Screening Accuracy of FeNO Measurement for Childhood Asthma in a Community Setting

Abstract

(1) Background: The exhaled fractional nitric oxide is a well-recognized biomarker used in clinical settings for controlling and managing asthma. Less is known about the value of Fractional Exhaled Nitric Oxide (FeNO) measurement in epidemiological studies on childhood asthma, although available evidence suggests that an increased FeNO is associated with an increased risk of asthma. (2) Aim: The aim of the study was to assess FeNO accuracy in the identification of children with asthma, participants in a population-based respiratory survey. (3) Material and methods: The cross-sectional study included 449 children, 224 (49.9%) boys and 225 (50.1%) girls aged 6–10 years. The FeNO was measured in 449 children; Spirometry tests were completed with 441 children, but technically acceptable spirometry was done in 350. All participants fulfilled the questionnaire (ISAAC) for assessment of the status of their respiratory system on which diagnosis was based on. FeNO and Spirometry were performed according to ERS/ATS recommendations. (4) Results: The FeNO was significantly higher in asthmatic children (n = 22): 27.3 ± 21.3 ppb; with allergic rhinitis (n = 106): 9.9 ± 21.6 ppb, with atopic dermatitis (n = 67) 20.8 ± 25.0 ppb, with an asthmatic tendency (n = 27): 19.8 ± 16.0 ppb in comparison to children without any respiratory/atopy symptoms. The highest diagnostic odds ratio and area under the curve were found in any treated asthma or asthma without any atopic symptoms in relation to FeNO cutoff > 35 ppb; DOR 4.85 and 8.37; AUC 0.615 and 0.795, respectively. The adjustment for spirometry parameters did not improve the diagnostic accuracy of FeNO. In each FeNO cutoff, there were more false positive than true positive subjects. (5) Conclusions. The best diagnostic accuracy of FeNO was for isolated asthma without any atopy against children without any coexisting respiratory or allergic disease. The sensitivity and specificity did not reach the required values for a good screening tool; therefore, it should not be used in epidemiological settings.

Predictive Value of Fractional Exhaled Nitric Oxide (FeNO) in the Diagnosis of Asthma for Epidemiological Purposes—An 8-Year Follow-Up Study

“…Contrastingly, in a prior study conducted by the author, the conclusion reached was that FeNO measurement was not an effective screening tool for pediatric asthma in a community setting [23]. However, the findings of the present study contradict this, indicating that children exhibiting asthma-like symptoms and elevated FeNO levels are at an increased risk of asthma, and these findings suggest the need for additional investigation.…”

“…According to their study, they based the symptoms from the respiratory system on the responses from the questionnaire. The lack of validated diagnosis probably decreased the explained variability of FeNO; however, their study reflected the study performed in the epidemiological conditions [ 23 ]. In the study performed by Garcia-Marcos, it was revealed that approximately 27% of the variability in FeNO levels could be explained.…”

Predictive meaning of Fractional Exhaled Nitric Oxide (FeNO) in the diagnosis of asthma for epidemiological purposes – an 8-year follow-up study

“…Moreover, the in the author's previous study, the conclusion considered FeNO measurement as not a good screening tool for pediatric asthma in a community setting [23]. However, the current results of this study show that children with asthma-like symptoms and elevated FeNO levels are at increased risk of asthma and need further investigation, such results have been presented in the cross-sectional screening study conducted by Prasad et.…”

“…[24]. According to their study, they based the symptoms from the respiratory system on the responses from the questionnaire The lack of validated diagnosis probably decreased the explained variability of FeNO, however, their study re ected the study performed in the epidemiological con-ditions [23]. In the study performed by Garcia-Marcos, the variability of FeNO was ex-plained in 27%.…”