Study on small airway function in asthmatics with fractional exhaled nitric oxide and impulse oscillometry

Liu, Lin; Li, Wen; Liu, Chunhong; Wang, Dexiang; Zhao, Jiping; Wang, Junfei; Wu, Jinxiang; Liu, Tian; Zhang, Yuanyuan; Liu, Yahui; Cao, Liuzhao; Dong, Liang

doi:10.1111/crj.12548

Cited by 13 publications

(14 citation statements)

References 42 publications

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“…Further published studies have shown that the FeNO was associated with the pulmonary function parameters of small airway [2,34,35]. The present study showed that the small airway functional parameters of MMEF, MEF50, and MEF25 were significantly correlated with the levels of FeNO in the patients with cough variant asthma, which suggests that the dysfunction of small airway might be correlated with airway inflammation.…”

Section: Discussionsupporting

confidence: 70%

“…The present study showed that the small airway functional parameters of MMEF, MEF50, and MEF25 were significantly correlated with the levels of FeNO in the patients with cough variant asthma, which suggests that the dysfunction of small airway might be correlated with airway inflammation. Liu et al reported that the FeNO test combined with impulse oscillometry (IOS) testing resulted in increased diagnostic sensitivity and specificity for dysfunction of small airways in patients with asthma [34]. Feng-Jia et al also reported that the increased levels of FeNO indicated dysfunction of small airways and was diagnostic for cough variant asthma [33].…”

Section: Discussionmentioning

confidence: 99%

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Fractional Exhaled Nitric Oxide (FeNO) Combined with Pulmonary Function Parameters Shows Increased Sensitivity and Specificity for the Diagnosis of Cough Variant Asthma in Children

et al. 2019

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Background Cough variant asthma in children presents with a dry nonproductive cough. This study aimed to investigate the diagnostic value of fractional exhaled nitric oxide (FeNO) combined with small airway functional parameters in cough variant asthma. Material/Methods Children with asthma (n=136) were divided into a cough variant asthma (CVA) group (n=57; mean age, 8.03±2.1 years) and a non-cough variant asthma (nCVA) group (n=79; mean age, 8.61±1.7 years). In both groups, FeNO and other pulmonary function parameters were measured including forced expiratory volume in one second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), maximum mid-expiratory flow (MMEF), forced expiratory flow (FEF), and maximum expiratory flow at 25%, 50%, and 75% expired volume (MEF25, MEF50, and MEF75). Receiver-operating characteristic (ROC) curve analysis compared the sensitivity and specificity between the diagnostic parameters. Results The FeNO values were significantly increased in the CVA group compared with the nCVA group (Z=6.890, p<0.001). The MMEF, MEF25, MEF50, and MEF75 values were significantly lower in the CVA group compared with the nCVA group (p=0.000, p=0.014, p=0.000, and p=0.000, respectively). The FeNO values were negatively correlated with MEF25, MEF50, and MMEF (r=−0.334, r=−0.257 and r=−0.276, respectively). FeNO was significantly more efficient diagnosing cough variant asthma comparing with pulmonary parameters (p<0.05), and was most sensitive and specific when combined with MMEF/MEF50 compared with single diagnostic parameters (p<0.05). Conclusions FeNO combined with pulmonary function parameters of MMEF/MEF50 showed increased sensitivity and specificity for the diagnosis of cough variant asthma.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Fractional Exhaled Nitric Oxide (FeNO) Combined with Pulmonary Function Parameters Shows Increased Sensitivity and Specificity for the Diagnosis of Cough Variant Asthma in Children

et al. 2019

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“…Liu et al [14] showed that FeNO combined with IOS better assesses the small airway function of patients with asthma, with high sensitivity and specificity. Asthma control is closely related to small airway function.…”

Section: Discussionmentioning

confidence: 99%

“…The guidelines also mention that continuous FeNO monitoring helps to assess asthma control and guide treatment planning [1]. In addition, Liu et al showed that IOS combined with FeNO was highly sensitive and specific when assessing small airway function [14]. Previous studies have only used FeNO or IOS parameters (R5-20, AX, Fres, and X5) to assess asthma control [10,15,16].…”

mentioning

confidence: 99%

Asthma control in preschool children with small airway function as measured by IOS and fractional exhaled nitric oxide

Zeng¹,

Chen²,

Ying

et al. 2018

Respiratory Medicine

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This study investigated the accuracy of impulse oscillometry (IOS) combined with fractional exhaled nitric oxide (FeNO) to assess asthma control among preschool children. Methods: A total of 79 preschool children(3-6 year old) with asthma and 25 healthy preschool children who visited a paediatrician were enrolled in this study. All of the children were tested for allergens, respiratory system resistance (at 5 and 20 Hz [R5, R20]), respiratory system reactance (at 5 Hz [X5]), the resonant frequency of reactance (Fres), and the area under the reactance curve (between 5 Hz and Fres (reactance area [AX]) using IOS and FeNO. A paediatric respiratory specialist who was unaware of the IOS and FeNO results assigned children with asthma to either the asthma-controlled group (n = 27) or the asthma-uncontrolled group (n = 52) based on the Global Initiative for Asthma (GINA) criteria. A healthy control group (n = 25) was also included. The relationships between the FeNO and IOS values as well as the asthma control of the three groups were analysed, and the areas under the curve (AUCs) were calculated for each measure. Results: (1) During the controlled group, means ± standard deviations of AX,

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“…FeNO is a measure of airway inflammation in asthma, which has been associated with small airway dysfunction ( 26 , 27 ). In the present study, no correlation was found between FeNO and FVC in the restricted group.…”

Section: Discussionmentioning

confidence: 99%

“Poor Effort” Does Not Account for Reduced Forced Vital Capacity in Asthmatic Children

2021

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Purpose: Poor forced vital capacity (FVC) effort has been considered to be the main reason for FVC reduction by the ATS/ERS guideline; however, this has rarely been mentioned in previous studies. The present study aims to determine whether reduced FVC in asthmatic children is correlated to poor FVC effort.Methods: A total of 209 asthmatic children within 5–13 years old were included and divided into reduced FVC (“restricted,” n = 66) and typical obstruction group (“obstructed,” n = 143). Forced expiratory flows before and after bronchodilation were recorded in asthmatic children. The differences in clinical characteristics, spirometric results, FVC effort, and bronchodilator response were compared between two groups. Exhalation time (ET) was divided into effective ET (ETe) and plateau ET (ETp) by the start point of exhalation plateau on the time-volume curve. FVC effort was assessed by ET, ETp, and back extrapolated volume (EV)/FVC (%).Results: Asthmatic children in the restricted group had significantly higher slow vital capacity (SVC)/FVC (%), higher EV/FVC (%), shorter ET, shorter ETe, and longer ETp, when compared with those with obstructed. In the obstructed group, ET (r = 0.201, P = 0.016) and ETe (r = 0.496, P < 0.001) positively correlated with FVC, and ETp (r = −0.224, P = 0.007) negatively correlated with FVC. In the restricted group, FVC positively correlated with ETe (r = 0.350, P = 0.004) but not ET and ETp. FVC z-score significantly correlated with total IgE (n = 51, r = −0.349, P = 0.012) and with FEF25−75% z-score (n = 66, r = 0.531, P < 0.001) in the restricted group. The further logistic regression revealed that the risk of restricted increased by 1.12 (95% CI, 1.04–1.22, P = 0.005) with every 1% increase in %ΔFVC. In subjects with restricted and bronchodilation tests, %ΔFVC was significantly associated with FeNO (n = 29, r = 0.386, P = 0.039), FEF25−75% z-score (n = 29, r = −0.472, P = 0.010), and SVC/FVC (%) (n = 19, r = 0.477, P = 0.039) but not with EV/FVC (%), ET, ETe, or ETp (P > 0.05).Conclusion: These findings suggested that “poor FVC effort” does not account for the FVC reduction in asthmatic children. Short ET and high SVC/FVC (%) are characteristics of reduced FVC.

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Study on small airway function in asthmatics with fractional exhaled nitric oxide and impulse oscillometry

Abstract: FeNO and IOS are helpful in diagnosis of small airway dysfunction with high sensitivity and specificity, and FeNO combined with IOS can better evaluate the small airway function in asthmatic patients.

Cited by 13 publications

References 42 publications

Fractional Exhaled Nitric Oxide (FeNO) Combined with Pulmonary Function Parameters Shows Increased Sensitivity and Specificity for the Diagnosis of Cough Variant Asthma in Children

Fractional Exhaled Nitric Oxide (FeNO) Combined with Pulmonary Function Parameters Shows Increased Sensitivity and Specificity for the Diagnosis of Cough Variant Asthma in Children

Asthma control in preschool children with small airway function as measured by IOS and fractional exhaled nitric oxide

“Poor Effort” Does Not Account for Reduced Forced Vital Capacity in Asthmatic Children

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