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Title: [Evaluating the efficacy of fractional exhaled nitric oxide and impulse oscillometry in screening out cough variant asthma from patients with subacute cough].
Author: Fang S, Chen SY, He X, Shen QX, Fan HZ, Wu XP, Fang ZK, Yu HP.
Journal: Zhonghua Yi Xue Za Zhi; 2017 Aug 08; 97(30):2338-2343. PubMed ID: 28822450.
Abstract:
Objective: To evaluate the clinical value of fractional exhaled nitric oxide (FeNO) and impulse oscillometry (IOS) in screening out cough variant asthma (CVA) from patients with subacute cough. Methods: Patients with subacute cough were included from the outpatient department of Respiratory Medicine of Zhujiang Hospital of Southern Medical University from May to October in 2016. Based on "the guidelines for the diagnosis and treatment of cough (2015 edition)" , patients were classified into CVA group, and non CVP group with other causes of subacute cough. Lung function, bronchial provocation test, FeNO and IOS were measured. The diagnostic efficiency and optimal cut-off points of FeNO and IOS indicators to diagnose CVA from subacute cough were respectively assessed by the receiver operating characteristic (ROC) curves. Results: A total of 85 patients with subacute cough were included. Among them, 35 patients were diagnosed with CVA (CVA group), the others are classified as non CVP group (n=50). In CVA group, the levels of FeNO and total respiratory impedance (Zrs) were significantly higher, while maximal mid expiratory flow (MMEF)%pred, and mid expiratory flow (MEF)75/50/25%pred, reactance at 5 Hz (X5) levels were significantly lower than those in non CVP group (all P<0.05). Furthermore, the FeNO had a positive correlation with Zrs and Fres (ρ=0.312, P=0.003 and ρ=0.318, P=0.003, respectively), had a negative correlation with X5 (ρ=-0.288, P=0.007). A ROC analysis indicated that the area under ROC curve (AUC) of FeNO in diagnosis of CVA was 0.786 (95% CI: 0.684-0.889), the best cut-off point of FeNO volume ratio was 24.5×10(-9). When FeNO volume ratio=24.5×10(-9,) the sensitivity of in diagnosing CVA was 77.8%, specificity was 70.0%. The AUC for Zrs and X5 were 0.679 and 0.687, respectively. The combination of FeNO and X5 had a greater AUC than other indicators (AUC: 0.817, 95% CI: 0.726-0.908), the sensitivity and specificity were 80.6% and 66.0%, respectively. Conclusion: Both FeNO level and IOS index can be used to screen CVA in patients with subacute cough, and the combination of both have better value in diagnosing CVA. 目的： 评估呼出气一氧化氮(FeNO)与脉冲振荡技术(IOS)对亚急性咳嗽患者筛查咳嗽变异性哮喘(CVA)的价值。 方法： 纳入2016年5—10月南方医科大学珠江医院呼吸科门诊就诊的亚急性咳嗽患者，根据《咳嗽的诊断与治疗指南(2015版)》诊断标准，诊断为CVA者为CVA组，其他诊断为其他病因组。对患者进行肺功能、支气管激发试验、FeNO及IOS检测。通过绘制受试者工作特征(ROC)曲线，评价FeNO及IOS检测指标对亚急性咳嗽患者筛查CVA的诊断效能及最佳界值。 结果： 85例亚急性咳嗽患者中，CVA组35例，其他病因组50例。CVA组FeNO和呼吸总阻抗(Zrs)均显著高于其他病因组，最大呼气中期流量占预计值百分比和剩余75%、50%、25%肺活量时用力呼气流速占预计值百分比、外周弹性阻力(X5)均显著小于其他病因组(均P<0.05)；FeNO与Zrs和响应频率(Fres)呈正相关(ρ＝0.312，P＝0.003和ρ＝0.318，P＝0.003)，与X5呈负相关(ρ＝－0.288，P＝0.007)；以FeNO指标诊断CVA的曲线下面积(AUC)为0.786(95% CI：0.684～0.889)，FeNO体积浓度最佳界值为24.5×10(－9)，敏感度和特异度分别为77.8%和70.0%；以Zrs和X5指标诊断CVA的曲线下面积分别为0.679和0.687；FeNO与IOS检测指标联合诊断CVA效能更佳(均P<0.05)，其中FeNO联合X5的AUC最大为0.817(95% CI：0.726～0.908)，敏感度和特异度分别为80.6%和66.0%。 结论： FeNO及IOS检测均可作为亚急性咳嗽患者筛查CVA的指标，两者联合效果更好。.

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