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Soccio P, Quarato CMI, Tondo P, Lacedonia D, Hoxhallari A, Foschino Barbaro MP, Scioscia G. Breath and Sputum Analyses in Asthmatic Patients: An Overview. Cells 2024; 13:1355. [PMID: 39195245 DOI: 10.3390/cells13161355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/10/2024] [Accepted: 08/13/2024] [Indexed: 08/29/2024] Open
Abstract
Recent advancements in asthma management include non-invasive methodologies such as sputum analysis, exhaled breath condensate (EBC), and fractional exhaled nitric oxide (FeNO). These techniques offer a means to assess airway inflammation, a critical feature of asthma, without invasive procedures. Sputum analysis provides detailed insights into airway inflammation patterns and cellular composition, guiding personalized treatment strategies. EBC collection, reflecting bronchoalveolar lining fluid composition, provides a non-invasive window into airway physiology. FeNO emerges as a pivotal biomarker, offering insights into eosinophilic airway inflammation and aiding in asthma diagnosis, treatment monitoring, and the prediction of exacerbation risks. Despite inherent limitations, each method offers valuable tools for a more comprehensive assessment of asthma. Combining these techniques with traditional methods like spirometry may lead to more personalized treatment plans and improved patient outcomes. Future research is crucial to refine protocols, validate biomarkers, and establish comprehensive guidelines in order to enhance asthma management with tailored therapeutic strategies and improved patient outcomes.
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Affiliation(s)
- Piera Soccio
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | | | - Pasquale Tondo
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Institute of Respiratory Diseases, Policlinico Riuniti of Foggia, 71122 Foggia, Italy
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Institute of Respiratory Diseases, Policlinico Riuniti of Foggia, 71122 Foggia, Italy
| | - Anela Hoxhallari
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Institute of Respiratory Diseases, Policlinico Riuniti of Foggia, 71122 Foggia, Italy
| | - Maria Pia Foschino Barbaro
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Institute of Respiratory Diseases, Policlinico Riuniti of Foggia, 71122 Foggia, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
- Institute of Respiratory Diseases, Policlinico Riuniti of Foggia, 71122 Foggia, Italy
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2
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Hauk M, Todter E, Sitarik A, Lin CH, Joseph C, Kim H, Eapen A, Johnson C, Ownby D, Wegienka G, Zoratti E. Associations between FeNO and clinical characteristics of asthma and allergy among Black and White children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00569-5. [PMID: 38821439 DOI: 10.1016/j.jaip.2024.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 05/16/2024] [Accepted: 05/22/2024] [Indexed: 06/02/2024]
Affiliation(s)
- Michael Hauk
- Department of Internal Medicine, Henry Ford Health, Detroit, Mich
| | - Erika Todter
- Department of Public Health Sciences, Henry Ford Health, Detroit, Mich
| | - Alexandra Sitarik
- Department of Public Health Sciences, Henry Ford Health, Detroit, Mich
| | - Chun-Hui Lin
- Department of Public Health Sciences, Henry Ford Health, Detroit, Mich
| | - Christine Joseph
- Department of Public Health Sciences, Henry Ford Health, Detroit, Mich
| | - Haejin Kim
- Department of Internal Medicine, Henry Ford Health, Detroit, Mich
| | - Amy Eapen
- Department of Internal Medicine, Henry Ford Health, Detroit, Mich
| | - Christine Johnson
- Department of Public Health Sciences, Henry Ford Health, Detroit, Mich
| | - Dennis Ownby
- Department of Public Health Sciences, Henry Ford Health, Detroit, Mich; Department of Pediatrics, Augusta University Medical Center, Augusta, Ga
| | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health, Detroit, Mich
| | - Edward Zoratti
- Department of Internal Medicine, Henry Ford Health, Detroit, Mich.
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Högman M, Bowerman C, Chavez L, Dressel H, Malinovschi A, Radtke T, Stanojevic S, Steenbruggen I, Turner S, Dinh-Xuan AT. ERS technical standard: Global Lung Function Initiative reference values for exhaled nitric oxide fraction ( F ENO50 ). Eur Respir J 2024; 63:2300370. [PMID: 37973177 DOI: 10.1183/13993003.00370-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/22/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Elevated exhaled nitric oxide fraction at a flow rate of 50 mL·s-1 (F ENO50 ) is an important indicator of T-helper 2-driven airway inflammation and may aid clinicians in the diagnosis and monitoring of asthma. This study aimed to derive Global Lung Function Initiative reference equations and the upper limit of normal for F ENO50 . METHODS Available individual F ENO50 data were collated and harmonised using consensus-derived variables and definitions. Data collected from individuals who met the harmonised definition of "healthy" were analysed using the generalised additive models of location, scale and shape (GAMLSS) technique. RESULTS Data were retrospectively collated from 34 782 individuals from 34 sites in 15 countries, of whom 8022 met the definition of healthy (19 sites, 11 countries). Overall, height, age and sex only explained 12% of the between-subject variability of F ENO50 (R2=0.12). F ENO device was neccessary as a predictor of F ENO50 , such that the healthy range of values and the upper limit of normal varied depending on which device was used. The range of F ENO50 values observed in healthy individuals was also very wide, and the heterogeneity was partially explained by the device used. When analysing a subset of data in which F ENO50 was measured using the same device and a stricter definition of health (n=1027), between-site heterogeneity remained. CONCLUSION Available F ENO50 data collected from different sites using different protocols and devices were too variable to develop a single all-age reference equation. Further standardisation of F ENO devices and measurement are required before population reference values might be derived.
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Affiliation(s)
- Marieann Högman
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Cole Bowerman
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Luis Chavez
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Holger Dressel
- Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention Institute, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Thomas Radtke
- Division of Occupational and Environmental Medicine, Epidemiology, Biostatistics and Prevention Institute, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Sanja Stanojevic
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | | | - Steve Turner
- Women and Children Division, NHS Grampian, Aberdeen, UK
- Child Health, University of Aberdeen, Aberdeen, UK
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Fraser A, Simpson R, Turner S. Use of exhaled nitric oxide in the diagnosis and monitoring of childhood asthma: myth or maxim? Breathe (Sheff) 2023; 19:220236. [PMID: 38125803 PMCID: PMC10729813 DOI: 10.1183/20734735.0236-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/14/2023] [Indexed: 12/23/2023] Open
Abstract
Asthma is a common condition in children. This review describes the evidence from the literature and international asthma guidelines for using fractional exhaled nitric oxide (FENO) in the diagnosis and monitoring of childhood asthma. The accuracy of FENO measuring devices could be further improved, the difference in FENO results between devices are equivalent to what is considered a clinically important difference. For diagnosing asthma no guideline currently recommends FENO is used as the first test, but many recommend FENO as part of a series of tests. A cut-off of 35 ppb is widely recommended as being supportive of an asthma diagnosis, but evidence from children at risk of asthma suggests that a lower threshold of 25 ppb may be more appropriate. Nine randomised clinical trials including 1885 children have added FENO to usual asthma care and find that exacerbations are reduced when care is guided by FENO (OR for exacerbation compared to usual care 0.77, 95% CI 0.62-0.94). What is not clear is what cut-off(s) of FENO should be used to trigger a change in treatment. After 30 years of intensive research there is not sufficient evidence to recommend FENO for routine diagnosing and monitoring asthma in children. Educational aims To give the reader an overview of literature that supports and does not support the role of FENO in diagnosing asthma in children.To give the reader an overview of literature that supports and does not support the role of FENO in monitoring asthma in children.To give the reader an understanding of the role of FENO in international guidelines for diagnosing and monitoring asthma in children.
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Affiliation(s)
- Anna Fraser
- Child Health, Women and Children's Division, NHS Grampian, Aberdeen, UK
- Joint first authors
| | - Ruaraidh Simpson
- Child Health, Women and Children's Division, NHS Grampian, Aberdeen, UK
- Joint first authors
| | - Steve Turner
- Child Health, Women and Children's Division, NHS Grampian, Aberdeen, UK
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Accordini S, Lando V, Calciano L, Bombieri C, Malerba G, Margagliotti A, Minelli C, Potts J, van der Plaat DA, Olivieri M. SNPs in FAM13Aand IL2RBgenes are associated with FeNO in adult subjects with asthma. J Breath Res 2023; 18:016001. [PMID: 37733009 DOI: 10.1088/1752-7163/acfbf1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/21/2023] [Indexed: 09/22/2023]
Abstract
Nitric oxide has different roles in asthma as both an endogenous modulator of airway function and a pro-inflammatory mediator. Fractional exhaled nitric oxide (FeNO) is a reliable, quantitative, non-invasive, simple, and safe biomarker for assessing airways inflammation in asthma. Previous genome-wide and genetic association studies have shown that different genes and single nucleotide polymorphisms (SNPs) are linked to FeNO. We aimed at identifying SNPs in candidate genes or gene regions that are associated with FeNO in asthma. We evaluated 264 asthma cases (median age 42.8 years, female 47.7%) who had been identified in the general adult population within the Gene Environment Interactions in Respiratory Diseases survey in Verona (Italy; 2008-2010). Two hundred and twenty-one tag-SNPs, which are representative of 50 candidate genes, were genotyped by a custom GoldenGate Genotyping Assay. A two-step association analysis was performed without assuming ana priorigenetic model: step (1) a machine learning technique [gradient boosting machine (GBM)] was used to select the 15 SNPs with the highest variable importance measure; step (2) the GBM-selected SNPs were jointly tested in a linear regression model with natural log-transformed FeNO as the normally distributed outcome and with age, sex, and the SNPs as covariates. We replicated our results within an independent sample of 296 patients from the European Community Respiratory Health Survey III. We found that SNP rs987314 in family with sequence similarity 13 member A (FAM13A) and SNP rs3218258 in interleukin 2 receptor subunit beta (IL2RB) gene regions are significantly associated with FeNO in adult subjects with asthma. These genes are involved in different mechanisms that affect smooth muscle constriction and endothelial barrier function responses (FAM13A), or in immune response processes (IL2RB). Our findings contribute to the current knowledge on FeNO in asthma by identifying two novel SNPs associated with this biomarker of airways inflammation.
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Affiliation(s)
- Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy
| | - Valentina Lando
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy
| | - Lucia Calciano
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy
| | - Cristina Bombieri
- Biology and Genetics Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona 37134, Italy
| | - Giovanni Malerba
- Biology and Genetics Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona 37134, Italy
| | - Antonino Margagliotti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona 37134, Italy
| | - Cosetta Minelli
- National Heart and Lung Institute, Imperial College London, London SW3 6LR, United Kingdom
| | - James Potts
- National Heart and Lung Institute, Imperial College London, London SW3 6LR, United Kingdom
| | - Diana A van der Plaat
- National Heart and Lung Institute, Imperial College London, London SW3 6LR, United Kingdom
| | - Mario Olivieri
- Retired Professor of Occupational Medicine, University of Verona, Verona, Italy
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Collaro AJ, Chang AB, Marchant JM, Vicendese D, Chatfield MD, Cole JF, Blake TL, McElrea MS. Developing Fractional Exhaled Nitric Oxide Predicted and Upper Limit of Normal Values for a Disadvantaged Population. Chest 2023; 163:624-633. [PMID: 36279906 DOI: 10.1016/j.chest.2022.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Fractional exhaled nitric oxide (Feno), used as a biomarker, is influenced by several factors including ethnicity. Normative data are essential for interpretation, and currently single cutoff values are used in children and adults. RESEARCH QUESTION Accounting for factors that influence Feno, (1) what are appropriate predicted and upper limit of normal (ULN) Feno values in an underserved population (First Nations Australians), (2) how do these values compare with age-based interpretive guidelines, and (3) what factors influence Feno and what is the size of the effect? STUDY DESIGN AND METHODS Feno data of First Nations Australians (age < 16 years, n = 862; age ≥ 16 years, n = 348) were obtained. Medical history using participant questionnaires and medical records were used to define healthy participants. Flexible regression using spline functions, as used by the Global Lung Function Initiative, were used to generate predicted and ULN values. RESULTS Look-up tables for predicted and ULN values using age (4-76 years) and height (100-200 cm) were generated and are supplied with a calculator for clinician use. In healthy First Nations children (age < 18 years), ULN values ranged between 25 and 60 parts per billion (ppb) when considering only biologically plausible age and height combinations. For healthy adults, ULN values ranged between 39 and 88 ppb. Neither the current Feno interpretation guidelines, nor the currently recommended cutoff of 50 ppb for First Nations children 16 years of age or younger were appropriate for use in this cohort. Our modelling revealed that predicted and ULN values of healthy participants varied nonlinearly with age and height. INTERPRETATION Because single pediatric, adult, or all-age Feno cutoff values used by current interpretive guidelines to define abnormality fail to account for factors that modify Feno values, we propose predicted and ULN values for First Nations Australians 4 to 76 years of age. Creating age- and height-adjusted predicted and ULN values could be considered for other ethnicities.
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Affiliation(s)
- Andrew J Collaro
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Child Health Division, Menzies School of Health Research, Casuarina, NT, Australia
| | - Julie M Marchant
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Don Vicendese
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; School of Engineering and Mathematical Sciences, La Trobe University, Bundoora, VIC, Australia
| | - Mark D Chatfield
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Child Health Division, Menzies School of Health Research, Casuarina, NT, Australia
| | - Johanna F Cole
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Tamara L Blake
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Margaret S McElrea
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia
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Czubaj-Kowal M, Nowicki GJ, Kurzawa R, Polak M, Ślusarska B. Factors Influencing the Concentration of Exhaled Nitric Oxide (FeNO) in School Children Aged 8–9-Years-Old in Krakow, with High FeNO Values ≥ 20 ppb. Medicina (B Aires) 2022; 58:medicina58020146. [PMID: 35208470 PMCID: PMC8877257 DOI: 10.3390/medicina58020146] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 11/21/2022] Open
Abstract
Background and Objectives: Measurement of fractional exhaled nitric oxide (FeNO) concentration is currently used as a non-invasive biomarker to assess airway inflammation. Many factors can influence the FeNO level. However, there have been no reports concerning factors attributed to FeNO levels in different age groups of children, especially those with high FeNO values. Therefore, this study aimed to assess the influence of selected factors on nitric oxide concentration in exhaled air in children aged 8–9 attending class 3 of public primary schools in Krakow with high FeNO values ≥ 20 ppb. Materials and Methods: The population-based study covered all third-grade pupils attending primary schools in the city of Krakow. Five thousand, four hundred and sixty children participated in the first screening stage, conducted from October 2017 to January 2018. Then, 792 participants with an FeNO level ≥ 20 ppb were selected. Finally, those selected pupils were invited to participate in the second stage, diagnostic, in April 2018. Four hundred and fifty-four children completed the diagnostic stage of the study, and their data was included in the presented analysis. Results and Conclusions: Significantly higher FeNO levels were observed in children diagnosed with the following diseases: asthma, allergic rhinitis, atopic dermatitis, and allergy (p < 0.05). In addition, it was observed that a higher FeNO concentration characterised children taking antihistamines compared to children not taking those medications (p = 0.008). In multivariate models, we observed that regardless of sex, age, BMI value, home smoking, and whether they were taking medications, children who had allergic rhinitis, or atopic dermatitis, or allergies had significantly higher FeNO levels. The strongest relationship was noted with allergic diseases. The results of our study may be of importance to clinicians when interpreting FeNO results, for example, when making a therapeutic decision.
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Affiliation(s)
- Marta Czubaj-Kowal
- Department of Paediatrics, Stefan Zeromski Specialist Hospital in Krakow, Na Skarpie 66 Str., 31-913 Krakow, Poland
- Department of Pediatrics, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzińskiego 1 Str., 30-705 Krakow, Poland
- Correspondence: ; Tel.: +48-604-433-42
| | - Grzegorz Józef Nowicki
- Department of Family and Geriatric Nursing, Medical University of Lublin, Staszica 6 Str., 20-081 Lublin, Poland; (G.J.N.); (B.Ś.)
| | - Ryszard Kurzawa
- Department of Alergology and Pneumonology, Institute of Tuberculosis and Lung Disorders, Prof. Jana Rudnika 3B Str., 34-700 Rabka-Zdrój, Poland;
| | - Maciej Polak
- Department of Epidemiology and Population Studies, Jagiellonian University Medical College, Grzegórzecka 20 Str., 31-531 Krakow, Poland;
| | - Barbara Ślusarska
- Department of Family and Geriatric Nursing, Medical University of Lublin, Staszica 6 Str., 20-081 Lublin, Poland; (G.J.N.); (B.Ś.)
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Zhang C, Zhang M, Wang Y, Su X, Lei T, Yu H, Liu J. Diagnostic value of fractional exhaled nitric oxide in differentiating the asthma-COPD overlap from COPD: a systematic review and meta-analysis. Expert Rev Respir Med 2021; 16:679-687. [PMID: 34821171 DOI: 10.1080/17476348.2022.2011221] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patients with asthma-COPD overlap (ACO) account for 15-20% of chronic obstructive pulmonary disease (COPD), and the incidence increases with age. Patients with ACO have worse outcomes without proper treatment than those with COPD alone. However, the current diagnostic criteria of ACO are mainly based on symptom features and lack of objective indicators. Recently, several studies have demonstrated that fractional exhaled nitric oxide (FeNO) was higher in ACO than in COPD alone. Thus, this study aims to determine the diagnostic value of FeNO in differentiating ACO from COPD and assisting clinical decision-making. METHODS We conducted searches in the databases including PubMed, Web of Science, Cochrane Library, and Embase to extract original studies. RESULTS In all, 10 studies involving 1335 participants were included in this meta-analysis. FeNO level was significantly higher in ACO patients than in patients with COPD alone (WMD = 11.15ppb, 95%CI = 9.01‒13.28; I2 = 18.0%, p = 0.000). The sensitivity and specificity of FeNO in distinguishing ACO from COPD were both 0.71, and the area under the receiver-operating characteristic curve (AUC) was 0.76, indicating that FeNO has moderate diagnostic accuracy in differentiating ACO from COPD. CONCLUSION FeNO as an inflammatory biomarker is effective in differentiating ACO from COPD and assisting in clinical decision-making.
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Affiliation(s)
- Chuchu Zhang
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lan Zhou, Gansu Province, China.,The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu Province, China
| | - Meng Zhang
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lan Zhou, Gansu Province, China.,The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yalei Wang
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lan Zhou, Gansu Province, China.,The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu Province, China
| | - Xiaojie Su
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lan Zhou, Gansu Province, China.,The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu Province, China
| | - Ting Lei
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lan Zhou, Gansu Province, China.,The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu Province, China
| | - Haichuan Yu
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lan Zhou, Gansu Province, China.,The First Clinical Medical College, Lanzhou University, Lanzhou, Gansu Province, China
| | - Jian Liu
- Department of Intensive Care Unit, Lanzhou University First Affiliated Hospital, Lan Zhou, Gansu Province, China
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9
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Normal FeNO: What Do We Know? Indian J Pediatr 2021; 88:743-744. [PMID: 34097236 DOI: 10.1007/s12098-021-03819-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
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Chen T, Liu T, Li T, Zhao H, Chen Q. Exhaled breath analysis in disease detection. Clin Chim Acta 2021; 515:61-72. [PMID: 33387463 DOI: 10.1016/j.cca.2020.12.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 02/05/2023]
Abstract
Investigating the use of exhaled breath analysis to diagnose and monitor different diseases has attracted much interest in recent years. This review introduces conventionally used methods and some emerging technologies aimed at breath analysis and their relevance to lung disease, airway inflammation, gastrointestinal disorders, metabolic disorders and kidney diseases. One section correlates breath components and specific diseases, whereas the other discusses some unique ideas, strategies, and devices to analyze exhaled breath for the diagnosis of some common diseases. This review aims to briefly introduce the potential application of exhaled breath analysis for the diagnosis and screening of various diseases, thereby providing a new avenue for the detection of non-invasive diseases.
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Affiliation(s)
- Ting Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Tiannan Liu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Ting Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China.
| | - Hang Zhao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Qianming Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China
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Li M, Yang T, He R, Li A, Dang W, Liu X, Chen M. The Value of Inflammatory Biomarkers in Differentiating Asthma-COPD Overlap from COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:3025-3037. [PMID: 33244228 PMCID: PMC7685357 DOI: 10.2147/copd.s273422] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/23/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose To evaluate the accuracy of inflammatory biomarkers in differentiating patients with asthma-COPD overlap (ACO) from those with COPD alone. Methods Clinical data of 134 patients with COPD and 48 patients with ACO admitted to the First Affiliated Hospital of Xi'an Jiaotong University from January 2016 to June 2019 were retrospectively analyzed. Receiver operating characteristic (ROC) curve analysis was performed to determine the best cut-off values of fractional exhaled nitric oxide (FeNO), blood eosinophil counts (EOS), and neutrophil to lymphocyte ratio (NLR) for differentiating between ACO and COPD alone. Spearman correlation analysis was conducted to evaluate the relationships between these inflammatory biomarkers and the forced expiratory volume in one second/prediction (FEV1%pred). Results FeNO and EOS in the ACO patients were significantly higher than those in the COPD patients (FeNO: median 37.50 vs 24.50 ppb, P < 0.001; EOS: median 0.20 vs 0.10 ×109/L, P = 0.004). FeNO was positively correlated with FEV1%pred (r = 0.314, P = 0.030), while NLR was negatively correlated with FEV1%pred (r = -0.372, P = 0.009) in patients with ACO. In addition, a positive correlation between FeNO and EOS was also found in ACO, especially in patients without history of inhaled corticosteroids (ICS) use (r = 0.682, P < 0.001). The optimal cut-off value of FeNO was 31.5 ppb (AUC = 0.758, 95% CI = 0.631-0.886) in patients with smoking history, with 70.0% sensitivity and 89.9% specificity for differentiating ACO from COPD. In patients without history of ICS use, the best cut-off value of FeNO was 39.5 ppb (AUC = 0.740, 95% CI = 0.610-0.870), with 58.3% sensitivity and 84.9% specificity. Among patients without history of ICS use and smoking, 27.5 ppb was optimal cut-off level for FeNO (AUC = 0.744, 95% CI = 0.579-0.908) to diagnose ACO, with 81.8% sensitivity and 60.7% specificity, and the sensitivity was improved to 91.7% when FeNO was combined with EOS. Conclusion The inflammatory biomarkers FeNO and EOS can be used as indicators for differentiating between ACO and COPD alone.
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Affiliation(s)
- Meng Li
- Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, People's Republic of China
| | - Tian Yang
- Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, People's Republic of China
| | - Ruiqing He
- Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, People's Republic of China
| | - Anqi Li
- Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, People's Republic of China
| | - Wenhui Dang
- Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, People's Republic of China
| | - Xinyu Liu
- Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, People's Republic of China
| | - Mingwei Chen
- Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, People's Republic of China
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12
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Garcia E, Zhang Y, Rappaport EB, Berhane K, Muchmore P, Silkoff PE, Molshatzki N, Gilliland FD, Eckel SP. Patterns and determinants of exhaled nitric oxide trajectories in schoolchildren over a 7-year period. Eur Respir J 2020; 56:13993003.00011-2020. [PMID: 32299857 DOI: 10.1183/13993003.00011-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 03/24/2020] [Indexed: 11/05/2022]
Abstract
Fractional exhaled nitric oxide (F ENO50 ), a marker of allergic airway inflammation, is used in respiratory research and asthma clinical care; however, its trajectory with increasing age during childhood has not been well characterised. We examined F ENO50 longitudinally during a period of important somatic growth to describe trajectories across childhood and adolescence in healthy participants and evaluate clinical factors as potential determinants of trajectories.F ENO50 was collected at six visits over 8 years in a population-based cohort of 1791 schoolchildren without asthma (median age at entry 8.4 years). Smooth sex-specific F ENO50 trajectories were estimated using generalised additive mixed models, with participant-level random effects. We evaluated whether sex-specific trajectories were influenced by race/ethnicity, body mass index (BMI) percentile, allergic rhinitis or puberty.Different F ENO50 patterns were observed by sex in later childhood and several factors were associated with either F ENO50 level or change in F ENO50 as participants aged. F ENO50 -age trajectories were similar by sex until age ∼11.5 years, after which males had greater F ENO50 change than females. This divergence in F ENO50 -age trajectories coincides with puberty. Males with higher starting BMI percentile had attenuated F ENO50 -age slopes. Among males, F ENO50 levels were lower in non-Hispanic white subjects. Among both sexes, participants with rhinitis had higher F ENO50 F ENO50 levels within individuals tracked over time; however, there was considerable variation in F ENO50 patterns across participants.F ENO50 trajectories from longitudinal data provide evidence of sex differences coinciding with puberty, suggesting potential hormone link. Improved understanding of determinants of F ENO50 trajectories is needed to realise the potential for using individualised predicted F ENO50 trajectories.
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Affiliation(s)
- Erika Garcia
- Dept of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yue Zhang
- Dept of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Edward B Rappaport
- Dept of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kiros Berhane
- Dept of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Patrick Muchmore
- Dept of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Noa Molshatzki
- Dept of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Frank D Gilliland
- Dept of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sandrah P Eckel
- Dept of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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13
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Chang AB, Oppenheimer JJ, Irwin RS, Adams TM, Altman KW, Azoulay E, Blackhall F, Birring SS, Bolser DC, Boulet LP, Braman SS, Brightling C, Callahan-Lyon P, Chang AB, Cowley T, Davenport P, El Solh AA, Escalante P, Field SK, Fisher D, French CT, Grant C, Harding SM, Harnden A, Hill AT, Irwin RS, Kahrilas PJ, Kavanagh J, Keogh KA, Lai K, Lane AP, Lilly C, Lim K, Lown M, Madison JM, Malesker MA, Mazzone S, McGarvey L, Molasoitis A, Murad MH, Narasimhan M, Oppenheimer J, Russell RJ, Ryu JH, Singh S, Smith MP, Tarlo SM, Vertigan AE. Managing Chronic Cough as a Symptom in Children and Management Algorithms. Chest 2020; 158:303-329. [DOI: 10.1016/j.chest.2020.01.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/11/2019] [Accepted: 01/09/2020] [Indexed: 12/12/2022] Open
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14
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Comberiati P, Peroni D, Malka-Rais J, Morganti R, Spahn JD. Fractional exhaled nitric oxide response to oral corticosteroids in children with mild-to-moderate asthma: Influence of race. Ann Allergy Asthma Immunol 2020; 125:440-446.e1. [PMID: 32621994 DOI: 10.1016/j.anai.2020.06.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/11/2020] [Accepted: 06/24/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fractional exhaled nitric oxide (FeNO) is a noninvasive biomarker of type 2 asthma that can predict response to inhaled corticosteroid therapy. Little is known regarding the magnitude of FeNO reduction after an oral corticosteroid (OCS) course, and less is known whether there are differential responses based on race in children with mild-to-moderate asthma. OBJECTIVE To assess the effect of a short course of OCS on FeNO in children with asthma and to determine whether the effect is influenced by race. METHODS Children presenting with an acute asthma exacerbation, who had a FeNO measurement within the past 6 months when clinically stable, were enrolled. Spirometry and FeNO were obtained at the time of exacerbation and after a short course of prednisone. RESULTS A total of 92 children were identified (aged 11 ± 3.3 years; white, n = 46 [50%], Hispanics, n = 30 [33%], African Americans [AAs], n = 16 [7%]). At baseline, AAs were more atopic and had higher mean FeNO values than both white (48.9 vs 25.6 ppb; P < .05) and Hispanic children (22.5 ppb; P < .05), despite being prescribed similar inhaled corticosteroid doses. During the exacerbation, AAs had the highest FeNO values, whereas there was no difference in lung function between AAs and non-AAs. After prednisone therapy, there was a 56.6% reduction in FeNO, and although AAs maintained the highest FeNO levels, the relative reduction was similar between AAs and non-AAs (53.9% vs 57.8%, respectively). CONCLUSION FeNO levels reduced by more than 50% after an OCS course. African American children had a greater degree of type 2-driven airway inflammation at baseline, during an exacerbation and after a short course of OCS, compared with non-AAs, although the relative reduction in FeNO was similar between the groups.
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Affiliation(s)
- Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy; Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
| | - Diego Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Jonathan Malka-Rais
- Pediatric Associates, Division of Allergy and Immunology, Plantation, Florida
| | | | - Joseph D Spahn
- Allergy and Immunology Center, Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, Division of Allergy and Immunology, National Jewish Health, Denver, Colorado
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15
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Abstract
PURPOSE OF REVIEW In asthma, there is an increasing focus on personalizing treatment by targeting treatable traits. Ethnicity has effects on many biological and behavioural traits, and so is an important consideration when personalizing asthma care. This review has particular relevance in light of current patterns of international migration, which are leading to unprecedented levels of ethnic heterogeneity in many geographic regions. RECENT FINDINGS This review examines the effect of ethnicity on three key domains - biological traits, behavioural traits and health system behaviour. Ethnicity influences asthma biology by affecting biomarker reference ranges, response to drug therapy and asthma phenotypes. Ethnicity impacts behavioural traits through its effects on psychosocial well being, adherence and asthma self-management. Ethnic minorities are often disadvantaged with regards to healthcare access and healthcare interactions. SUMMARY Concerted action is needed to address current issues around behavioural traits and healthcare behaviour, which are influenced by ethnicity. More research is required to understand the impact of ethnicity on asthma biology, especially the interplay between genetic and environmental influences on asthma, and the differential response to asthma therapies.
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16
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Heffler E, Carpagnano GE, Favero E, Guida G, Maniscalco M, Motta A, Paoletti G, Rolla G, Baraldi E, Pezzella V, Piacentini G, Nardini S. Fractional Exhaled Nitric Oxide (FENO) in the management of asthma: a position paper of the Italian Respiratory Society (SIP/IRS) and Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC). Multidiscip Respir Med 2020; 15:36. [PMID: 32269772 PMCID: PMC7137762 DOI: 10.4081/mrm.2020.36] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/05/2020] [Indexed: 02/08/2023] Open
Abstract
Asthma prevalence in Italy is on the rise and is estimated to be over 6% of the general population. The diagnosis of asthma can be challenging and elusive, especially in children and the last two decades has brought evidences that asthma is not a single disease but consists of various phenotypes. Symptoms can be underestimated by the patient or underreported to the clinician and physical signs can be scanty. Usual objective measures, like spirometry, are necessary but sometimes not significant. Despite proper treatment, asthma can be a very severe condition (even leading to death), however new drugs have recently become available which can be very effective in its control. Since asthma is currently thought to be caused by inflammation, a direct measure of the latter can be of paramount importance. For this purpose, the measurement of Fractional Exhaled Nitric Oxide (FENO) has been used since the early years of the current century as a non-invasive, easy-to-assess tool useful for diagnosing and managing asthma. This SIP-IRS/SIAAIC Position Paper is a narrative review which summarizes the evidence behind the usefulness of FENO in the diagnosis, management and phenotypization of asthma.
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Affiliation(s)
- Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano (MI).,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI)
| | - Giovanna Elisiana Carpagnano
- Department of Medical and Surgical Sciences, University of Foggia; Section of Respiratory Diseases, Hospital d'Avanzo, Foggia
| | - Elisabetta Favero
- Department of Medicine-DIMED, Immunological and Respiratory Rare Disease, Allergologic Clinic Ca' Foncello Hospital, Treviso
| | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O. S. Croce e Carle, Cuneo
| | - Mauro Maniscalco
- Respiratory Rehabilitation Unit, ICS Maugeri, Institute of Telese Terme IRCCS
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, Pozzuoli (NA)
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano (MI).,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI)
| | - Giovanni Rolla
- Allergy and Clinical Immunology, University of Turin and A.O. Mauriziano, Turin
| | - Eugenio Baraldi
- Department of Woman's and Child's Health, University Hospital of Padua
| | - Vincenza Pezzella
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples
| | - Giorgio Piacentini
- Paediatric Section, Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona
| | - Stefano Nardini
- Italian Respiratory Society-Società Italiana di Pneumologia, Milan, Italy
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17
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Blake TL, Chang AB, Chatfield MD, Marchant JM, Petsky HL, McElrea MS. How does parent/self-reporting of common respiratory conditions compare with medical records among Aboriginal and Torres Strait Islander (Indigenous) children and young adults? J Paediatr Child Health 2020; 56:55-60. [PMID: 31054237 DOI: 10.1111/jpc.14490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 04/12/2019] [Accepted: 04/14/2019] [Indexed: 12/20/2022]
Abstract
AIM Self-reporting and/or data from medical records are frequently used in studies to ascertain health history. Data on the discrepancies between these information sources is lacking for Indigenous Australians. This study reports such data for selected respiratory and atopic conditions common among Indigenous Australians. METHODS Data were extracted from the Indigenous respiratory reference value study, a multicentre cross-sectional study of Indigenous children and young adults (3-25 years) between June 2015 and November 2017. Only those living in rural/remote regions were included. Self-reported history was collected from parents (if participants <18 years) or participants. Medical records were manually reviewed. Participants with incomplete data (missing self-reported and/or medical record information) were excluded. Agreement between sources was examined using Cohen's kappa. RESULTS Of 1097 participants, 889 (97.1% <18 years) had sufficient self-reported and medical record histories for comparison. Asthma was self-reported by 15.7% of participants and was reported in medical records for 10.3% (κ = 0.53, 95% confidence interval (CI) 0.45-0.61). For bronchiectasis, the reported rates were 1.5 and 0.7% (κ = 0.52, 95% CI 0.25-0.80), pneumonia 1.1 and 5.8% (κ = 0.15, 95% CI 0.02-0.27), allergic rhinitis 6.6 and 0.6% (κ = 0.05, 95% CI -0.03, 0.13) and eczema 5.8 and 6.2% (κ = 0.30, 95% CI 0.18-0.42). CONCLUSIONS Within our cohort, agreement was moderate for asthma and bronchiectasis, fair for eczema and poor for pneumonia and allergic rhinitis. These results highlight the challenges associated with how best to obtain an accurate health history within Australian Indigenous rural/remote communities. Generalisability of findings and contributions of poor health knowledge and/or poor medical record documentation need further exploration.
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Affiliation(s)
- Tamara L Blake
- Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia.,Indigenous Respiratory Outreach Care Program, Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Mark D Chatfield
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Julie M Marchant
- Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Helen L Petsky
- Griffith Health, School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Margaret S McElrea
- Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia.,Indigenous Respiratory Outreach Care Program, Prince Charles Hospital, Brisbane, Queensland, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
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18
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Liu J, Xu R, Zhan C, Luo W, Lai K, Zhong N, Chen W, Chen R. Clinical utility of ultrahigh fractional exhaled nitric oxide in predicting bronchial hyperresponsiveness in patients with suspected asthma. Postgrad Med J 2019; 95:541-546. [PMID: 31296792 DOI: 10.1136/postgradmedj-2018-136333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/18/2019] [Accepted: 06/23/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker for airway eosinophilic inflammation. However, the clinical value of ultrahigh FeNO (≥100 parts per billion (ppb)) in predicting asthma is never explored. We aimed to investigate the value of ultrahigh FeNO as a predictor of bronchial hyperresponsiveness (BHR), an important index for asthma diagnosis. METHODS A retrospective cohort study was conducted on 259 patients with suspected asthma who received the examination of FeNO, spirometry, bronchial provocation test (BPT) and differential cell count of induced sputum. Patients were stratified by FeNO value: ultrahigh (group A:≥100 ppb), high (group B: 50-99 ppb), intermediate (group C: 26-49 ppb) and normal (group D:≤25 ppb). The positive rates of BPT and sputum eosinophils percentage (Eos%) were compared among four cohorts. The correlations between FeNO and sputum Eos% were measured. RESULTS A significant higher positive rate of BPT was observed in group A (90.91%) than all others (B: 51.43%, C: 31.43%, D: 28.13%, all p<0.01). Referring to group D, the ORs of positive BPT in groups A, B and C were 26.84, 2.84 and 1.05. Sputum Eos% in group A (19.75 (7.00, 46.25)) is higher than that in others (B: 3.50 (1.00, 12.75), C: 1.13 (0.06,3.50), D: 0.50 (0.00, 2.13)). FeNO correlates with sputum Eos% in groups A and B, but not group C or D. CONCLUSIONS Ultrahigh FeNO correlates with BHR and could serve as a practical alternative to methacholine challenge to support an asthma diagnosis in patients with suspected asthma in primary care.
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Affiliation(s)
- Jiaxing Liu
- Department of Respirology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Rong Xu
- Department of Respirology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chen Zhan
- Department of Respirology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Luo
- Department of Respirology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kefang Lai
- Department of Respirology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nanshan Zhong
- Department of Respirology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Chen
- Department of Biostatistics, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ruchong Chen
- Department of Respirology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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19
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Blake TL, Chang AB, Chatfield MD, Marchant JM, Petsky HL, McElrea MS. Fractional Exhaled Nitric Oxide Values in Indigenous Australians 3 to 16 Years of Age. Chest 2019; 156:239-246. [PMID: 30910638 DOI: 10.1016/j.chest.2019.02.401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/12/2019] [Accepted: 02/22/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Fractional exhaled nitric oxide (Feno) levels can identify eosinophilic asthma phenotypes. We aimed to determine Feno values of healthy Aboriginal and/or Torres Strait Islander (Indigenous) Australians, differences between these Indigenous ethnic groups, and appropriateness of published cutoff values. METHODS We measured Feno levels in 1,036 Indigenous Australians (3-16 years of age). Participants were classified into healthy (ie, no asthma or atopy history) or asthmatic and/or atopic groups. RESULTS Median Feno values and distribution did not differ between Indigenous ethnicities. For healthy participants < 12 years of age (n = 390), 7.2% of our cohort fell into the inflammatory zone of the American Thoracic Society (ATS), National Institute for Health and Care Excellence (NICE), and British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN) guidelines (cutoff 35 parts per billion [ppb]), but only 3.8% fell into this category when using the Global Initiative for Asthma (GINA) guidelines (50 ppb). Similarly, when using the NICE and BTS/SIGN guidelines (40 ppb) for participants 12 to 16 years of age (n = 213), more healthy participants fell into the inflammatory zone compared with the ATS and GINA guidelines (50 ppb) (9.9% vs 4.7%, respectively). CONCLUSIONS Feno values for healthy Indigenous Australians children (3-16 years of age) are likely higher than published white-based values. The GINA recommended cutoff value (> 50 ppb) appears the most appropriate for identifying healthy Indigenous children but requires confirmation from a larger study.
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Affiliation(s)
- Tamara L Blake
- Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD; Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Brisbane, QLD.
| | - Anne B Chang
- Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD; Child Health Division, Menzies School of Health Research, Darwin, NT
| | - Mark D Chatfield
- Child Health Division, Menzies School of Health Research, Darwin, NT; The University of Queensland, Brisbane, QLD
| | - Julie M Marchant
- Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD
| | - Helen L Petsky
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
| | - Margaret S McElrea
- Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD; Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Brisbane, QLD; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD
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20
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Association of exhaled nitric oxide with ethnicity and sex in rural Georgia youth. Ann Allergy Asthma Immunol 2018; 122:333-334.e1. [PMID: 30557616 DOI: 10.1016/j.anai.2018.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/06/2018] [Accepted: 12/10/2018] [Indexed: 11/23/2022]
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21
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Wang D, Wang Y, Liang H, David JE, Bray CL. Race and ethnicity have significant influence on fractional exhaled nitric oxide. Ann Allergy Asthma Immunol 2018; 120:272-277.e1. [PMID: 29398244 DOI: 10.1016/j.anai.2017.11.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 11/10/2017] [Accepted: 11/27/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Race and ethnicity have been shown to influence fractional exhaled nitric oxide (FeNO). There is a need to investigate cutoff points for different races and ethnicities to improve clinical application. OBJECTIVE To investigate cutoff points for different races and ethnicities by analyzing the FeNO data collected by the National Health and Nutrition Examination Survey from 2007 to 2012. METHODS This study included 23,433 participants. After excluding participants with confounding factors, 11,084 participants were eligible for data analysis. Based on age and the probability of having allergic airway inflammation, participants were divided into 4 groups. The geometric mean and 5th, 50th, and 95th percentiles of FeNO in Hispanic, white, black, and other races were analyzed in all groups. RESULTS Compared with white participants, the geometric mean for FeNO in black participants was 36% to 41% higher in children and 5% to 8% higher in adults. Hispanic children had significantly higher FeNO values (14% to 19%) compared with non-Hispanic white children; however, those differences were not significant in adults. Other races had significantly higher FeNO values in children (24-54%) and adults (9-29%) compared with white participants. Further, for normal healthy black children, the 95th percentile was 40.2 parts per billion (ppb), which is significantly higher than the cutoff point recommended by current guidelines. CONCLUSION Although there are significant differences in FeNO values among races and ethnicities, the current cutoff point at 50 ppb is sufficient to separate healthy from asthmatic populations in adults. However, for black children, we suggest increasing the cutoff point from 35 to 40 ppb to avoid unnecessary diagnosis and treatment.
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Affiliation(s)
- Dong Wang
- University of Central Florida, College of Medicine, Hospital Corporation of American Graduate Medical Education Program in Internal Medicine at North Florida Regional Medical Center, Gainesville, Florida.
| | - Yanning Wang
- University of Central Florida, College of Medicine, Hospital Corporation of American Graduate Medical Education Program in Internal Medicine at North Florida Regional Medical Center, Gainesville, Florida
| | - Hong Liang
- University of Central Florida, College of Medicine, Hospital Corporation of American Graduate Medical Education Program in Internal Medicine at North Florida Regional Medical Center, Gainesville, Florida
| | - John E David
- University of Central Florida, College of Medicine, Hospital Corporation of American Graduate Medical Education Program in Internal Medicine at North Florida Regional Medical Center, Gainesville, Florida
| | - Christopher L Bray
- University of Central Florida, College of Medicine, Hospital Corporation of American Graduate Medical Education Program in Internal Medicine at North Florida Regional Medical Center, Gainesville, Florida
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