The Use of Exhaled Nitric Oxide in the Diagnosis of Asthma in School Children

Sivan, Yakov; Gadish, Tali; Fireman, Elizabeth; Soferman, Ruth

doi:10.1016/j.jpeds.2009.02.034

Cited by 94 publications

(69 citation statements)

References 33 publications

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“…In children with respiratory symptoms, FE NO in the diagnosis of asthma can be a predictor of asthma [101,102,104]. Significant association between FE NO and reported asthma symptoms is also shown [14,99,101,105], while the correlations between symptoms and spirometry are poor [105].…”

Section: Asthmamentioning

confidence: 98%

“…In epidemiologic studies, FE NO can be used as an indicator for allergic airway inflammation in children [14,49,99,100], and performs better than respiratory function measured and bronchodilator responsiveness in identifying preschool children with probable asthma [101], and in predicting subsequent wheezing treated with systemic steroid in infants and toddlers [29]. Sensitivity, specificity, and positive and negative predictive values as diagnostic of asthma are high [101,102]. However, a cross-sectional survey in adolescent children shows high negative predictive values of FE NO for asthma but positive predictive value is low for the diagnosis of asthma [14].…”

Section: Asthmamentioning

confidence: 99%

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Fractional Exhaled Nitric Oxide: Indications and Interpretation

Kim

Kercsmar

Davis

2014

Diagnostic Tests in Pediatric Pulmonology

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Exhaled nitric oxide (NO) is a marker for eosinophilic airway inflammation. The correlations between fraction of exhaled NO (FE NO ) and eosinophils in blood, sputum, bronchoalveolar lavage, and mucosal biopsies of the airway have been well studied. A quantitative, noninvasive, and simple methodology has been developed to determine how best to assess FE NO as a measure of airway inflammation. FE NO measurement has been standardized by the American Thoracic Society/ European Respiratory Society (Am J Respir Crit Care Med 171(8): [912][913][914][915][916][917][918][919][920][921][922][923][924][925][926][927][928][929][930] 2005). The gold standard for measuring FE NO is the single-breath online method, which can be performed in young children from the age of 4-5 years. A chemiluminescencebased analyzer or a portable analyzer using an electrochemical sensor can be used to measure FE NO . Many studies have shown that FE NO has potential diagnostic and therapeutic roles in various respiratory diseases, particularly asthma. In asthma, FE NO is useful to diagnose and monitor eosinophilic airway inflammation, and predict steroid responsiveness. It also can be helpful in supporting the diagnosis of asthma and in guiding adjustment of anti-inflammatory medication. ATS Clinical Practice Guidelines have been published for interpretation and clinical applicability of FE NO (Dweik et al., 184(5):602-615, 2011). FE NO can provide additional information on underlying airway inflammation, and is complementary to respiratory symptoms, lung function tests, and bronchial provocation tests for asthma and other respiratory diseases in the clinical setting.

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Section: Asthmamentioning

confidence: 98%

Section: Asthmamentioning

confidence: 99%

Fractional Exhaled Nitric Oxide: Indications and Interpretation

Kim

Kercsmar

Davis

2014

Diagnostic Tests in Pediatric Pulmonology

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“…Measurement of FeNO is relatively easy, and several devices are readily available and not too costly [111]. In a recently published study of children aged 5–18 years, FeNO compared favorably with sputum eosinophil percentage and better than spirometry for confirming asthma diagnosis [112]. However, obtaining FeNO was easier and less time consuming than obtaining induced sputum.…”

Section: The Role Of Eosinophilia In Asthma Development/exacerbationmentioning

confidence: 99%

Respiratory Viruses, Eosinophilia and Their Roles in Childhood Asthma

Callaway¹,

Kim²

2010

Int Arch Allergy Immunol

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With the advent of highly sensitive and specific screening of respiratory specimens for viruses, new viruses are discovered, adding to the growing list of those associated with wheezing illness and asthma exacerbations. It is not known whether early childhood infections with these viruses cause asthma, and, if so, what exactly are the pathophysiologic mechanisms behind its development. The current consensus is that respiratory viral infection works together with allergy to produce the immune and physiologic conditions necessary for asthma diasthesis. One link between viruses and asthma may be the eosinophil, a cell that plays a prominent role in asthma and allergy, but can also be found in the body in response to viral infection. In turn, the eosinophil and its associated products may be novel therapeutic targets, or at the very least, used to elucidate the complex pathophysiologic pathways of asthma and other respiratory illnesses. Together or separately, they can be used for diagnosis, treatment and monitoring. Not only symptoms, but also the underlying disease mechanisms must be taken into consideration for the optimal care of a patient.

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“…FeNO may be a useful marker in the assessment of asthma status and control [3,4]. It has shown potential promise as a non-invasive biomarker for asthma because it is a simple, well tolerated test with no risk to the participant [5] and it provides real-time, reproducible results in children aged ≥4 years [1][2][3][6][7][8][9]. For these reasons, FeNO has been recently recommended as a clinical endpoint for the characterization of study populations, in clinical trials and observational studies [10].…”

Section: Introductionmentioning

confidence: 99%

Role Of Exhaled Nitric Oxide As A Predictor Of Atopy

Romero

Robinson

Baumann

et al. 2012

D39. Evaluation and Monitoring of Asthma and Copd

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Background: The fractional exhaled nitric oxide (FeNO) is a quantitative, noninvasive and safe measure of airways inflammation that may complement the assessment of asthma. Elevations of FeNO have recently been found to correlate with allergic sensitization. Therefore, FeNO may be a useful predictor of atopy in the general population. We sought to determine the diagnostic accuracy of FeNO in predicting atopy in a population-based study. Methods: We conducted a cross-sectional study in an age-and sex-stratified random sample of 13 to 15 year-olds in two communities in Peru. We asked participants about asthma symptoms, environmental exposures and sociodemographics, and underwent spirometry, assessment of FeNO and an allergy skin test. We used multivariable logistic regression to model the odds of atopy as a function of FeNO, and calculated area-under-the-curves (AUC) to determine the diagnostic accuracy of FeNO as a predictor of atopy. Results: Of 1441 recruited participants, 1119 (83%) completed all evaluations. Mean FeNO was 17.6 ppb (SD=0.6) in atopics and 11.6 ppb (SD=0.8) in non-atopics (p<0.001). In multivariable analyses, a FeNO>20 ppb was associated with an increase in the odds of atopy in non-asthmatics (OR=5.3, 95% CI 3.3 to 8.5) and asthmatics (OR=16.2, 95% CI 3.4 to 77.5). A FeNO>20 ppb was the best predictor for atopy with an AUC of 68% (95% CI 64% to 69%). Stratified by asthma, the AUC was 65% (95% CI 61% to 69%) in non-asthmatics and 82% (95% CI 71% to 91%) in asthmatics. Conclusions: FeNO had limited accuracy to identify atopy among the general population; however, it may be a useful indicator of atopic phenotype among asthmatics.

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The Use of Exhaled Nitric Oxide in the Diagnosis of Asthma in School Children

Cited by 94 publications

References 33 publications

Fractional Exhaled Nitric Oxide: Indications and Interpretation

Fractional Exhaled Nitric Oxide: Indications and Interpretation

Respiratory Viruses, Eosinophilia and Their Roles in Childhood Asthma

Role Of Exhaled Nitric Oxide As A Predictor Of Atopy

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