Diagnostic accuracy of FeNO in asthma and predictive value for inhaled corticosteroid responsiveness: A prospective, multicentre study

Schneider, Antonius; Brunn, Benjamin; Hapfelmeier, Alexander; Schultz, Konrad; Kellerer, Christina und Jörres, Rudolf A. (2022): Diagnostic accuracy of FeNO in asthma and predictive value for inhaled corticosteroid responsiveness: A prospective, multicentre study. In: Eclinicalmedicine, Bd. 50, 101533

Abstract

Background Fractional exhaled nitric oxide (FeNO) is promising for diagnosing asthma and could replace bronchial provocation (BP). To date, cut-off values have been derived by post hoc analysis only. The aim was to validate the diagnostic accuracy for predefined FeNO cut-off values and the predictive value for responsiveness to inhaled cortico-steroids (ICS). Methods We conducted a prospective, diagnostic, multicentre study with patients attending three private practices of pneumologists in Upper Bavaria, Germany, from July 3, 2020 to Jan 21, 2022. Index test was FENO measure-ment. Reference standard was Tiffeneau ratio (FEV1/VC) or airway resistance as assessed by whole body plethysmog-raphy, with additional BP or bronchodilation test. Follow-up was performed after 12 weeks. Analyses of Receiver Operating Characteristics curves were conducted to determine the diagnostic accuracy and predictive value of FeNO. Findings 308 patients with complete follow-up were recruited, 186 (60.4%) were female, average age was 44.7 years, 161 (52.3%) had asthma. Regarding diagnostic accuracy, the area under the curve (AUC) was 0.718 (95% CI 0.661-0.775;p < 0.001). Sensitivity at FeNO > 50 ppb was 0.24 (95% CI 0.18-0.32), specificity 0.99 (0.95 -1.0), positive predictive value (PPV) 0.95 (0.84-0.99), negative predictive value (NPV) 0.54 (0.48-0.60). In 66 patients with'wheezing'and'allergic rhinitis,' the sensitivity at FeNO > 33 ppb was 0.49 (0.34-0.64), specificity 0.88 (0.64-0.99), PPV 0.92 (0.75-0.99), NPV 0.38 (0.23-0.54). In 68 patients with ICS medication, responsiveness was predicted at the cut-off > 43 ppb, with a sensitivity of 0.55 (95%CI 0.36-0.74), specificity 0.82 (0.66-0.92), PPV 0.70 (0.47-0.87), NPV 0.71 (0.56-0.84). Interpretation FeNO measurement allows a valid ruling-in of an asthma diagnosis, whereas ruling-out of asthma is not possible. Enhanced probability of ICS responsiveness is also given with increased FeNO values.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin > Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Sprache: Englisch