Diagnostic value of fractional exhaled nitric oxide in differentiating the asthma-COPD overlap from COPD: a systematic review and meta-analysis

Zhang, Chuchu; Zhang, Meng; Wang, Yalei; Su, Xiaojie; Lei, Ting; Yu, Haichuan; Liu, Jian

doi:10.1080/17476348.2022.2011221

Cited by 8 publications

(6 citation statements)

References 50 publications

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“…However, there was no difference in BECs among the asthma, COPD, and ACO groups in the real-world study cohort, NOVELTY [ 6 ]. Additionally, patients with asthma and those with ACO had higher FeNO levels than those with COPD, which is similar to previous studies’ results [ 38 , 39 ]. Therefore, BDR combined with the biomarkers of type 2 airway inflammation may be a useful tool in distinguishing between COPD and ACO or asthma.…”

Section: Discussionsupporting

confidence: 91%

The value of bronchodilator response in FEV1 and FeNO for differentiating between chronic respiratory diseases: an observational study

Gong,

Huang,

et al. 2024

Eur J Med Res

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Background There is no uniform standard for a strongly positive bronchodilation test (BDT) result. In addition, the role of bronchodilator response in differentiating between asthma, chronic obstructive pulmonary disease (COPD), and asthma–COPD overlap (ACO) in patients with a positive BDT result is unclear. We explored a simplified standard of a strongly positive BDT result and whether bronchodilator response combined with fractional exhaled nitric oxide (FeNO) can differentiate between asthma, COPD, and ACO in patients with a positive BDT result. Methods Three standards of a strongly positive BDT result, which were, respectively, defined as post-bronchodilator forced expiratory volume in 1-s responses (ΔFEV1) increasing by at least 400 mL + 15% (standard I), 400 mL (standard II), or 15% (standard III), were analyzed in asthma, COPD, and ACO patients with a positive BDT result. Receiver operating characteristic curves were used to determine the optimal values of ΔFEV1 and FeNO. Finally, the accuracy of prediction was verified by a validation study. Results The rates of a strongly positive BDT result and the characteristics between standards I and II were consistent; however, those for standard III was different. ΔFEV1 ≥ 345 mL could predict ACO diagnosis in COPD patients with a positive BDT result (area under the curve [AUC]: 0.881; 95% confidence interval [CI] 0.83–0.94), with a sensitivity and specificity of 90.0% and 91.2%, respectively, in the validation study. When ΔFEV1 was < 315 mL combined with FeNO < 28.5 parts per billion, patients with a positive BDT result were more likely to have pure COPD (AUC: 0.774; 95% CI 0.72–0.83). Conclusion The simplified standard II can replace standard I. ΔFEV1 and FeNO are helpful in differentiating between asthma, COPD, and ACO in patients with a positive BDT result.

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Section: Discussionsupporting

confidence: 91%

The value of bronchodilator response in FEV1 and FeNO for differentiating between chronic respiratory diseases: an observational study

Gong,

Huang,

et al. 2024

Eur J Med Res

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“…Although our research shows that inflammatory biomarkers can distinguish CRD, the clinical application value is still in the exploration stage. We mainly differentiate CRD according to diagnostic criteria and some clinical indicators that can reflect the characteristics of the disease (e.g., fractional exhaled nitric oxide, total immunoglobulin E, allergy tests, et al) (48)(49)(50). Inflammatory biomarkers are just another auxiliary means for the hard-to-distinguish CRD.…”

Section: Discussionmentioning

confidence: 99%

Using inflammatory index to distinguish asthma, asthma-COPD overlap and COPD: A retrospective observational study

Yang

Liu

et al. 2022

Front. Med.

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BackgroundAlthough asthma and chronic obstructive pulmonary disease (COPD) are two well-defined and distinct diseases, some patients present combined clinical features of both asthma and COPD, particularly in smokers and the elderly, a condition termed as asthma-COPD overlap (ACO). However, the definition of ACO is yet to be established and clinical guidelines to identify and manage ACO remain controversial. Therefore, in this study, inflammatory biomarkers were established to distinguish asthma, ACO, and COPD, and their relationship with the severity of patients’ symptoms and pulmonary function were explored.Materials and methodsA total of 178 patients, diagnosed with asthma (n = 38), ACO (n = 44), and COPD (n = 96) between January 2021 to June 2022, were enrolled in this study. The patients’ pulmonary function was examined and routine blood samples were taken for the analysis of inflammatory indexes. Logistic regression analysis was used to establish inflammatory biomarkers for distinguishing asthma, ACO, and COPD; linear regression analysis was used to analyze the relationship between inflammatory indexes and symptom severity and pulmonary function.ResultThe results showed that, compared with ACO, the higher the indexes of platelet, neutrophil-lymphocyte ratio (NLR) and eosinophil-basophil ratio (EBR), the more likely the possibility of asthma and COPD in patients, while the higher the eosinophils, the less likely the possibility of asthma and COPD. Hemoglobin and lymphocyte-monocyte ratio (LMR) were negatively correlated with the severity of patients’ symptoms, while platelet-lymphocyte ratio (PLR) was negatively correlated with forced expiratory volume in the 1 s/forced vital capacity (FEV1/FVC) and FEV1 percent predicted (% pred), and EBR was positively correlated with FEV1% pred.ConclusionInflammatory indexes are biomarkers for distinguishing asthma, ACO, and COPD, which are of clinical significance in therapeutic strategies and prognosis evaluation.

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“…Although it has long been considered to be a type2 inflammatory marker used in asthma assessment [ 36 , 37 , 38 ], recent research has also demonstrated that it was associated with asthma-COPD overlap (ACO) and COPD. It has been reported that FeNO level could be related to pulmonary function and symptom severity of ACO patients in meta-analysis and cohort studies [ 35 , 39 , 40 ]. Some research has illustrated that FeNO and other type2 inflammatory markers, for example, eosinophil count, could be used to differentiate between ACO and COPD [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

The Combined Value of Type2 Inflammatory Markers in Chronic Obstructive Pulmonary Disease

Liu

Guo

Mou

et al. 2022

JCM

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The roles of type2 inflammatory markers in chronic airway diseases have been assessed in previous studies. However, the relationship between the combined value of these biomarkers and chronic obstructive pulmonary disease (COPD) has not been fully elucidated. We aimed to investigate the roles of the combined value of the fraction of exhaled nitric oxide (FeNO) level and blood eosinophil count in COPD and the predictive capability of these biomarkers. In total, 266 patients were included in our analysis. When the two type2 biomarkers were assessed separately, there were limited correlations between either increased FeNO level or blood eosinophil count and decreased incidence of total exacerbation or frequency of mild exacerbation. Combining these two biomarkers strengthened their association with both incidence and frequency of acute exacerbation. In addition, during further assessment, simultaneously increased FeNO level and blood eosinophil count were associated with both mild and moderate acute exacerbation. Among the subjects included in this analysis, although the predictive capability was improved when these two biomarkers were combined, the improvement was not statistically significant, indicating the need to increase the sample size. The combination of FeNO level and blood eosinophil count exhibited strong and independent additive value in the assessment of acute exacerbation in COPD; simultaneously increased FeNO level and blood eosinophil count played a protective role in progression of COPD.

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Diagnostic value of fractional exhaled nitric oxide in differentiating the asthma-COPD overlap from COPD: a systematic review and meta-analysis

Cited by 8 publications

References 50 publications

The value of bronchodilator response in FEV1 and FeNO for differentiating between chronic respiratory diseases: an observational study

The value of bronchodilator response in FEV1 and FeNO for differentiating between chronic respiratory diseases: an observational study

Using inflammatory index to distinguish asthma, asthma-COPD overlap and COPD: A retrospective observational study

The Combined Value of Type2 Inflammatory Markers in Chronic Obstructive Pulmonary Disease

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