, pela ajuda que me deu com a chave dos questionários que contribuíram para a seleção dos voluntários deste estudo. À Doutora Graça e Doutora Patrícia por me terem feito sentir "em casa" no Laboratório Resumo AlargadoA asma é uma doença crónica das vias aéreas que afeta todas as idades e é incorretamente tratada ou sub-diagnosticada na população idosa, resultando em complicações para o doente e numa diminuição da qualidade de vida. Diferentes fenótipos podem requerer diferentes tratamentos e, portanto, é necessário diagnosticar corretamente qual o tipo de asma de que o doente sofre. Apesar de grande parte do tratamento e pesquisa se concentrarem na asma alérgica, existem várias outras formas da doença que requerem atenção, tal como a asma neutrofílica ou asma não-alérgica, que afeta normalmente os doentes mais velhos. A doença pulmonar obstrutiva crónica (DPOC), também muito comum em idosos, pode prejudicar ainda mais o diagnóstico da asma, devido às semelhanças entre as duas doenças. Biomarcadores da asma estão a ser estudados clinicamente com vista a aumentar o poder discriminativo entre os diferentes fenótipos da doença, estando as citocinas dentro dos mais promissores.Assim sendo, o nosso principal objetivo foi medir seis citocinas, nomeadamente a IL-1β, IL-6, IL-8, IL-10, IL-12p70 e TNF-α, no sangue periférico de uma população de idosos asmátic...

show abstract

Diagnostic utility of inflammatory biomarkers in asthma: Exhaled nitric oxide and induced sputum eosinophil count

Cited by 45 publications

References 14 publications

Measurement of exhaled nitric oxide concentration in asthma: a systematic review and economic evaluation of NIOX MINO, NIOX VERO and NObreath

Measurement of exhaled nitric oxide concentration in asthma: a systematic review and economic evaluation of NIOX MINO, NIOX VERO and NObreath

The Clinical Utility of Fractional Exhaled Nitric Oxide (FeNO) in Asthma Management

Serum biomarkers in elderly asthma

Contact Info

Product

Resources

About